健康呼吸中心对支气管哮喘患者管理和生活质量的影响

Clinical center-based health management and quality of life of patients with asthma

目的评价健康呼吸中心管理与系统教育模式对哮喘防治及哮喘患者生活质量的影响。方法对2005年9月至今就诊“健康呼吸中心”，参加过“哮喘之家”活动的642名接受规范化治疗疗程3年以上的慢性持续哮喘患者，随机分为严格管理（依从性好）和松懈管理（依从性不好）两组，由哮喘专科门诊医生以面对面问卷方式调查门诊成年哮喘患者对疾病认知程度、用药情况及病情控制水平情况进行统计分析。并比较哮喘患者教育前、教育后6个月、1年及3年时生活质量的变化。结果326例严格管理（依从性好）患者病情达到完全控制水平占32％，部分控制47％，未控制21％；而松懈管理组依次为11．2％，30．8％和58％，且生活质量评分两组相比具有统计学差异（P〈0．05）。应用“健康呼吸中心”管理与教育模式患者病情明显控制，急性发作率由42％下降到11．24％，急诊率由23％下降到5．37％，住院率由23％下降到3．53％，规范治疗率由7．9％上升到62％，正确使用吸入制剂率由13％上升到68％，对哮喘的正确认识率由12％上升到86％，肺功能改善，6个月FEV，平均增加28％，应用峰流速仪监测病情由1％上升到20％，对非急性发作期哮喘患者接受教育并按GINA方案进行治疗6个月后，患者的哮喘症状得到较好的控制，活动受限、避免暴露危险因素以及对危险因素的反应均较教育前有所改善（P〈0．05），同时对疾病有了正确的认识，心理情绪、对疾病的担心得到了改善，与教育前比较差异均有统计学意义（P〈0．05）；教育后1年及3年较6个月改善更明显，差异有非常显著统计学意义（P〈0．01），提高了患者的生活质量。结论“健康呼吸中心”改善了哮喘患者的生活质量，实现哮喘患者个体化诊断和规范治疗为途径的哮喘完全控制，“健康呼吸中心”的教育管理和长期防治对于控制哮喘的发作具有积极意义，是哮喘患者规范化治疗、疾病预防、教育培训的基地。

Objective To evaluate the effects of clinical center-based health management on quality of life （QOL） of patients with asthma. Methods A total of 642 patients who had received standard antiasthma treatment over 3 years in our clinical center from September 2005 up to now were randomly assigned to the good compliance group （group A, n = 326）and bad compliance group （group B, n = 316）. A questionnaire was used to estimate the awareness about asthma, medical therapy and disease control. Levels of QOL were compared at 6 months and 1 and 3 years after health education. Results In group A, uncontrolled,partly controlled, and completely controlled asthma were found in 21%, 47%, and 32% participants, respectively. Significant difference of QOL was shown between the 2 groups after the intervention （P 〈 O. 05）. At 6 months, forced expiratory volume in one second （ FEV1 ）, percentage of predicted FEV1 （FEV1% pre）, and peak expiratory flow rate （PEF）were significantly improved in group A （all P 〈 0. 05 ）, although acute attack and hospitalization were largely reduced. In comparison with baseline,6 months and 1 year, self-reported QOL, limitation of motion, stimulus avoidance and response, and disease concerns were significantly changed at 3 years. Conclusions Clinic center-based health management could benefit disease control and QOL of patients with asthma.