分级诊疗管理对支气管哮喘患者吸入技术及疾病认知的影响  

Hierarchical management improves disease awareness and treatment adherence of asthmatic patients in the community

作　　者：刘霞 尹凤先[1] 范明鑫[1] 刘亚男 张永祥[1] Liu Xia;Yin Fengxian;Fan Mingxin;Liu Yanan;Zhang Yongxiang(Department of Pulmonary and Critical Care Medicine,Beijing Daxing Distrtct People′s Hospital,Beijing 102600,China)

机构地区：[1]北京市大兴区人民医院呼吸与危重症医学科,102600

出　　处：《中华全科医师杂志》2021年第5期575-580,共6页Chinese Journal of General Practitioners

基　　金：北京市大兴区人民医院科研课题基金(4201814217)。

摘　　要：目的评估分级诊疗管理对支气管哮喘患者吸入技术、认知程度的影响。方法采用简单随机抽样法选取北京市大兴区人民医院2018年1月至2019年11月门诊就诊的187例哮喘患者,用随机数字表法分为社区管理组(管理组,94例)及对照组(93例)。管理组由社区或一级医院医生对患者进行强化教育管理及督导治疗,对照组在我院门诊随访。管理1年,比较两组患者吸入糖皮质激素(ICS)依从性、吸入ICS技术、对疾病的认知情况、哮喘控制(ACT)评分、简略生命质量评分(miniAQLQ)、肺功能、1年内急性加重的次数、出现第1次急性加重距入组时间的差异。结果管理1年后,管理组较对照组吸入ICS依从性好[80.85%(76/94)比51.61%(48/93),χ^(2)=2.834,P=0.02];吸入ICS技术评分[(6.47±1.28)比(4.05±1.37)分,t=2.241,P=0.04]提高,应用吸入ICS各环节正确率比较:吸入药物前呼气[94.68%(89/94)比56.98%(53/93),χ^(2)=4.436,P=0.01]、吸气[90.43%(85/94)比68.82%(64/93),χ^(2)=2.943,P=0.04]、吸气后屏气[89.36%(84/94)比58.06%(54/93),χ^(2)=4.098,P=0.02]、吸入药物后漱口[92.55%(87/94)比65.59%(61/93),χ^(2)=2.876,P=0.04]正确率,管理组均较对照组高;对疾病认知情况比较:正确认知慢性炎性本质[70.21%(66/94)比44.08%(41/93),χ^(2)=2.673,P=0.02],知晓诱发因素[85.10%(80/94)比56.99%(53/93),χ^(2)=2.760,P=0.02],知晓治疗误区[88.29%(83/94)比53.76%(50/93),χ^(2)=4.874,P<0.01],知晓治疗目标[86.17%(81/94)比49.46%(46/93),χ^(2)=4.491,P<0.01],知晓需要长期治疗[90.43%(85/94)比48.38%(45/93),χ^(2)=4.503,P<0.01]方面,管理组均好于对照组;ACT评分[(22.71±2.81)比(19.50±5.34)分,t=2.041,P=0.04]、miniAQLQ评分[(84.28±11.16)比(64.23±14.38)分,t=3.298,P<0.01]均明显升高;1年内管理组急性加重次数[0(0,1)比2(1,3)次,Z=-3.237,P<0.01]较对照组少,第1次急性加重距入组时间[184(96,284)比96(59,177)d,Z=3.873,P<0.01]较对照组增加。结论分级诊疗管理可有效改善支气管哮喘�Objective To evaluate the effectiveness of hierarchical management for patients with bronchial asthma.Methods One hundred and eighty seven patients with bronchial asthma were recruited from January 2018 to November 2019 in Daxing District People′s Hospital.Patients were randomly divided into two groups,94 patients received disease management education and therapeutic guidance from doctors in the community hospital and district hospital(study group),and 93 patients were followed up in outpatient visits only(control group).After one year,the scores of inhalation technique,treatment adherence,disease management awareness,the Asthma Control Test(ACT),the Mini Asthma Quality of Life Questionnaire(MiniAQLQ)and pulmonary function were evaluated and compared between two groups.The annual acute attack times and time to first exacerbation were also compared between the two groups.Results After one year of management the treatment adherence rate in study group was higher than that in control group[80.85%(76/94)vs.51.61%(48/93),χ^(2)=2.834,P=0.02].The scores of inhaled corticosteroids(ICS)inhalation technique[(6.47±1.28)vs.(4.05±1.37),t=2.241,P=0.04],the correct rates of exhaling before ICS inhalation[94.68%(89/94)vs.56.98%(53/93),χ^(2)=4.436,P=0.01],inhalation[90.43%(85/94)vs.68.82%(64/93),χ^(2)=2.943,P=0.04],holding breath after inhalation[89.36%(84/94)vs.58.06%(54/93),χ^(2)=4.098,P=0.02],rinsing mouth after ICS inhalation[92.55%(87/94)vs.65.59%(61/93),χ^(2)=2.876,P=0.04]in study group were higher than those in control group.The awareness rates of chronic inflammatory airway disease[70.21%(66/94)vs.44.08%(41/93),χ^(2)=2.673,P=0.02],causative factors[85.10%(80/94)vs.56.99%(53/93),χ^(2)=2.760,P=0.02],treatment misunderstanding[88.29%(83/94)vs.53.76%(50/93),χ^(2)=4.874,P<0.01],therapeutic goal[86.17%(81/94)vs.49.46%(46/93),χ^(2)=4.491,P<0.01]and requiring long-term treatment[90.43%(85/94)vs.48.38%(45/93),χ^(2)=4.503,P<0.01]in study group were higher than those in control group.The scores of ACT[(22.71±2.81)vs.(

关 键 词：哮喘 社区卫生服务 投药 吸入 生活质量 

分 类 号：R562.25[医药卫生—呼吸系统]