本文選題：支氣管哮喘 + 教育和管理　； 參考：《大連醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：支氣管哮喘（以下簡稱哮喘）是一種常見的慢性疾病，據(jù)資料顯示全球哮喘患者已近3億，由于大多數(shù)患者沒有能夠接受規(guī)范化的教育管理等原因造成了哮喘的反復(fù)發(fā)作，導(dǎo)致疾病進行性加重，給社會和家庭帶來了沉重的的負擔(dān)。本課題通過開展我院特色的哮喘�？崎T診、哮喘知識講座、哮喘之家的規(guī)范化教育管理模式并評估其對哮喘患者病情控制情況和生命質(zhì)量的影響，為進一步推廣這一管理模式提供依據(jù)。 方法：2011年7月至2012年3月選取大連醫(yī)科大學(xué)附屬第二醫(yī)院哮喘門診就診的哮喘患者157例，其中接受過我院規(guī)范化教育管理的患者為管理組（78例），每位患者均接受哮喘�？崎T診、哮喘知識講座、哮喘之家的教育管理模式，參加過一次初級班教育和至少兩次強化班教育。未接受過我院規(guī)范化教育管理模式的患者為對照組（79例）。兩組患者均符合2008年中華醫(yī)學(xué)會呼吸病分會哮喘學(xué)組制定的支氣管哮喘防治指南的診斷標(biāo)準(zhǔn)。由本課題研究生和醫(yī)師采用面對面調(diào)查問卷的方式，應(yīng)用通俗易懂的語言進行描述，分別調(diào)查兩組患者的病情控制情況和生命質(zhì)量評分�；颊卟∏榭刂魄闆r問卷參照國內(nèi)外文獻設(shè)計，問卷內(nèi)容包括以下方面：1.基本資料：包括姓名、性別、年齡、文化程度、病程、病情嚴(yán)重程度等；2.哮喘控制情況：包括按2009年全球哮喘防治創(chuàng)議（GlobalInitiative for Asthma，GINA）制定的哮喘控制水平和按哮喘控制測試（ACT）評分兩個標(biāo)準(zhǔn)進行評估；3.未來風(fēng)險的評估：包括過去一年中因哮喘急性發(fā)作而急診就醫(yī)和住院的情況、FEV1低、高劑量糖皮質(zhì)激素（簡稱激素）使用情況、有無煙草的暴露。高劑量激素的標(biāo)準(zhǔn)是參照2009年GINA指南定義的吸入激素（ICS）的劑量標(biāo)準(zhǔn)判定。在煙草暴露方面，調(diào)查問卷分為主動吸煙和被動吸煙兩個方面，其中被動吸煙頻率分為經(jīng)常、有時和偶爾三種，本研究將主動吸煙和經(jīng)常被動吸煙視為患者處于煙草暴露�；颊呱|(zhì)量的問卷采用李凡的成人哮喘生命質(zhì)量5分制評分表，將測評期限調(diào)整為測評前8周。內(nèi)容包括活動受限、哮喘癥狀、心理狀況、對刺激原的反應(yīng)和對自身健康關(guān)心5個維度，35個項目逐項計分，1分為最差，5分為最好，總分35～175分，分值越高，表明哮喘患者的生命質(zhì)量越高。進行問卷調(diào)查時，問卷內(nèi)容不得空缺，共完成問卷157份。采用SPSS13.0軟件進行統(tǒng)計分析，P0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果：1.臨床控制水平：（1）按照2009年GINA指南制定的哮喘控制水平分級標(biāo)準(zhǔn)達到控制的患者，管理組為62.8％，對照組為20.3％（χ2=29.314，P＜0.01），管理組明顯優(yōu)于對照組，也高于1999年歐洲哮喘控制狀況調(diào)查(AsthmaInsights and Reality in Europe, AIRE)的5.1％；與國內(nèi)研究結(jié)果比較，管理組的控制率高于2006年全國10個省市三級醫(yī)院（28.7％）和2007年陜西省6個地區(qū)級城市中8所三級醫(yī)院（26.4％）的結(jié)果；也高于2007年北京城區(qū)3家教學(xué)醫(yī)院（30.6％）和2007年沈陽市（13.68％）的結(jié)果。（2）按照ACT評分達到良好控制以上（ACT評分≥20分），管理為74.4％，對照組為44.3％（χ2=14.682，P＜0.01），管理組優(yōu)于對照組。也高于2007年陜西省6個地區(qū)級城市中8所三級醫(yī)院（36.7％）、2006年北京6大城區(qū)6家醫(yī)院（46.3％）和2007年沈陽（59.43％）的結(jié)果，僅稍低于2006年北京大學(xué)人民醫(yī)院接受過哮喘“三位一體”教育管理模式的教育組患者結(jié)果（85％）。 