本文選題：支氣管哮喘 + 規(guī)范化管理�。� 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：支氣管哮喘（bronchial asthma),簡稱哮喘，是臨床中一種較為多見的呼吸道的慢性疾病。據統(tǒng)計，全世界患有哮喘疾病的病人約有3億人口，而我國的哮喘患者約占全球的10%，大約為3000萬人。為了能夠有效地控制哮喘疾病在世界范圍內的蔓延，在臨床工作中對哮喘疾病規(guī)范化的防治成為必然。但事實并非如此，多數(shù)患者并沒有能夠接受到規(guī)范化管理，造成目前哮喘控制情況不佳，給患者和社會帶來了極大的心理和經濟負擔。本課題通過對去年來我院就診的哮喘患者的問卷調查，了解我院哮喘患者的控制現(xiàn)狀，為哮喘人群防治提供更好的依據。 方法：選取84例哮喘患者，均于2013年1月至2013年3月在大連醫(yī)科大學附屬第二醫(yī)院（簡稱大醫(yī)二院）呼吸內科門診和哮喘門診就診，且全部符合2011年GINA指南和2008年中國哮喘防治指南制定的支氣管哮喘診斷標準。由大醫(yī)二院的呼吸門診及哮喘門診醫(yī)生采用面對面問卷調查形式，運用通俗易懂的語言進行描述，調查患者的哮喘控制情況和哮喘發(fā)作情況等。問卷內容包括：1.患者基本資料：姓名、性別、年齡和病程等。2.哮喘的基本情況：過去1年內門診隨診和治療的情況等。3.哮喘控制情況：包括兩種標準：（1）按照2011年全球哮喘防治創(chuàng)議(Global Initiative forAsthma，GINA)制定的哮喘控制水平的方法；（2）哮喘控制測試（ACT）評分。4.哮喘發(fā)作情況：包括過去3個月內呼吸道感染情況和哮喘發(fā)作的次數(shù)，過去1年中因哮喘急性發(fā)作而急診就醫(yī)和住院的情況等。進行問卷調查時，問卷內容不得空缺，共完成84份調查。采用SPSS17.0軟件進行統(tǒng)計分析，P＜0.05為差異有統(tǒng)計學意義。 結果：1.臨床控制水平：（1）按照2011年GINA指南制定的哮喘控制水平分級達到控制水平，哮喘門診組為43.1%明顯優(yōu)于呼吸門診組的18.2%（χ2=5.615，P＜0.05），但低于2011年我院經過規(guī)范化教育和治療的管理組患者（62.8%）。（2）按照ACT評分達到良好控制以上（ACT評分≥20分），哮喘門診組為51%明顯優(yōu)于呼吸門診組的21.2%（χ2=7.444，P＜0.05），但低于我院經過規(guī)范化教育和治療的管理組患者（74.4%）。 2.吸入型糖皮質激素（ICS）治療與呼吸道感染：將患者分成激素規(guī)范治療組和未規(guī)范治療組。規(guī)范治療組是指持續(xù)3個月以上規(guī)范應用ICS或ICS+長效β2受體激動劑（LABA）治療；未規(guī)范組指沒有應用ICS或ICS+LABA治療，或雖然應用，但未達到3個月療程。84個患者中，規(guī)范治療組30人（35.7%），未規(guī)范組54人（64.3%）。3個月內呼吸道感染的情況，規(guī)范治療組為66.7%，未規(guī)范治療組55.6%（χ2=0.988，P=0.361），兩組統(tǒng)計學沒有明顯差異。 3.哮喘控制水平與呼吸道感染：按照2011年GINA指南制定的哮喘控制水平分級，84人中達到控制的患者（控制組）28人，未達到控制的患者（未控制組）56人，發(fā)生呼吸道感染的情況，控制組為32.1%，未控制組為58.9%，（χ2=5.357，P=0.036），控制組明顯低于未控制組。 4.哮喘控制水平與急診和住院情況：按照2011年GINA指南制定的哮喘控制水平分級達到控制的患者（控制組）28人，未達到控制的患者（未控制組）56人，過去12個月中有急診和住院的患者控制組為7.1%；未控制組為26.8%（χ2=4.462，P=0.044），控制組明顯低于未控制組。 5.依從性與哮喘控制水平：84個哮喘患者中，依從性差的患者（12個月內門診就診的次數(shù)≤1次）35人，依從性好的患者（12個月之內門診就診的次數(shù)≥2次）49人。依從性差的患者哮喘控制率為14.3%，依從性好的患者哮喘控制率為46.9%（χ2=9.796，，P=0.002），依從性好的患者哮喘控制的比率明顯高于依從性差的患者。 結論：規(guī)范化管理可以提高哮喘患者的控制水平和治療的依從性，從而減少患者的呼吸道感染和急性發(fā)作的幾率。規(guī)范化地使用ICS治療哮喘并不增加呼吸道感染的風險。
[Abstract]:Objective : Bronchial asthma ( bronchial asthma ) is a kind of chronic disease of respiratory tract in clinic . According to statistics , there are about 300 million people with asthma in the world . In order to control the spread of asthma disease in the world , it is necessary to prevent and cure asthma disease .

