学龄期哮喘患儿症状控制水平的影响因素及路径分析

Analysis of influencing factors and impact path of asthma control in school-age children

目的 分析父母教养方式、服药依从性等因素对学龄期哮喘患儿症状控制水平的影响以及影响因素间的作用路径,为制订针对性的护理干预方案提供依据。方法 采用便利抽样法,选取2020年12月—2021年9月在山东省济南市3所三级甲等医院就诊或住院的学龄期哮喘患儿及其父母作为调查对象,使用一般资料调查表、简式父母教养方式问卷中文版、服药依从性问卷、儿童哮喘控制测试对其进行调查。采用单因素分析、Pearson相关性分析、多元线性回归分析数据,并构建结构方程模型。结果 共纳入211例学龄期哮喘患儿,其儿童哮喘控制测试得分为(19.15±4.27)分,哮喘未控制率为43.6%。影响因素分析结果显示,父母教养方式、患儿服药依从性、一级亲属哮喘史是学龄期哮喘患儿症状控制水平的影响因素(P<0.05)。路径分析结果显示,患儿服药依从性在父母积极教养方式和患儿症状控制水平间起部分中介作用,效应值为0.395,95%CI为(0.273,0.540),占总效应的54.6%;患儿服药依从性在父母消极教养方式和其症状控制水平间起部分中介作用,效应值为-0.435,95%CI为(-0.598,-0.254),占总效应的58.8%。结论 学龄期哮喘患儿症状控制较差,临床医护人员需重视父母教养方式对患儿症状控制水平的影响,应指导父母采取积极的教养方式,以提高患儿服药依从性及症状控制水平。

Objective From the aspects of parenting style and medication adherence,the influencing factors of asthma symptom control level of school-age children and the impact path of influencing factors were analyzed,so as to provide a basis for the formulation of targeted nursing intervention programs. Methods Using convenient sampling method,from December 2020 to September 2021,we investigated school-age asthmatic children and their parents in pediatric respiratory outpatient departments and wards of 3 tertiary hospitals in Jinan,Shandong province,using the General Demographic Questionnaire,Short-Egna Minnen av Barndoms Uppfostran-Chinese(s-EMBU-C),Medication Adherence Questionnaire and Childhood Asthma Control Test(C-ACT). Univariate analysis,Pearson correlation analysis and multiple linear stepwise regression analysis were used to analyze the data,and the structural equation model was established. Results A total of 211 school-age children with asthma were enrolled. The score of C-ACT was(19.15 ±4.27),and the uncontrolled rate was 43.6%(92 cases). The results of influencing factor analysis showed that the parenting style,medication adherence and asthma history of first-degree relatives were the influencing factors of symptom control level in school-age children with asthma(P<0.05). Pathway analysis results showed that medication adherence played a partially mediating role between positive parenting style and asthma symptom control level(ES=0.395),with 95%CI(0.273,0.540),accounting for 54.6% of the total effect. The medication adherence played a partially mediating role between negative parenting style and asthma symptom control level(ES=-0.435),with 95%CI(-0.598,-0.254),accounting for 58.8% of the total effect. Conclusion The symptom control of school-age children with asthma is poor. Clinical doctors and nurses should pay attention to the influence of parenting style on children’s symptom control level,guide parents to adopt positive parenting styles,and improve children’s medication compliance,so as to improve their symptom control level.