2.未來風(fēng)險的評估：（1）過去一年中因為哮喘急性加重而急診就醫(yī)和住院率的情況，管理組分別為15.4％和5.1％，不僅低于對照組（35.4％，21.5％）的結(jié)果（χ2分別為8.317和9.100，P均小于0.01），同時低于2000年亞太地區(qū)哮喘控制現(xiàn)狀（Asthma Insights and Reality In Asia Pacific,AIRIAP）調(diào)查中中國的結(jié)果（33.3％，16.0％），也低于2006年全國10省市三級醫(yī)院（33.9％，20.0％）的結(jié)果，但高于2005年北京大學(xué)人民醫(yī)院接受過“三位一體”哮喘教育管理模式的教育組患者（7.1％，3.6％）的結(jié)果。（2）在肺功能方面，管理組FEV1％pred≥80％的患者占66.7％，對照組為25.3％，管理組明顯優(yōu)于對照組（χ2=27.029，P＜0.01）。（3）在應(yīng)用高劑量激素治療方面，管理組的比例為2.6％，對照組為15.2％，對照組高于管理組（χ2=7.703，P＜0.01）。（4）在煙草暴露方面，管理組為6.4％，對照組為27.8％，對照組煙草暴露的比率高于管理組（χ2=12.667，P＜0.01）。與國外比較，管理組煙草暴露的比率低于2000年AIRIAP（19.1％）、1999年AIRE（17.5％）和2000年美國（30.5％）的結(jié)果；與國內(nèi)比較，低于2007年沈陽（29.41％）的結(jié)果。 3.生命質(zhì)量的評估：按照李凡的成人哮喘生命質(zhì)量5分制評分表評估生命質(zhì)量，將測評期限調(diào)整為測評前8周。結(jié)果顯示：在活動受限方面，管理組為49.95±5.61分，高于對照組(39.99±7.64分)（t=9.3，P＜0.01）；在哮喘癥狀方面，管理組為36.54±3.61分，高于對照組(26.38±5.50分)（t=13.7，P＜0.01）；在心理狀況方面，管理組為27.03±3.15分，高于對照組(21.16±5.66分)（t=8.0，P＜0.01）；對刺激原的反應(yīng)方面，管理組為23.35±2.36分，，高于對照組(18.32±4.13分)（t=9.4，P＜0.01）；對自身健康的關(guān)心方面，管理組為15.00±3.79分，高于對照組(11.42±4.90分)（t=5.1，P＜0.01）；管理組的生命質(zhì)量總分為151.82±12.83分，明顯優(yōu)于對照組（116.87±20.66分）（t=12.7，P＜0.01）。 結(jié)論：哮喘專科門診、哮喘知識講座、哮喘之家的規(guī)范化教育管理模式提高了哮喘患者的臨床控制水平和生命質(zhì)量，降低了未來的風(fēng)險，值得進一步推廣。
[Abstract]:Objective: bronchial asthma (hereinafter referred to as asthma) is a common chronic disease, according to the data of patients with asthma has been nearly 300 million, because most patients are not able to accept the education management standardization caused the recurrent attacks of asthma, leading to progressive disease, bring heavy burden to society and family. This paper carried through our hospital outpatient specialist features of asthma, asthma knowledge, asthma family management mode of standardized education and to evaluate its impact on patients with asthma control and quality of life, provide the basis for the further promotion of this management mode.
