出院后细菌性脑膜炎儿童综合保健管理模式效果初探  

Preliminary exploration of the effectiveness of comprehensive healthcare management model for children with bacterial meningitis after discharge

作　　者：李世杰 刘钢[2] 张晚霞 胡惠丽[2] 赵明 窦珍珍[2] 纪文静[1] 杜娟[1] 梁爱民[1] Li Shijie;Liu Gang;Zhang Wanxia;Hu Huili;Zhao Ming;Dou Zhenzhen;Ji Wenjing;Du Juan;Liang Aimin(Department of Child Health Care,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Infectious Diseases,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院保健中心,北京100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院感染内科,北京100045

出　　处：《中华健康管理学杂志》2024年第10期761-767,共7页Chinese Journal of Health Management

基　　金：北京市卫生健康委委托项目(2-1-1-1-69)。

摘　　要：目的探索出院后细菌性脑膜炎儿童综合保健管理模式的效果。方法本研究为回顾性队列研究,连续纳入2018年9月至2023年9月自北京儿童医院感染内科病房出院且采用多学科协作综合保健管理模式进行管理的268例细菌性脑膜炎儿童为研究对象,收集其出院后1个月、6个月、12个月及24个月就诊时的门诊资料,包括身长(高)、体重、体重指数、营养喂养情况、听力视力筛查结果、Gesell发育评估结果及干预指导服务情况等,根据儿童情况酌情动态调整随访间隔或增加随访次数。采用配对样本t检验和χ^(2)检验比较首次评估及末次评估时的Gesell发育评估发育商(DQ)及发育迟缓率差异,初步探索出院后细菌性脑膜炎儿童综合保健管理模式的效果。结果268例儿童均在出院后1个月完成首次评估,发现体格生长异常者37例,以肥胖为主(28例),另有9例为营养不良,均给予了营养干预及喂养指导服务,截至末次随访时,有20例儿童体格生长评价转为正常。188例儿童完成≥2次发育评估,首次和末次评估间隔为(14.2±9.4)个月(范围:3.1~49.5个月),末次评估适应性、大运动、精细动作、语言、个人-社交5个能区的DQ值均显著高于首次评估[(91.93±13.28)比(80.73±15.96)分、(91.69±12.96)比(78.31±16.58)分、(89.32±16.11)比(80.68±15.63)分、(90.10±16.65)比(82.04±18.43)分、(92.01±14.05)比(77.82±17.42)分],且各能区发育迟缓率均显著低于首次评估(9.6%比35.1%、9.6%比42.0%、18.1%比33.0%、13.3%比31.9%、9.6%比42.0%)(均P<0.05)。200例完成听力筛查的儿童中,异常者18例,转诊耳鼻喉科后确诊存在听力损失者2例。217例完成视力筛查的儿童中,异常者23例,转诊眼科后明确存在眼科相关异常者5例(斜视2例,屈光不正2例,视神经损伤1例)。2例儿童在监测中发现孤独症样行为,转诊发育行为门诊后确诊孤独症谱系障碍,获得了早期诊断及干预指导。结Objective To explore the effectiveness of the comprehensive healthcare management model for children with bacterial meningitis after discharge.Methods This study was a retrospective cohort study that included 268 children with bacterial meningitis who were discharged from the infectious medicine ward of Beijing Children′s Hospital from September 2018 to September 2023.The children were managed with a multidisciplinary collaborative comprehensive healthcare management model after discharge.Outpatient data at 1 month and 6,12 and 24 months after discharge were collected,including(height),weight,body mass index,nutritional feeding status,hearing and vision screening results,Gesell developmental assessment results and intervention guidance services.The follow-up interval or frequency was dynamically adjusted or increased according to the child′s situation.The paired sample t-test and chi square test were applied to compare the differences in Gesell developmental quotient(DQ)and developmental delay rate between the first and last assessments to preliminarily explore the effectiveness of the comprehensive healthcare management model for children with bacterial meningitis after discharge.Results All the 268 children completed their first assessment one month after discharge,and 37 children were found to have abnormal physical growth,mainly obesity(28 children),and another 9 children were malnutrition.Nutritional intervention and feeding guidance services were provided to all the 37 children,and as of the last follow-up,20 children′s physical growth evaluations had turned normal.A total of 188 children completed at least 2 developmental assessments,with an interval of(14.2±9.4)months between the first and last assessments(range:3.1-49.5 months).The DQ values of in the energy region of adaptability,gross motor skills,fine motor skills,language,and personal social skills at the last assessment were significantly higher than those at the first assessment[(91.93±13.28)vs(80.73±15.96)points,(91.69±12.96)vs(78.31±16

关 键 词：儿童 细菌性脑膜炎 儿童保健服务 特殊健康状态 健康管理 健康促进 

分 类 号：R725.1[医药卫生—儿科]