联合诊治模式下变应性鼻炎合并哮喘儿童的疗效观察及满意度调查

发布时间：2018-06-05 10:08

本文选题：变应性鼻炎 + 哮喘　；参考：《福建医科大学》2014年硕士论文

【摘要】：目的观察变应性鼻炎合并哮喘患儿在“儿童鼻炎与哮喘联合门诊”（简称联合门诊）诊治后的临床疗效，调查在该诊治模式下的家长满意度；探讨联合门诊模式的临床意义及社会效应。方法选取2013年9月至2013年12月期间在联合门诊就诊的59例变应性鼻炎合并哮喘的患儿，其就诊前均已在单独耳鼻喉门诊、单独儿科门诊或分别在耳鼻喉门诊和儿科门诊（这三种门诊，简称单科门诊）诊治3个月及以上，疗效不满意；由耳鼻喉科医师和儿科医师在同一诊室共同诊断，并经过商讨后制定规范化、个体化治疗方案。经过3个月的的上下气道共同治疗，比较治疗前后的相关指标进行疗效评价，包括：鼻部及肺部总体症状视觉模拟量表（Visual Analogue Scale，VAS）评分、鼻部症状总分（Total Nasal Symptom Score,TNSS）、肺部症状总分（Total Pulmanory Symptom Score,TPSS）、鼻部及肺部体征及哮喘控制水平分级；对能配合并复查肺功能和/或呼出气一氧化氮（Fractional Concentration of Exhaled Nitric oxide, FeNO）的儿童进行治疗前后比较。对家长行联合门诊和单科门诊的诊治满意度问卷调查，定期复诊患儿采用现场调查，未定期复诊患儿采用电话随访。结果联合诊治后3个月，共有42例患儿定期复诊。与治疗前相比，59例患儿鼻部、肺部总体症状VAS评分有统计学意义（P均＜0.05）；TNSS显效26例，有效17例，总有效率为72.9%；TPSS显效31例，有效14例，总有效率76.3%；哮喘控制水平分级有统计学意义（P＜0.05）。42例复诊的患儿鼻部体征无统计学意义（P＞0.05），肺部体征差异有统计学意义（P＜0.05）；20例复查FeNO的患儿，其值治疗前后差异有统计学意义（P＜0.05）；12例复查肺功能的患儿，其指标FEV1/pre1(1秒用力呼气量占正常预计值百分比，Forced Expiratory Flow in One Second/Predictive Value)及FEF25-75%（用力肺活量的25%-75%的呼气中期流速，Forced Expiratory Flow at25%and75%of the Pulmonary Volume），，治疗前后差异有统计学意义（P均＜0.05）。在预约及现场等待时间、综合费用、就诊环境、鼻部疾病疗效、哮喘疗效、健康教育及答疑解惑及综合满意度方面，患儿家长对联合门诊的满意度优于单科门诊（P均＜0.05）；而在综合费用满意度方面，联合门诊与单科门诊无统计学意义（P＞0.05）。结论由耳鼻喉科医师和儿科医师在同一诊室对变应性鼻炎合并哮喘的患儿进行联合诊治，临床疗效优于单科门诊，其家长对联合诊治的满意度优于单科门诊。该诊治模式是一种高效、方便、优质的医疗模式，临床疗效好、患方满意度高、无明显增加费用，值得推广应用。
[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.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R765.21

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