Methods: 157 patients with asthma from July 2011 to March 2012 from the Second Affiliated Hospital of Dalian Medical University asthma outpatient cases, which received in our hospital standardized management for patients with education management group (78 cases), all patients received outpatient asthma, asthma knowledge, asthma family education management mode, attended a junior class at least two intensive education and class education. Not received in our hospital standardized management mode of education of patients as the control group (79 cases). Two groups of patients were diagnosed in 2008 Chinese medicine respiratory diseases asthma study group to develop guidelines for prevention and treatment of bronchial asthma. By this research students and physicians investigated by face to face the questionnaire, using plain language to describe, respectively, survey two groups of patients with the disease control and quality of life score. Patients with the disease control questionnaire reference The domestic and foreign literature design, the contents of the questionnaire include the following aspects: 1. basic information: including name, gender, age, culture degree, course of disease, the severity of the disease; 2. asthma control: according to 2009 Gina (GlobalInitiative for Asthma, GINA) to develop the level of asthma control and asthma control test (according to ACT) the evaluation score of two standard; assessment of future risk include: 3. in the past year due to acute asthma and emergency medical treatment and hospitalization, low FEV1, high dose of Glucocorticoid (hormone) usage, there is no exposure to tobacco. High dose hormone is the standard of inhaled corticosteroids in reference to the 2009 GINA guidelines the definition of (ICS) to determine the standard dose. In tobacco exposure, the questionnaire is divided into two aspects: active and passive smoking, including passive smoking frequency divided by three and often, sometimes occasionally, In this study, active smoking and passive smoking often regarded as patients in tobacco exposure. The quality of life of patients with questionnaire by Li Fan adult asthma quality of life score 5 points, the evaluation period of 8 weeks before the evaluation. The content includes the activity limitation, asthma symptoms, psychological status, the 5 dimensions of the stimuli and care for their own health, 35 items scoring 1 points for the worst, 5 points for the best, a total of 35~175 points, the higher score indicates that the quality of life of patients with asthma. The higher the questionnaire, the questionnaire content may not be vacant, completed a total of 157 questionnaires. Statistical analysis was performed by SPSS13.0 software, P0.05 the difference was statistically significant.
Results: 1. clinical control level: (1) according to the 2009 GINA guide for establishing the levels of asthma control standards to control patients, management group was 62.8%, 20.3% in the control group (2=29.314, P < 0.01), control group than the control group, also higher than the European survey of asthma control status in 1999 (AsthmaInsights and Reality in Europe AIRE, 5.1%); compared with the domestic research results, the control group was higher than that in 2006, 10 provinces and cities nationwide three hospitals (28.7%) 6 prefecture level city in Shaanxi province in 2007 and 8 in three hospitals (26.4%) were also higher than in 2007; 3 teaching hospitals in Beijing city (30.6%) and Shenyang, 2007 (13.68%). (2) according to the results of ACT score achieved good control over (ACT score = 20), were 74.4% and 44.3% in the control group (2=14.682, P < 0.01), management group better than the control group. Higher than 2007 Shaanxi The 6 district level city west province in 8 grade three hospitals (36.7%), 2006 6 Beijing city 6 hospitals (46.3%) and Shenyang (2007 59.43%) of the results, only slightly lower than 2006 in Peking University People's Hospital educated patients results "three-in-one" asthma education management model (85%).
2. assessment of future risk: (1) in the past year because of acute asthma exacerbation and emergency medical treatment and hospitalization rate, control group were 15.4% and 5.1%, not only lower than that of the control group (35.4%, 21.5%) results (x 2 respectively 8.317 and 9.100, P were less than 0.01), while low in asthma in 2000, the Asia Pacific region (Asthma Insights and Reality of In Asia Pacific, AIRIAP) China survey results (33.3%, 16%), is also lower than in 2006 10 provinces and cities in three hospitals (33.9%, 20%) of the results, but higher than that of Peking University People's Hospital in 2005 received a "Education Group three-in-one" mode of education and management of asthma (7.1%. 3.6%). (2) results in pulmonary function, management group FEV1%pred = 80% patients accounted for 66.7%, 25.3% in the control group, the management group was significantly better than the control group (2=27.029, P < 0.01). (3) in the application of high dose steroid treatment Treatment group management, the proportion is 2.6%, 15.2% in the control group, the control group was higher than that of the management group (x 2=7.703, P < 0.01). (4) in tobacco exposure, control group was 6.4%, 27.8% in the control group, the control group is higher than the ratio of tobacco exposure management group (x 2=12.667, P < 0.01). Compared with other countries, the ratio of tobacco exposure management group was lower than that in 2000 1999, AIRIAP (19.1%) AIRE (17.5%) and 2000 (30.5%) results; in comparison with the mainland, Shenyang is lower than in 2007 (29.41%) results.
3.鐢熷懡璐ㄩ噺鐨勮瘎浼幫細鎸夌収鏉庡嚒鐨勬垚浜哄摦鍠樼敓鍛借川閲

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