门诊哮喘患儿药物吸入技术现况及对策

Current situation and countermeasures of drug inhalation technology in children outpatient with asthma

目的了解门诊支气管哮喘患儿药物吸入技术现状,并分析其影响因素,提出针对性对策。方法采用横断面调查研究,便利抽样方法,调查该院428例哮喘患儿及家长。医护人员面对面评估吸入技术配合问卷调查法收集资料,采用多元logistic回归分析吸入技术的影响因素。结果428例患儿中,共涉及4种药物吸入装置,压力定量气雾剂+储雾罐(PMDI+Spacer)344例(80.4%)、PMDI 26例(6.1%)、准纳器(Diskus)28例(6.5%),都保吸入器(Turbuhaler)30例(7.0%)。吸入技术不完全掌握者274例(64.0%),其中主要吸入步骤错误者:PMDI+Spacer类及PMDI类吸药前未摇匀药物141例(38.1%);PMDI、Diskus及Turbuhaler类吸药装置吸药前未呼气49例(11.5%)、吸药时未深慢吸气37例(8.6%)、吸药后屏气错误36例(8.4%);4种吸药装置吸药后未漱口112例(26.2%)等。多元logistic回归分析显示,患儿使用吸药装置时长、医务人员指导次数、患儿或主要照顾者对吸入技术态度均影响吸入技术水平(P<0.05)。结论哮喘患儿及家长的吸入技术不容乐观,医护人员应从吸入装置结构、患儿自身特点、对疾病态度等方面着手,根据不同患儿及家长特点采取针对性措施,提高吸入技术正确率,进而改善哮喘控制水平。

Objective To understand the current situation of drug inhalation technology in the children outpatients with bronchial asthma,to analyze its influencing factors and put forward the corresponding countermeasures.Methods The cross sectional study and convenient sampling method were adopted to survey 428 children outpatients with asthma and their parents.The medical staff face to face evaluation of inhalation technology combined with the questionnaire survey was used to collect the data.The multiple Logistic regression was adopted to analyze the influencing factors of inhalation technology.Results Among 428 children patients,the four drug inhalation devices were involved,PMDI+spacer in 344 cases(80.4%),PMDI in 26 cases(6.1%),Diskus in 28 cases(6.5%)and Turbuhaler in 30 cases(7.0%).There were 274 cases(64.0%)of incomplete master of inhalation technology,among them,the cases of main inhalation step mistake:141 cases(38.1%)did not shake up the drugs before drug inhalation of PMDI+spacer and PMDI drugs;49 cases(11.5%)did not exhale before drug inhalation by PMDI,Diskus and Turbuhaler inhalation device,37 cases(8.6%)were not inhaled deeply and slowly during inhalation,36 cases(8.4%)were the breath holding errors after inhalation;112 cases(26.2%)were not rinsed after inhalation.The multiple Logistic regression analysis showed that the duration of using the drug inhalation device,times of medical staff′s guidance and the attitude of children patients or main caregivers on the inhalation technology all affected the level of inhalation technology(P<0.05).Conclusion The inhalation technology of asthmatic children patients and their parents is not optimistic.The medical staff should start to take the targeted measures for increasing the accuracy of inhalation technology from the aspects of the inhalation device structure,children patients themselves characteristics and their attitude towards the disease and according to the characteristics of different children patients and parents,thus improve the asthma control level.