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目的 探讨基层医院儿童哮喘的管理模式。方法 应用全科医学的管理理念,对2000年1月～2002年10月儿童哮喘专科门诊的465例哮喘患儿进行管理,在对患儿按《全球哮喘防治创议》的基本原则和个体化原则相结合的专科治疗基础上,让患儿、家长及社区医生接受哮喘知识的健康教育。分析比较不同时期患儿、家长和社区医生对哮喘新知识的掌握情况,比较纳入管理前后患儿病情的差异。结果 2001年1月以后就诊的279例与2000年12月以前就诊的186例做比较,就诊前已诊断为哮喘的例数、吸入过气管扩张剂和吸人过皮质激素的例数分别占45.88％(128/279)、21.14％(59/279)、10.03％(28/279)和17.20％(32/186)、4.30％(8/186)、1.16％(3/186),差异均有显著性;使用过峰流速仪者仅分别为1.45％(1/69)和3.30％(4/121),差异无显著性。465例患儿纳入管理前后的年平均哮喘发作次数、因哮喘而住院的平均年人次数和峰流速达正常预计值人数分别为4.23±1.55、0.61±0.59、36/190和0.83±0.86、0.03±0.17、179/190,前后差异有极显著性。结论 运用全科医学管理理念对哮喘患儿进行系统管理,效果显著;但社会科普工作和社区医生的哮喘知识还需进一步加强和提高。
Objective To explore the management of childhood asthma in primary hospital. Methods The management concept of general medicine was used to manage 465 asthmatic children with special asthma clinics from January 2000 to October 2002. According to the basic principles and individual principles of the “Global Initiative for Asthma Prevention and Treatment” Based on a combination of specialist treatment, children, parents and community doctors are given health education on asthma knowledge. Analysis and comparison of different stages of children, parents and community doctors mastery of new knowledge of asthma, compared with the management of children into the management of the differences. Results A total of 279 cases were observed after January 2001 compared with 186 cases treated before December 2000. The number of cases with asthma diagnosed before treatment, inhaled bronchodilators and corticosteroids were 45.88 (128/279), 21.14% (59/279), 10.03% (28/279) and 17.20% (32/186), 4.30% (8/186) and 1.16% (3/186) Significant; the use of excessive peak velocity meter were only 1.45% (1/69) and 3.30% (4/121), the difference was not significant. 465 cases were included in the management of annual average number of asthma attacks, asthma hospitalizations for the average number of years and the peak flow of the normal expected value of the number were 4.23 ± 1.55,0.61 ± 0.59,36 / 190 and 0.83 ± 0.86,0.03 ± 0.17,179 / 190, before and after the difference was significant. Conclusion The systematic management of asthma children using the concept of general management of medicine has remarkable effect, but the knowledge of social science popularization and community doctors need to be further strengthened and improved.