上海地区儿童哮喘急性发作诱因分析及哮喘患者教育  

Inducing factors of childhood asthma exacerbation in Shanghai and asthma education

作　　者：孙静怡 房定珠[1] 华丽[1] 张建华 张军[2] SUN Jingyi;FANG Dingzhu;HUA Li;ZHANG Jianhua;ZHANG Jun(Department of Pediatric Pulmonology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院小儿呼吸内科,中国上海200092 [2]教育部和上海市环境与儿童健康重点实验室,中国上海200092

出　　处：《教育生物学杂志》2019年第4期213-219,共7页Journal of Bio-education

基　　金：国家自然科学基金重点项目(81530086)

摘　　要：目的通过大样本横断面调查描述儿童哮喘急性发作的诱因和临床特点,探讨不同年龄、性别、合并过敏性疾病情况等因素对哮喘急性发作的影响,为儿童哮喘诱因早期识别和个体化患者教育提供依据。方法对2015年6月—2016年1月在上海交通大学医学院附属新华医院门诊就诊的12岁及以下哮喘儿童进行横断面调查。儿童哮喘的诊断标准依照全球哮喘防治创议(Global Initiative for Asthma,GINA)。对哮喘儿童的人口学特征、哮喘急性发作的诱发因素、个人及家族过敏性疾病进行描述分析。进行多因素Logistic回归分析计算比值比(odds ratio,OR),探究哮喘发作诱因与年龄、性别、过敏情况等之间的关系。利用研究结果对门诊初诊的哮喘患儿家长进行个体化宣教,统计初诊4周后的复诊情况。结果研究共纳入了515名哮喘儿童。呼吸道感染(89.9%)是最常见的诱发儿童哮喘急性发作的诱发因素,其他常见原因还有接触屋尘(47.2%)、接触特殊食物(29.9%)、接触冷空气(28.7%)、接触花粉(15.5%)、运动(11.7%)、接触化学气味(8.9%)等。男孩接触花粉诱发的哮喘急性发作的比例相对女孩更高。年长哮喘儿童(≥6岁)更倾向于因吸入性因素(如屋尘、花粉)诱发哮喘急性发作,运动诱发哮喘的比例也高于年幼儿童(<6岁)。有特应性皮炎(OR=5.046,95%CI:2.550~9.986)、食物过敏(OR=4.386,95%CI:1.922~10.011)、药物过敏(OR=2.721,95%CI:1.284~5.766)的哮喘患儿更易因接触特殊化学气味诱发哮喘的急性发作。合并过敏性鼻炎的哮喘患儿因接触屋尘诱发哮喘急性发作的可能性更高(OR=2.591,95%CI:1.594~4.213)。家长接受了个体化哮喘教育的患儿4周后复诊率为98.0%。结论呼吸道感染是最常见的儿童哮喘急性发作诱发因素。不同年龄、性别、合并过敏性疾病情况哮喘患儿的诱因分布存在差异。针对哮喘患儿的临床特点进行个体化宣教有助�Objective To describe the inducing factors and clinical characteristics of childhood asthma exacerbation by conducting a large hospital-based cross-sectional survey,and explore the effects of age,gender,and history of allergic diseases on these inducing factors in order to provide evidence for early identification of inducing factors of childhood asthma exacerbation and individualized patient education.Methods This cross-sectional study was conducted in the Department of Pediatric Pulmonology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,from June 2015 to January 2016.The subjects were children aged 12 years and younger with a diagnosed asthma by pediatricians according to the definition of the Global Initiative for Asthma(GINA).The demographic characteristics,inducing factors of asthma exacerbation,and individual and family history of allergic diseases of these children were described and analyzed.Multiple logistic regressions were used to estimate the odds ratios(ORs).Results of this study were applied to individualized asthma education to the caregivers of asthmatic children who attended the outpatient department for the first time.The attendance of scheduled follow-up for four weeks was evaluated.Results A total of 515 asthmatic children were included in this study.Respiratory tract infection was the most common inducing factor of childhood asthma exacerbation(89.9%),followed by house dust(47.2%),food(29.9%),cold air(28.7%),pollen(15.5%),exercise(11.7%),and chemical odors(8.9%).Boys had a higher proportion of pollen-induced asthma exacerbation compared to girls.School-age children(6 years and older)were more vulnerable to inhaled factors such as house dust and pollen compared to younger children.The proportion of exercise-induced asthma in school-age children was also higher than that of younger children.Asthmatic children with atopic dermatitis(OR=5.046,95%CI:2.550-9.986),food allergy(OR=4.386,95%CI:1.922-10.011),and drug allergy(OR=2.721,95%CI:1.284-5.766)were more likely to have asthma a

关 键 词：儿童哮喘 哮喘急性发作 诱发因素 横断面调查 患者教育 

分 类 号：R72[医药卫生—儿科]