社区卫生管理儿童哮喘的效果分析

Exploration of Community Medical Management Model for Asthmatic Children

目的讨论社区卫生管理儿童哮喘的成效。方法依据《全球哮喘防治指南》的要求,对昆山地区发现的患哮喘儿童230例,建立和健全社区卫生医院管理儿童哮喘的方案,即建立患儿病案,通过专线、微信及网络等医患互动信息,对患儿与家长举办哮喘知识培训学校,督导规范用药,定期门诊随访。并对实施社区卫生管理前和管理1年后的哮喘患儿在规范用药,病情变化,抗生素等药物使用,家长认同等方面进行对比分析。结果管理1年后,用局部吸入糖皮质激素(75.8%)及口服白三烯受体拮抗剂-孟鲁司特(75.2%)与管理前使用(6.8%、6.5%)比较有显著增加(P<0.01)。哮喘年发作次数(0.8±0.3),抗生素及β2受体激动剂使用天数(3.9±1.8),最大呼气流量值提高50%的百分比(32.3±7.6)较管理前(4.8±2.6)、(17.4±5.9)、(70.3±10.8)比较,均有统计学意义(P均<0.01)。其管理后全身用激素(18.5%)与管理前(70.4%)比较明显减少(χ2=53.2,P<0.01);家长对治疗满意率为(97.2%)比管理前的(62.7%)明显提升(χ2=52.9,P<0.01)。有28例(12.2%)初始失诊,对其跟踪、教育,最后失诊为18例(7.8%)。结论把患哮喘儿童纳入社区卫生管理是防治儿童哮喘的有效模式。

Objective To discuss the efficacy of community medical management model of bronchial asthma in children. Method Through community medical center and clinic, 230 cases of children with asthma were enrolled from the kunshan area, aged 0 to 12 year, to build a community medical management model of asthma according to the Global Initiative for Asthma requirements combined with the actul situation of the community,both pediatics and patients with parents participated in case identification, file creation, and long-term standardized management, with repeated medical asthma education, the micro letter, the telephone call and interactive, network of asthma among pediatrics, children and parents, a pediatrics-patient relationship as established. The time of standardized medication, data of re-visiting to the hospital, frequency of asthma attacks, antibiotic and β2 receptor antagonist use, medical expenses, and the effective approve of parents etc. Before and after the implementation of community medical management model were analyzed and compared. Result After implementation of community medical management mod, use of inhaled corticosteroids（75.8%） and oral leukotriene receptor antagonist（75.2%） was significantly higher compared with central and before management level（6.8%, 6.5%）, P〈 0.01. The time of attacks of asthma（0.8±0.3）, the days of use with antibiotics and β2 receptor antagonist（3.9±1.8） significantly decreased. The approve of treating efficacy was higher. The use of systemic corticosteroids（18.5%）, was significantly lower than before implementation（70.4%）, χ^2=53.2, P 〈0.01. In this study, 28 cases（12.2%） was dropout, by culling, micro letter and network supervision of lost cases, made some children return to management, eventually the dropout rate was 7.8%（18）. Conclusion Enrolling children with bronchial asthma into community medical management model should make the children adhere to the management treatment regularly and a standardized management.