本文選題：兒童癲癇　切入點(diǎn)：依從性　出處：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景癲癇是一種常見的神經(jīng)系統(tǒng)疾病,相關(guān)人員統(tǒng)計(jì)后發(fā)現(xiàn),我國的癲癇患者將近900萬人,患病率高達(dá)到7%,而新癲癇病例正在以約每年40萬人次快速增加,其中絕大部分的癲癇患者在長期規(guī)律治療過程中,得到緩解控制,但仍有約五分之一的患者最后發(fā)展成為難治性癲癇[1]。新醫(yī)學(xué)模式逐漸完善,影響不同類型癲癇治療的各種因素也逐漸引起人們的重視。全面提高患者的治療療效,并且減少綜合藥物和多方面的因素帶來的副作用,最終達(dá)到提高患者的生活質(zhì)量。就目前而言。臨床中口服抗癲癇藥物(anti-epileptic drags,AEDs)仍然是抗癲癇治療的首選方案。癲癇本來就是個慢性病、長期病。癲癇藥物治療的療效、發(fā)作后服藥時間、服藥過程中的注意事項(xiàng)以及停藥后復(fù)發(fā)率可能成為患者及家屬關(guān)心的核心問題。一部分患兒癲癇發(fā)作不能得到很好地控制,除疾病本身的因素外,依從性也是其不可忽視的因素之一。國內(nèi)外研究調(diào)查就發(fā)現(xiàn)癲癇患者中無依從性的發(fā)生率約為25%~50%,私自換用癲癇藥物、未遵醫(yī)囑下私自換用或者停用藥等均可以歸為不依從的范圍,導(dǎo)致癲癇難以控制,最嚴(yán)重可能發(fā)生癲癇持續(xù)狀態(tài)[2-3]的根源之一。癲癇患者中,兒童可能屬于癲癇的高發(fā)人群。對于我國這樣一個癲癇大國來說,兒童的發(fā)病率也明顯超過成人。目的通過對影響癲癇患者依從性相關(guān)因素進(jìn)行分析、歸納和總結(jié),進(jìn)一步探討這些相關(guān)因素對兒童癲癇患者療效的影響。同時在此基礎(chǔ)上提出兒童癲癇患者依從性的相關(guān)對策,以改善兒童癲癇患者臨床治療效果,并提升其生活質(zhì)量。方法2014年7月-2015年7月期間河南省人民醫(yī)院兒科門診收治的84例患兒,臨床診斷為癲癇,對這些患兒的臨床資料和治療方法進(jìn)行分析,并發(fā)放自行設(shè)計(jì)的調(diào)查問卷進(jìn)行調(diào)查分析,將所有的調(diào)查問卷進(jìn)行總結(jié),分別從兒童癲癇患兒的就診時間、家長診治意識、堅(jiān)持定期復(fù)診、維持長期用藥等方面歸納分析,并從這幾個方面對兒童癲癇患者依從性的相關(guān)因素。同時通過跟蹤隨訪,分析依從性對治療療效的影響。采用SPSS20.0統(tǒng)計(jì)軟件對數(shù)據(jù)進(jìn)行分析和處理,以P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果1.本次問卷調(diào)查發(fā)現(xiàn):患兒監(jiān)護(hù)人的年齡、教育程度、生活背景等與癲癇患兒就診意識、就診時間、規(guī)律服藥、定期復(fù)查等因素具有相關(guān)性。2.經(jīng)過對比研究發(fā)現(xiàn)就診意識,就診時間、規(guī)律服藥、定期復(fù)查等與依從性具有明顯的相關(guān)性,P0.05,差異具有統(tǒng)計(jì)學(xué)意義。3.本次實(shí)驗(yàn)研究顯示,依從性的好壞對患兒疾病預(yù)后具有明顯的相關(guān)性,通過卡方檢驗(yàn)X2=26.56,P0.05,差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論患兒監(jiān)護(hù)人教育程度、生活背景等各個方面的因素直接影響到癲癇患兒就醫(yī)時間、遵醫(yī)囑的程度。治療期間不能按時服藥、患兒家長文化程度低、對疾病的認(rèn)識少、由于客觀原因患兒無規(guī)律的復(fù)診及服藥均不利于疾病恢復(fù)。這些因素在一定程度上影響依從性。癲癇患兒治療的依從性越差,其治療的效果就越差。對于患兒監(jiān)護(hù)人,治療效果差會讓他們對治療失去信心或者病急亂投醫(yī),最后導(dǎo)致疾病得不到良好的控制。針對上述情況,臨床醫(yī)生在癲癇患兒治療期間,要及時對其家長進(jìn)行有針對性的健康教育,并充分溝通,得到家長重視,并能夠爭取到他們的積極配合,提高依從性及療效。
[Abstract]:Background epilepsy is a common neurological disease, related personnel statistics showed that China's epilepsy patients nearly 9 million people, the prevalence rate reached 7%, and the new cases of epilepsy is about 400 thousand times a year increased rapidly, and the vast majority of patients with epilepsy in long-term regular treatment process, ease control, but still there are about 1/5 of the patients become refractory epilepsy [1]. new medical mode is gradually perfect, various factors of different types of epilepsy treatment has gradually aroused people's attention. Improve the curative effect in the treatment of patients, and reduce the factors in many aspects and drug side effects, and finally improve the quality of life of patients. For now. The clinical oral antiepileptic drugs (anti-epileptic, drags, AEDs) is still the preferred scheme of anti epilepsy treatment. Epilepsy is a chronic disease, chronic disease of epilepsy. Effect of antiepileptic medication, medication time after the onset, the matters needing attention in the process of treatment and relapse rate after may become the core problem of patients and their families concerned. Part of the children's seizure can not get good control, in addition to the factors of the disease itself, compliance is also one of the factors which can not be ignored. The domestic and foreign research investigation found no compliance of epilepsy patients the incidence is about 25%~50%, with epilepsy