金杨社区小学生哮喘流行状况及社区综合防治干预研究

发布时间：2018-08-02 17:47

【摘要】：研究背景支气管哮喘(bronchial asthma)是儿童最常见的慢性呼吸道疾病之一,它不仅严重威胁儿童的身体健康,而且还会影响儿童参与正常的社会活动,导致儿童缺课,造成学习成绩的下降。大多数儿童哮喘均有可能发展成难治性哮喘,以至于延续成年期后哮喘。近20年来,哮喘患病率在世界范围内尤其是发展中国家正以惊人的速度上升,许多地区在10～20年间哮喘患病率增加了近1倍。随着医学的发展,全球哮喘防治创议(Global Initiative for Asthma,简称GINA)的推行和防治哮喘的药物越来越多,但患病率和病死率并没有显著下降,没有切实落实规范化治疗方案以及患儿和家长缺乏哮喘防治常识是其主要原因。因此掌握社区儿童哮喘流行状况,利用社区资源,对其进行规范的综合防治,是一个值得探索和研究的课题。研究目的通过问卷调查、筛检及确诊,掌握上海市金杨社区小学生哮喘流行状况；对哮喘学生以落实GINA的整体管理计划为目标,实施有针对性的群体化和个体化相结合的社区综合防治措施,从而减少患病儿童的哮喘发作,提高其生活质量；初步评价社区综合防治在儿童哮喘管理中的作用,探索儿童慢性病防治的社区卫生服务新模式。方法以金杨社区6所小学1-4年级的学生作为研究对象,予以流调、筛查,将确诊病例随机整群分2组,干预组以切实落实GINA的整体管理计划为目标,予以社区综合防治。对照组予以常规治疗,每季度随访一次,随访一年,对防治效果进行评价。结果 1.调查对象基本情况：金杨社区有小学6所,1～4年级学生共5040名,本次实际调查4895名,调查率为97.1%。调查对象中男性2544名,占51.97%；女性2351名,占48.03%。 2.哮喘患病率情况：诊断明确的患病学生110人,患病率为2.25%,其中男性67例,占60.91%,患病率为2.63%;女性43例,占39.09%,患病率为1.83%,哮喘学生男女比例为1.56：1。 3.出生时体重：110名哮喘学生中,低体重儿(体重2500g)9例,占8.18%；巨大儿(体重4000g)10例,占9.09%。 4.出生时分娩方式：110名哮喘学生中,出生时分娩方式为剖宫产的67例,占60.90%；顺产41例,占37.27%。 5.首次发病年龄：本次调查哮喘学生发病年龄大多在3岁以前,共有82例,占哮喘学生总数的74.55%。 6.哮喘好发季节：以冬季最好发,占34.54%,其次是换季和春季,夏季最少,占6.36%。 7.哮喘发作诱发因素：最主要的诱发原因为呼吸道感染,占86.36%,其次是天气变化和运动,分别占50.90%和19.09%。 8.发作先兆症状：最常见的先兆症状为流涕、喷嚏和鼻塞,占69.09%。 9.发作症状：发作时最常见的症状是咳嗽,占94.54%；其次是呼气延长,占47.80%。 10.发作强度：以间歇发作最多,共77例,占70.00%,其次是轻度持续,共29例,占26.36%。 11.发作时间：最多见于晚上,占59.09%。 12.过敏史：65.45%哮喘学生有过敏性疾病史,过敏性疾病中以婴儿湿疹最常见,占26.36%；其次是过敏性鼻炎,占21.82%。 13.家族史：哮喘学生一级亲属中有哮喘者占14.55%,二级亲属中有哮喘者占10.91%。 14.既往用药情况：使用抗生素的比例为95.45%,使用全身激素的比例为80.90%,使用吸入型皮质激素的比例为37.27%。 15.峰流速仪使用情况：从未听说过峰流速仪的比例为56.36%,曾经使用过的仅占17.27%。 16.社区综合防治效果：干预组规范管理1年后患儿治疗效果、哮喘发作次数、急诊次数、住院次数、缺课天数、PEF (peak expiratory flow最大呼气流速)值与对照组比较差异有显著性意义。 17.社会经济效果：干预组患儿因哮喘所致的直接和间接经济损失明显低于对照组。进行社区整体管理计划,推行GINA和综合防治措施,可有效控制哮喘发作,减少医药费用支出,提高患儿生活质量。 18.干预中存在的问题：社区医生对哮喘控制方案的认知和技能还有待提高,特别是部分中医医生；家长对GINA的哮喘分级控制方案认知不足,特别对吸入型激素治疗理解存在误区；学校的卫生老师还缺乏哮喘的防治和监测技能。结论金杨社区小学生哮喘患病率与全国水平持平,哮喘学生首次发病年龄偏小,发病与遗传因素密切相关,最主要的诱发原因仍然为呼吸道感染。虽然GINA推行已有多年,但哮喘患儿的治疗仍很不规范,使用抗生素及使用全身激素的比例相当高,而使用吸入型皮质激素比例很低。通过对哮喘学生进行规范的社区综合防治,能使患儿的临床症状得到有效控制,减少因哮喘发作而导致的急诊和住院,提高了患儿生活质量,减轻了家庭和社会的负担,值得推广应用。
[Abstract]:Research background
Bronchial asthma (bronchial asthma) is one of the most common chronic respiratory diseases in children. It not only seriously threatens the health of children, but also affects children's participation in normal social activities, causes children to be absent from class and causes a decline in academic performance. Most children asthma may develop into refractory asthma and continue to continue. Asthma. Over the last 20 years, the prevalence of asthma has increased at an alarming rate worldwide, especially in developing countries. In many areas, the prevalence of asthma has increased by nearly 1 times in 10~20 years. With the development of medicine, the Global Initiative for Asthma, referred to as GINA, and the drug control of asthma The more and more, the prevalence and fatality rate did not decrease significantly. The main reason for the lack of standardized treatment plan and the lack of common sense of asthma prevention and treatment for children and parents is the main reason. Therefore, it is a subject worthy of exploration and research to master the epidemic situation of children's asthma in the community and to use community resources to prevent and cure them.
research objective
Through the questionnaire survey, screening and diagnosis, mastering the prevalence of asthma in primary school children in Shanghai City, to implement the overall management plan of GINA for the students of asthma, to implement a targeted community integrated prevention and control measures combined with group and individualization, so as to reduce the attack and improve the quality of life of the children suffering from disease. Objective to evaluate the role of comprehensive community prevention and control in the management of childhood asthma, and explore a new community health service model for children with chronic diseases.
Method
Taking the 1-4 grade students of 6 primary schools in Jinyang community as the research object, the patients were divided into 2 groups by flow adjustment and screening. The group was divided into 2 groups randomly. The intervention group aimed at implementing the overall management plan of GINA. The control group was treated with general treatment. The control group was treated with regular treatment every quarter, followed up for one year, and the effect of prevention and control was evaluated.
Result
