门诊支气管哮喘患者控制和治疗现状调查

发布时间：2018-06-21 00:00

  本文选题：支气管哮喘 + 规范化管理　； 参考：《大连医科大学》2014年硕士论文

【摘要】：目的：支气管哮喘（bronchial asthma),简称哮喘，是临床中一种较为多见的呼吸道的慢性疾病。据统计，全世界患有哮喘疾病的病人约有3亿人口，而我国的哮喘患者约占全球的10%，大约为3000万人。为了能够有效地控制哮喘疾病在世界范围内的蔓延，在临床工作中对哮喘疾病规范化的防治成为必然。但事实并非如此，多数患者并没有能够接受到规范化管理，造成目前哮喘控制情况不佳，给患者和社会带来了极大的心理和经济负担。本课题通过对去年来我院就诊的哮喘患者的问卷调查，了解我院哮喘患者的控制现状，为哮喘人群防治提供更好的依据。 方法：选取84例哮喘患者，均于2013年1月至2013年3月在大连医科大学附属第二医院（简称大医二院）呼吸内科门诊和哮喘门诊就诊，且全部符合2011年GINA指南和2008年中国哮喘防治指南制定的支气管哮喘诊断标准。由大医二院的呼吸门诊及哮喘门诊医生采用面对面问卷调查形式，运用通俗易懂的语言进行描述，调查患者的哮喘控制情况和哮喘发作情况等。问卷内容包括：1.患者基本资料：姓名、性别、年龄和病程等。2.哮喘的基本情况：过去1年内门诊随诊和治疗的情况等。3.哮喘控制情况：包括两种标准：（1）按照2011年全球哮喘防治创议(Global Initiative forAsthma，GINA)制定的哮喘控制水平的方法；（2）哮喘控制测试（ACT）评分。4.哮喘发作情况：包括过去3个月内呼吸道感染情况和哮喘发作的次数，过去1年中因哮喘急性发作而急诊就医和住院的情况等。进行问卷调查时，问卷内容不得空缺，共完成84份调查。采用SPSS17.0软件进行统计分析，P＜0.05为差异有统计学意义。 结果：1.临床控制水平：（1）按照2011年GINA指南制定的哮喘控制水平分级达到控制水平，哮喘门诊组为43.1%明显优于呼吸门诊组的18.2%（χ2=5.615，P＜0.05），但低于2011年我院经过规范化教育和治疗的管理组患者（62.8%）。（2）按照ACT评分达到良好控制以上（ACT评分≥20分），哮喘门诊组为51%明显优于呼吸门诊组的21.2%（χ2=7.444，P＜0.05），但低于我院经过规范化教育和治疗的管理组患者（74.4%）。 2.吸入型糖皮质激素（ICS）治疗与呼吸道感染：将患者分成激素规范治疗组和未规范治疗组。规范治疗组是指持续3个月以上规范应用ICS或ICS+长效β2受体激动剂（LABA）治疗；未规范组指没有应用ICS或ICS+LABA治疗，或虽然应用，但未达到3个月疗程。84个患者中，规范治疗组30人（35.7%），未规范组54人（64.3%）。3个月内呼吸道感染的情况，规范治疗组为66.7%，未规范治疗组55.6%（χ2=0.988，P=0.361），两组统计学没有明显差异。 3.哮喘控制水平与呼吸道感染：按照2011年GINA指南制定的哮喘控制水平分级，84人中达到控制的患者（控制组）28人，未达到控制的患者（未控制组）56人，发生呼吸道感染的情况，控制组为32.1%，未控制组为58.9%，（χ2=5.357，P=0.036），控制组明显低于未控制组。 4.哮喘控制水平与急诊和住院情况：按照2011年GINA指南制定的哮喘控制水平分级达到控制的患者（控制组）28人，未达到控制的患者（未控制组）56人，过去12个月中有急诊和住院的患者控制组为7.1%；未控制组为26.8%（χ2=4.462，P=0.044），控制组明显低于未控制组。 5.依从性与哮喘控制水平：84个哮喘患者中，依从性差的患者（12个月内门诊就诊的次数≤1次）35人，依从性好的患者（12个月之内门诊就诊的次数≥2次）49人。依从性差的患者哮喘控制率为14.3%，依从性好的患者哮喘控制率为46.9%（χ2=9.796，，P=0.002），依从性好的患者哮喘控制的比率明显高于依从性差的患者。 结论：规范化管理可以提高哮喘患者的控制水平和治疗的依从性，从而减少患者的呼吸道感染和急性发作的几率。规范化地使用ICS治疗哮喘并不增加呼吸道感染的风险。
[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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