發(fā)布時(shí)間：2018-06-05 10:08

  本文選題：變應(yīng)性鼻炎 + 哮喘��； 參考：《福建醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的觀察變應(yīng)性鼻炎合并哮喘患兒在“兒童鼻炎與哮喘聯(lián)合門診”（簡稱聯(lián)合門診）診治后的臨床療效，調(diào)查在該診治模式下的家長滿意度；探討聯(lián)合門診模式的臨床意義及社會(huì)效應(yīng)。 方法選取2013年9月至2013年12月期間在聯(lián)合門診就診的59例變應(yīng)性鼻炎合并哮喘的患兒，其就診前均已在單獨(dú)耳鼻喉門診、單獨(dú)兒科門診或分別在耳鼻喉門診和兒科門診（這三種門診，簡稱單科門診）診治3個(gè)月及以上，療效不滿意；由耳鼻喉科醫(yī)師和兒科醫(yī)師在同一診室共同診斷，并經(jīng)過商討后制定規(guī)范化、個(gè)體化治療方案。經(jīng)過3個(gè)月的的上下氣道共同治療，比較治療前后的相關(guān)指標(biāo)進(jìn)行療效評價(jià)，包括：鼻部及肺部總體癥狀視覺模擬量表（Visual Analogue Scale，VAS）評分、鼻部癥狀總分（Total Nasal Symptom Score,TNSS）、肺部癥狀總分（Total Pulmanory Symptom Score,TPSS）、鼻部及肺部體征及哮喘控制水平分級；對能配合并復(fù)查肺功能和/或呼出氣一氧化氮（Fractional Concentration of Exhaled Nitric oxide, FeNO）的兒童進(jìn)行治療前后比較。對家長行聯(lián)合門診和單科門診的診治滿意度問卷調(diào)查，定期復(fù)診患兒采用現(xiàn)場調(diào)查，未定期復(fù)診患兒采用電話隨訪。 結(jié)果聯(lián)合診治后3個(gè)月，共有42例患兒定期復(fù)診。與治療前相比，59例患兒鼻部、肺部總體癥狀VAS評分有統(tǒng)計(jì)學(xué)意義（P均＜0.05）；TNSS顯效26例，有效17例，總有效率為72.9%；TPSS顯效31例，有效14例，總有效率76.3%；哮喘控制水平分級有統(tǒng)計(jì)學(xué)意義（P＜0.05）。42例復(fù)診的患兒鼻部體征無統(tǒng)計(jì)學(xué)意義（P＞0.05），肺部體征差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；20例復(fù)查FeNO的患兒，其值治療前后差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；12例復(fù)查肺功能的患兒，其指標(biāo)FEV1/pre1(1秒用力呼氣量占正常預(yù)計(jì)值百分比，F(xiàn)orced Expiratory Flow in One Second/Predictive Value)及FEF25-75%（用力肺活量的25%-75%的呼氣中期流速，F(xiàn)orced Expiratory Flow at25%and75%of the Pulmonary Volume），，治療前后差異有統(tǒng)計(jì)學(xué)意義（P均＜0.05）。在預(yù)約及現(xiàn)場等待時(shí)間、綜合費(fèi)用、就診環(huán)境、鼻部疾病療效、哮喘療效、健康教育及答疑解惑及綜合滿意度方面，患兒家長對聯(lián)合門診的滿意度優(yōu)于單科門診（P均＜0.05）；而在綜合費(fèi)用滿意度方面，聯(lián)合門診與單科門診無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 結(jié)論由耳鼻喉科醫(yī)師和兒科醫(yī)師在同一診室對變應(yīng)性鼻炎合并哮喘的患兒進(jìn)行聯(lián)合診治，臨床療效優(yōu)于單科門診，其家長對聯(lián)合診治的滿意度優(yōu)于單科門診。該診治模式是一種高效、方便、優(yōu)質(zhì)的醫(yī)療模式，臨床療效好、患方滿意度高、無明顯增加費(fèi)用，值得推廣應(yīng)用。
[Abstract]:Objective to observe the clinical effect of children with allergic rhinitis complicated with asthma after the diagnosis and treatment of Children's rhinitis and Asthma. Methods 59 children with allergic rhinitis complicated with asthma were selected from September 2013 to December 2013. Paediatric outpatients alone or in the otolaryngology outpatient department and the pediatrics outpatient clinic (these three types of outpatient clinics, referred to as the single-department clinics) are treated for three months or more, and the results are unsatisfactory; the otolaryngologist and the pediatrician are jointly diagnosed in the same clinic. And after discussion, the formulation of standardized, individualized treatment program. After 3 months of upper and lower airway therapy, the curative effect was evaluated by comparing the relative indexes before and after treatment, including visual Analogue scale (VAS) score of nasal and pulmonary symptoms. Total Nasal symptom score Total Nasal symptom Scoreboard TNSSN, Total Pulmanory symptom ScoreTPS, nasal and Pulmonary signs and Asthma Control level; comparison of children who can cooperate and review pulmonary function and / or exhaled nitric oxide concentration (Feno) before and after treatment. A questionnaire survey was carried out on parents' satisfaction with diagnosis and treatment in joint outpatient and single-department outpatient clinics. Field investigation was used for children with periodic follow-up and telephone follow-up for children without regular follow-up. Results after 3 months of combined diagnosis and treatment, 42 children were regularly followed up. Compared with those before treatment, there were significant differences in VAS scores of total pulmonary symptoms (P < 0.05) in 26 cases and effective in 17 cases. The total effective rate was 72.9% TPSS in 31 cases and effective in 14 cases. The total effective rate was 76. 3%, the control level of asthma was statistically significant (P < 0. 05, P < 0. 05, P < 0. 05). There was no significant difference in nasal signs (P > 0. 05), but the difference of pulmonary signs was statistically significant in 20 patients with FeNO reexamination, and there was no significant difference between them (P < 0. 05, P < 0. 05, P < 0. 05). Before and after treatment, the difference was statistically significant (P < 0.05). FEV1 / pre1 (percentage of forced expiratory flow in one second / predictive value) and forced Expiratory flow at25%and75%of the pulmonary volume (FEF25-75% of forced vital capacity) were significantly different before and after treatment (P < 0.05). In the aspects of booking and waiting time on the spot, comprehensive cost, treatment environment, curative effect of nasal diseases, curative effect of asthma, health education, answering questions and comprehensive satisfaction, The satisfaction of the parents of the children was better than that of the single department outpatient patients (P < 0.05), but the satisfaction degree of the patients' comprehensive expenses was higher than that of the single department outpatients. There was no significant difference (P > 0.05) between the combined outpatient department and the single-department outpatient department. Conclusion the clinical effect of otolaryngologist and pediatrician in the same clinic for children with allergic rhinitis complicated with asthma is better than that of single department outpatient. Their parents' satisfaction with the combined diagnosis and treatment was superior to that of the single outpatient department. The diagnosis and treatment model is an effective, convenient and high quality medical treatment model, with good clinical efficacy, high patient satisfaction and no obvious increase in cost, so it is worth popularizing and applying.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R765.21

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本文編號(hào)：1981613