Methods : 84 patients with asthma were visited from January 2013 to March 2013 at the Second Affiliated Hospital of Dalian Medical University ( hereinafter referred to as the Second Affiliated Hospital of Dalian Medical University ) , and all met the diagnostic criteria of bronchial asthma developed by the GINA guide and the 2008 Chinese asthma prevention guidelines . The basic information of asthma was as follows : 1 . Basic information of asthma : name , sex , age and course of asthma .
( 2 ) Asthma control test ( ACT ) score . 4 . The incidence of asthma : including the number of respiratory tract infection and asthma attack in the past 3 months , the situation of emergency medical treatment and hospitalization in the past 1 year because of the acute attack of asthma .

Results : 1 . Clinical control level : ( 1 ) According to the control level of asthma control level established in GINA guidelines in 2011 , 43.1 % of asthma outpatient group was significantly superior to 18.2 % in respiratory outpatient group ( 蠂 2 = 5.615 , P < 0.05 ) .

2 . Treatment of inhaled corticosteroids ( ICS ) with respiratory tract infections : Patients were divided into hormone - regulated treatment groups and non - regulated treatment groups . The normative treatment group was defined as the treatment of the ICS or ICS + long - acting 尾2 - agonists ( LABA ) for more than 3 months ;
Unregulated groups mean that ICS or ICS + LABA therapy was not applied , or although it was applied , but did not reach a 3 - month course of treatment . Of the 84 patients , there were 30 patients ( 35.7 % ) in the standard treatment group , 54 ( 64.3 % ) in the untreated group , 66.7 % in the untreated group , and 55.6 % in the untreated group ( 蠂2 = 0.988 , P = 0.361 ) . There was no significant difference between the two groups .

3 . Asthma control level and respiratory tract infection : According to the level of asthma control established in the GINA guidelines in 2011 , 28 patients ( control group ) in 84 patients ( control group ) , 56 in control group ( control group ) , 56 in control group and 58.9 % in control group , ( 蠂2 = 5.357 , P = 0.036 ) , control group was significantly lower than that of control group .

4 . Asthma control level and emergency and hospitalization : 28 patients ( control group ) , 28 patients ( control group ) who had controlled the asthma control level according to the GINA guidelines in 2011 , 56 in the control group ( control group ) , 56 in the control group ( control group ) , and 7.1 % of patients with emergency and hospitalization in the past 12 months ;
The control group was 26 . 8 % ( 蠂2 = 4.462 , P = 0.044 ) , and the control group was significantly lower than that of the control group .

5 . Compliance and asthma control level : Among the 84 patients with asthma , the number of outpatient visits within 12 months was less than or equal to 35 , and the patients with good compliance ( 鈮

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