医患合作新模式在学龄期儿童哮喘管理中的价值

Evaluation of standardized management model for school-age children with asthma

关键词:  哮喘  儿童  学龄期  新模式  规范化管理

Key words:  asthma  children  school-age  new model  standardized management

摘要:

目的分析医患共同商讨哮喘儿童用药方案及管理计划新模式在学龄期儿童哮喘规范化管理中的价值。方法选取2019年4月—2019年10月在同济大学附属第十人民医院儿科就诊的100例哮喘患儿为研究对象，医务人员通过门诊与电话随访、微信互动等相结合的方法与患儿及家长建立良好的伙伴关系，共同商讨决策哮喘患儿的用药方案和管理计划，对哮喘儿童实施规范化管理。比较规范化管理之前与规范化管理6个月后哮喘儿童的哮喘急性发作次数、急诊就医次数、住院次数、用药依从性和哮喘控制率之间的差异，并进行年龄分层分析；比较入组时、规范化管理3个月后及规范化管理6个月后肺功能各指标的变化。结果规范化管理6个月后与规范化管理之前比较有着更少的哮喘急性发作、急诊就医和住院次数，有着更高的用药依从性和哮喘控制率。对规范化管理是否影响儿童哮喘控制情况进行年龄分层分析，不同年龄组中规范化管理对儿童哮喘急性发作次数、急诊就医次数、用药依从性和哮喘控制水平的的影响是一致的(P＞0.05)，哮喘急性发作次数、急诊就医次数与规范化管理呈负相关关系，用药依从性和哮喘控制水平与规范化管理呈正相关关系。规范化管理3个月后和6个月后的肺功能各指标较入组时明显改善，且差异具有统计学意义（P<0.05），但规范化管理6个月后与规范化管理3个月后的肺功能各指标比较，仅25%用力呼气流速、50%用力呼气流速指标差异具有统计学意义（P<0.05）。结论医务人员与患儿及家长通过多渠道合作共同商讨决策哮喘儿童用药方案及管理计划的新模式能有效提高儿童哮喘控制水平，降低未来哮喘发作风险，值得在临床进一步推广。

Abstract:

ObjectiveTo evaluate a new standardized management model for school-age children with asthma. MethodsOne hundred children with asthma attending the Department of Pediatrics of Shanghai Tenth People’s Hospital from April to October 2019 were enrolled. In the new standardized management model, a good partnership of medical staff with asthmatic children and their parents was established through outpatient service, telephone follow-up and WeChat interaction; the long-term medication plan and management plan for asthmatic children were discussed and the decision was made jointly. The times of asthma acute attack, emergency medical treatment, hospitalization, medication compliance and asthma control rate were compared before and 6 months after standardized management; the changes of lung function indexes were analyzed before and 3, 6 months after standardized management. ResultsCompared with before standardized management, the asthma acute attack, emergency medical treatment and hospitalization times were reduced, while the drug compliance and asthma control rate were increased in 6 months after standardized management, which was consistent in different age groups (P>0.05). There was a negative association between asthma emergency attack times, emergency treatment times and standardized management, a positive association between medication compliance, asthma control level and standardized management. The lung function indexes were significantly improved three and six months after standardized management, compared before standardized management (P<0.05); however, compared with the pulmonary function indexes after 6 months of standardized management and after 3 months of standardized management, only 25% and 50% of the forced expiatory flow rate are statistically significant （P＜0.05）. ConclusionThe new management model can improve the control level of asthma and reduce the risk of asthma attack for asthmatic children, it is worth promoting in clinical practice.