支气管哮喘专病门诊初诊和复诊患者疾病控制和认知的比较

Comparison of asthma control and cognition for the first visit outpatients to the specialist clinic for ashma between the return visit outpatients

目的通过针对支气管哮喘(简称哮喘)专病门诊就诊的患者的随机抽样调查,比较初诊患者和复诊患者在哮喘的控制情况、管理情况、用药情况以及对哮喘的认知程度等方面的差异性,进一步明确哮喘专病门诊在哮喘规范化治疗和管理中的重要性。方法随机选取于2007年6月至2007年11月在复旦大学附属中山医院哮喘专病门诊就诊的患者,其中初诊患者64例,复诊患者74例,合计138例。由经过培训的医师采用问卷调查的形式针对哮喘患者在疾病控制、管理和用药,以及对该病的认知程度等方面进行调查,采用SPSS11.5软件进行统计学分析。结果哮喘控制方面,初诊和复诊患者在过去一年中的急诊就医比例(48.4%vs37.8%)、住院比例(10.9%vs8.1%)、误工比例(15.6%vs9.5%)、误学比例(4.7%vs1.4%),初诊患者均较复诊患者高,但P值均>0.05。初诊和复诊患者的哮喘控制测试评分分别为15.53±5.24,20.45±5.03(P<0.01)。根据评分,初诊和复诊患者达到哮喘完全控制的比例为(6.2%vs23.0%)、良好控制的比例为(17.2%vs45.9%),复诊患者均明显高于初诊患者(P<0.01)。哮喘管理方面,初诊和复诊患者在过去一年内测定过肺功能的比例为(76.6%vs93.2%)、使用峰流速的比例(3.1%vs13.6%),复诊患者均明显高于初诊患者(P<0.05)。32.8%的初诊患者每月前往呼吸科门诊至少就诊一次,而复诊患者则为54.1%(P<0.05)。哮喘治疗方面,仅35.9%的初诊患者使用过吸入性糖皮质激素(inhaled corticosteroids,ICS),而复诊患者中使用的比例高达93.3%(P<0.01)。目前正在以规范使用ICS作为控制类药物的患者中,初诊者为32.8%,复诊者则为85.1%(P<0.05)。哮喘认知方面,认为ICS是一线控制类药物的患者中,初诊者仅占17.2%,复诊者则占66.2%(P<0.01)。对于哮喘的治疗目标,仅有37.5%的初诊患者认为哮喘是可以被完全或良好控制,而有59.5%的复诊患者认同(P<0.05)。对于哮喘本质的认识,短效β2受体激动剂的使用指征,哮喘相关知识讲座的需求性方面,两者差异无统计学意义。结论复诊患者无论在哮喘的控制、管理和用药方面,还是对疾病的认知方面均明显优于初诊患者。这提示哮喘专病门诊的设立有利于对哮喘患者的治疗和管理,有必要加强对呼吸科医师哮喘知识的再培训,推广哮喘专病门诊。同时有必要加强对哮喘患者的健康教育。

Objective To evaluate the importance of the specialist clinic for bronchial asthma(asthma) in standardized management and treatment of asthma.Methods 64 outpatients of the first visit and 74 of the return visit at the specialist clinic for asthma in affiliated Zhongshan Hospital of Fudan University were randomly selected from June to December 2007.The trained physicians used the form of questionnaire to survey such as disease control,management,medication and cognition for asthma patients,then using SPSS 11.5 for statistical analysis.Results The proportion of going to a doctor in emergency,being hospitalized,delaying work or study in the first visit outpatients were higher than the return visit outpatients (48.4% vs 37.8%,10.9% vs 8.1%,15.6% vs 9.5%,4.7% vs 1.4%),though there were no statistical significance.The scores of asthma control test of the former were significantly lower than the latter (15.53±5.24 vs 20.45±5.03).The proportion of full or good control of asthma in the first visit outpatients were 6.2%,17.2% respectively,in the return visit ones were 23.0%,45.9%.In the past year,both of the proportion of checking pulmonary function and peak flow rate in the former were significantly lower than in the latter (76.6% vs 93.2%,3.1% vs 13.6%).The frequency of seeing a doctor in the first visit outpatients was significantly lower than in the return ones (32.8% vs 54.1%).There were only 35.9% outpatients of the first visit who ever used inhaled corticosteroids(ICS),however,the return visit ones were 93.3%.In the outpatients who regarded ICS as the first-line control drugs,the first visit outpatients were 17.2%,the return visit ones were 66.2%.Furthermore,in the patients who thought asthma could be fully or good controlled,the former were 37.5%,the latter were 59.5%.Conclusions No matter where in the asthma control,management,medication and cognition,the return visit outpatients were superior to the first ones.It suggested the establish of the specialist clinic for asthma was in favor of patients with asthma,so which should be popularized.