drugs for privately, noncompliance with or without change under the discontinuation of drugs can be classified as the scope of non-compliance, resulting in epilepsy is difficult to control, the worst possible source of status epilepticus [2-3] in patients with epilepsy. In the high risk population of children may belong to epilepsy. For such a seizure in our country, the incidence of children is significantly more than adults. Objective to influence compliance and related factors in patients with epilepsy. For the analysis, the induction and the summary, further explore the impact of these factors on the curative effect of children with epilepsy. At the same time puts forward relevant measures for children with epilepsy patient compliance, to improve clinical curative effect for children with epilepsy, and improve their quality of life. Methods in July 2014 -2015 year in July 84 cases admitted to the outpatient department of Pediatrics, Henan Province People's Hospital, clinical a diagnosis of epilepsy, the clinical data and treatment methods for these children were analyzed, and the questionnaire designed by the investigation and analysis of the questionnaire, all of the total, respectively from children with epilepsy treatment time, diagnosis and treatment of parents awareness, adhere to regular follow up and maintain long-term medication and other aspects of analysis of related factors children with epilepsy compliance from these aspects. At the same time and followed up by the analysis on the compliance of therapy. Ring. The data were analyzed by SPSS20.0 statistical software, using P0.05 as the difference was statistically significant. The results of the 1. survey found that: with the guardians of the age, level of education, taking the life background and treatment of children with epilepsy awareness, treatment time, law, periodic review and other factors associated with.2. were found after the comparative study awareness, treatment time, regular medication, regular follow-up and compliance has obvious relevance, P0.05, the difference has statistical significance in this experiment.3. showed that compliance is significantly correlated with the prognosis of the disease, through the chi square test X2=26.56, P0.05, the difference was statistically significant. Conclusion the children's Guardian education, the background of life and other aspects of the factors that directly affect the children with epilepsy treatment time, doctor degree. During treatment can not take medication, children home Long low cultural level, the understanding of the disease, due to objective reasons and referral medication in children with no rules are not conducive to the recovery of the disease. These factors affect compliance in some extent. The treatment compliance of children with epilepsy is poor, the treatment effect is worse. For the children's guardian, poor treatment effect will make them to lose confidence in treatment or critically ill patients, resulting in disease is not well controlled. In view of the above situation, clinicians in children with epilepsy during the treatment, the parents should be timely targeted health education, and fully communicate, parents can get attention, and actively cooperate with them, improve compliance and the curative effect.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R742.1

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