1. the basic situation of the survey subjects: 6 primary schools in Jinyang community, 5040 students in grade 1~4, and 4895 actual surveys. The investigation rate is 2544 of men in 97.1%. survey, 51.97% of them, and 2351 of women, accounting for 48.03%..
2. the prevalence of asthma: 110 students with a clear diagnosis, the prevalence rate was 2.25%, of which 67 were male, 60.91%, and 2.63%, 43 women, 39.09%, and 1.83%, and the proportion of male and female asthma was 1.56:1.
3. Birth weight: Among 110 asthmatic students, 9 (8.18%) were low weight infants (weighing 2 500 g), 10 (9.09%) were macrosomia (weighing 4 000 g).
4. Delivery mode at birth: Of 110 asthmatic students, 67 (60.90%) were delivered by cesarean section and 41 (37.27%) were spontaneous delivery.
5. Age of onset for the first time: Most of the Asthmatic Students in this survey were before the age of 3 years old, a total of 82 cases, accounting for 74.55% of the total number of asthmatic students.
6. the best season for asthma: the best in winter, accounting for 34.54%, followed by season and spring, the lowest in summer, accounting for 6.36%.
7. Inducing factors of asthma attack: The main cause of asthma attack was respiratory tract infection (86.36%), followed by weather changes and exercise (50.90% and 19.09%, respectively).
8. premonitory symptoms: the most common symptoms are runny nose, sneezing and stuffy nose, accounting for 69.09%.
9. seizure symptoms: the most common symptom was cough, accounting for 94.54%, followed by prolonged expiration, accounting for 47.80%.
10. seizure intensity: the most frequent episodes, 77 cases, accounting for 70%, followed by mild persistent, a total of 29 cases, accounting for 26.36%.
11. attack time: at most at night, accounting for 59.09%.
12. Allergic history: 65.45% of asthmatic students had allergic disease history. Infant eczema was the most common allergic disease, accounting for 26.36%, followed by allergic rhinitis, accounting for 21.82%.
13. family history: asthma students' first degree relatives had asthma, 14.55% of them, and two of their relatives had asthma, accounting for 10.91%.
14. Previous use of antibiotics was 95.45%, systemic hormones 80.90% and inhaled corticosteroids 37.27%.
15. peak flow meter usage: never heard of peak current meter ratio of 56.36%, used only accounted for 17.27%.
16. the effect of comprehensive prevention and control in the community: the treatment effect of children in the intervention group after 1 years of standardized management, the number of asthma attacks, the times of emergency, the number of hospitalization, the days of absence of class, and the difference of PEF (peak expiratory flow maximum expiratory flow) was significantly different from that of the control group.
17. social economic effect: the direct and indirect economic losses caused by asthma in the intervention group were obviously lower than that of the control group. The overall management plan of the community, the implementation of GINA and the comprehensive prevention and control measures could effectively control the attack of asthma, reduce the cost of medicine and improve the quality of life of the children.
18. the problems existing in the intervention: the cognition and skills of community doctors on asthma control programs have still to be improved, especially some doctors of traditional Chinese medicine; parents are not aware of GINA's asthma classification control scheme, especially on the understanding of inhaled hormone treatment; the school health veteran still lacks the prevention and monitoring skills of asthma.
conclusion
The prevalence rate of asthma in primary school pupils in Jinyang community is equal to that of the national level. The first onset age of asthma students is smaller. The incidence of asthma is closely related to the genetic factors. The main cause is still respiratory infection. Although GINA has been carried out for many years, the treatment of children with asthma is still very unstandardized, and the proportion of antibiotics and the use of systemic hormones is equal. The proportion of inhaled corticosteroids is very low. The standardized community prevention and control of asthma students can effectively control the clinical symptoms of the children, reduce the emergency and hospitalization caused by the asthma attack, improve the quality of life of the children, reduce the burden of family and society, and deserve to be popularized.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

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