儿童支气管哮喘社区管理模式的探索

Exploration and research of community management model for asthmatic children

目的 探讨儿童支气管哮喘的社区管理模式的有效性.方法 按照《全球哮喘防治创议》的要求,对北京市西城区展览路地区1.1万0～14岁儿童中发现的哮喘患儿120例,建立儿童支气管哮喘社区管理模式：在社区建立患儿档案、通过哮喘热线、网络互动建立医患联系,对患儿及家长反复进行健康教育、使患儿坚持规范用药,定期复诊.对实施社区管理前和管理1年后儿童哮喘患者的规范用药、病情监测、发作次数、抗生素使用、医疗费用、家长误工等情况进行比较和分析.结果 纳入社区管理后,使用全身激素（19.4％）与管理前（68.3％）比较明显减少（x2=51.9,P＜0.01）,使用吸入糖皮质激素（76.5％）及口服白三烯受体拮抗剂（79.6％）控制药物与管理前（4.2％、10.0％）比较明显增加（x2=121.6、106.0,P＜0.01）.纳入社区管理后,哮喘年发作次数（0.5±0.7）、抗生素使用天数（2.3±2.3）、治疗费用（元）（2.8±1.3）、家长因患儿哮喘误工天数（4.9±1.4）、C-ACT评分（23.3±2.3）、最大呼气流量占个人最佳值百分比（91.9±8.2）较管理前（4.6±2.3、16.2 ±6.1、5.7±2.9、10.9±3.6、15.2±3.3、71.7±12.2）比较,差异有统计学意义（t=17.008、21.395、8.881、15.467、-20.344、-9.341,P均＜0.01）.16例（13.3％）进行了双向转诊.最初失访率为18.3％,通过电话及网络督导分析原因,进行再教育,使部分患儿回归管理中,失访率最终降为9.2％.结论 将儿童支气管哮喘纳入社区管理,是哮喘控制的有效途径.

Objective To study the efficacy of community management model of bronchial asthma in children.Method Through community outreach and clinic,120 cases of children with asthma were enrolled from the 11 000 children aged 0 to 14 in Zhanlanlu area,and a community management model of asthma was established according to the Global Initiative for Asthma requirements combined with the actual situation of the community,both physicians and patients participated in case identification,file creation,and long-term standardized management.Through repeated medical education,the telephone hotline and interactive network of asthma among physicians,children and parents,a physician-patient relationship was established.The data of standardized medication,scheduled re-visit to the hospital,frequency of asthma attacks,antibiotic use,medical expenses,the loss of parents work hours etc.before and after the implementation of community management model were analyzed and compared.Result After implementation of community management model,the use of systemic corticosteroids （19.4％）,oral medication （31.6％） was significantly lower than those before implementation （68.3％ and 90.0％） （x2 =51.9,41.1,P ＜0.01）,use of inhaled corticosteroids （76.5％） and oral leukotriene receptor antagonist （79.6％） was significantly higher compared with control and before management level （10.0％）,x2 =106.0,P ＜ 0.01.The days of attacks of asthma （4.6 ± 2.3）,the use of antibiotics （16.2 ± 6.1）,（5.7 ± 2.9） and the cost of treatment significantly decreased.In 16 cases （13.3％） two-way referral was applied.In this study,the dropout rate was 18.3％,by telephone and network supervision of lost cases,re-education,made some children return to management,eventually the dropout rate was 9.2％.Conclusion Enrollment of children with bronchial asthma into community management model made the children adhere to the management regularly and a standardized management was achieved.