规范化教育管理对支气管哮喘患者病情控制情况和生命质量的影响

发布时间：2018-04-17 18:33

  本文选题：支气管哮喘 + 教育和管理　； 参考：《大连医科大学》2012年硕士论文

【摘要】：目的：支气管哮喘（以下简称哮喘）是一种常见的慢性疾病，据资料显示全球哮喘患者已近3亿，由于大多数患者没有能够接受规范化的教育管理等原因造成了哮喘的反复发作，导致疾病进行性加重，给社会和家庭带来了沉重的的负担。本课题通过开展我院特色的哮喘专科门诊、哮喘知识讲座、哮喘之家的规范化教育管理模式并评估其对哮喘患者病情控制情况和生命质量的影响，为进一步推广这一管理模式提供依据。 方法：2011年7月至2012年3月选取大连医科大学附属第二医院哮喘门诊就诊的哮喘患者157例，其中接受过我院规范化教育管理的患者为管理组（78例），每位患者均接受哮喘专科门诊、哮喘知识讲座、哮喘之家的教育管理模式，参加过一次初级班教育和至少两次强化班教育。未接受过我院规范化教育管理模式的患者为对照组（79例）。两组患者均符合2008年中华医学会呼吸病分会哮喘学组制定的支气管哮喘防治指南的诊断标准。由本课题研究生和医师采用面对面调查问卷的方式，应用通俗易懂的语言进行描述，分别调查两组患者的病情控制情况和生命质量评分。患者病情控制情况问卷参照国内外文献设计，问卷内容包括以下方面：1.基本资料：包括姓名、性别、年龄、文化程度、病程、病情严重程度等；2.哮喘控制情况：包括按2009年全球哮喘防治创议（GlobalInitiative for Asthma，GINA）制定的哮喘控制水平和按哮喘控制测试（ACT）评分两个标准进行评估；3.未来风险的评估：包括过去一年中因哮喘急性发作而急诊就医和住院的情况、FEV1低、高剂量糖皮质激素（简称激素）使用情况、有无烟草的暴露。高剂量激素的标准是参照2009年GINA指南定义的吸入激素（ICS）的剂量标准判定。在烟草暴露方面，调查问卷分为主动吸烟和被动吸烟两个方面，其中被动吸烟频率分为经常、有时和偶尔三种，本研究将主动吸烟和经常被动吸烟视为患者处于烟草暴露。患者生命质量的问卷采用李凡的成人哮喘生命质量5分制评分表，将测评期限调整为测评前8周。内容包括活动受限、哮喘症状、心理状况、对刺激原的反应和对自身健康关心5个维度，35个项目逐项计分，1分为最差，5分为最好，总分35～175分，分值越高，表明哮喘患者的生命质量越高。进行问卷调查时，问卷内容不得空缺，共完成问卷157份。采用SPSS13.0软件进行统计分析，P0.05为差异有统计学意义。 结果：1.临床控制水平：（1）按照2009年GINA指南制定的哮喘控制水平分级标准达到控制的患者，管理组为62.8％，对照组为20.3％（χ2=29.314，P＜0.01），管理组明显优于对照组，也高于1999年欧洲哮喘控制状况调查(AsthmaInsights and Reality in Europe, AIRE)的5.1％；与国内研究结果比较，管理组的控制率高于2006年全国10个省市三级医院（28.7％）和2007年陕西省6个地区级城市中8所三级医院（26.4％）的结果；也高于2007年北京城区3家教学医院（30.6％）和2007年沈阳市（13.68％）的结果。（2）按照ACT评分达到良好控制以上（ACT评分≥20分），管理为74.4％，对照组为44.3％（χ2=14.682，P＜0.01），管理组优于对照组。也高于2007年陕西省6个地区级城市中8所三级医院（36.7％）、2006年北京6大城区6家医院（46.3％）和2007年沈阳（59.43％）的结果，仅稍低于2006年北京大学人民医院接受过哮喘“三位一体”教育管理模式的教育组患者结果（85％）。 2.未来风险的评估：（1）过去一年中因为哮喘急性加重而急诊就医和住院率的情况，管理组分别为15.4％和5.1％，不仅低于对照组（35.4％，21.5％）的结果（χ2分别为8.317和9.100，P均小于0.01），同时低于2000年亚太地区哮喘控制现状（Asthma Insights and Reality In Asia Pacific,AIRIAP）调查中中国的结果（33.3％，16.0％），也低于2006年全国10省市三级医院（33.9％，20.0％）的结果，但高于2005年北京大学人民医院接受过“三位一体”哮喘教育管理模式的教育组患者（7.1％，3.6％）的结果。（2）在肺功能方面，管理组FEV1％pred≥80％的患者占66.7％，对照组为25.3％，管理组明显优于对照组（χ2=27.029，P＜0.01）。（3）在应用高剂量激素治疗方面，管理组的比例为2.6％，对照组为15.2％，对照组高于管理组（χ2=7.703，P＜0.01）。（4）在烟草暴露方面，管理组为6.4％，对照组为27.8％，对照组烟草暴露的比率高于管理组（χ2=12.667，P＜0.01）。与国外比较，管理组烟草暴露的比率低于2000年AIRIAP（19.1％）、1999年AIRE（17.5％）和2000年美国（30.5％）的结果；与国内比较，低于2007年沈阳（29.41％）的结果。 3.生命质量的评估：按照李凡的成人哮喘生命质量5分制评分表评估生命质量，将测评期限调整为测评前8周。结果显示：在活动受限方面，管理组为49.95±5.61分，高于对照组(39.99±7.64分)（t=9.3，P＜0.01）；在哮喘症状方面，管理组为36.54±3.61分，高于对照组(26.38±5.50分)（t=13.7，P＜0.01）；在心理状况方面，管理组为27.03±3.15分，高于对照组(21.16±5.66分)（t=8.0，P＜0.01）；对刺激原的反应方面，管理组为23.35±2.36分，，高于对照组(18.32±4.13分)（t=9.4，P＜0.01）；对自身健康的关心方面，管理组为15.00±3.79分，高于对照组(11.42±4.90分)（t=5.1，P＜0.01）；管理组的生命质量总分为151.82±12.83分，明显优于对照组（116.87±20.66分）（t=12.7，P＜0.01）。 结论：哮喘专科门诊、哮喘知识讲座、哮喘之家的规范化教育管理模式提高了哮喘患者的临床控制水平和生命质量，降低了未来的风险，值得进一步推广。
[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.
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