儿童哮喘规范化管理及治疗

支气管哮喘是儿童最常见的慢性呼吸道疾病之一，严重影响患儿生活质量，世界卫生组织在中国召开“全球哮喘防治战略”国际研讨会，推广哮喘的规范化诊断及治疗。我院儿科对门诊及住院的哮喘患儿进行分级管理、规范化治疗，取得了一定成绩，现报告如下。     

规范化治疗儿童哮喘的临床观察

支气管哮喘(下简称哮喘)是危害儿童身心健康的慢性呼吸道疾病,正规MDI吸入糖皮质激素是控制哮喘发作的重要手段。为观察哮喘患儿正规吸入糖皮质激素前后有症状日,经济支出情况及测定呼气峰流速达预计值情况变化,作者对63例确诊为支气管哮喘的患儿进行规范化治疗并进行随访。     

哮喘规范化治疗179例分析

目的:评价哮喘规范化治疗及院外教育在临床应用的价值。方法:对179例患者均采用严格规范化药物治疗,建立个人病档,专科医生管理,定期肺功能检查,示教吸入方法。成立“哮喘之家”,采用门诊、电话、书信咨询、定期宣传哮喘基本知识、设立哮喘日记并随诊2年以上。结果:按第一届全国哮喘会议制定疗程标准,临床控制33.50%,显效40.68%,好转22.83%,无效2.43%,死亡0.56%,取得较好的临床效果。结论:强调规范化药物治疗和院外管理教育,可避免哮喘病人因漏诊、误诊或缺乏系统治疗导致病程迁延难愈、易复发的恶性循环。其中加强对哮喘患者院外管理,使患者对治疗原则、计划方案充分理解,提高患者用药适应性,是防治哮喘的关键。     

儿童哮喘门诊规范化管理的实践

目的 开展儿童哮喘门诊规范化管理实践并探讨其效果。方法 采用方便抽样法,选取2016年12月-2017年2月在上海市某三级曱等儿童医院哮喘门诊就诊的哮喘患儿173例为研究对象,成立哮喘门诊规范化管理团队,干预措施包括流程优化、患儿档案建立、专业评估、规范诊疗、个性化的健康教育和干预措施的实施、示教药物吸入治疗、实时疾病监控、运用信息技术为哮喘患儿提供专业哮喘管理服务。结果 干预6个月后,173例患儿的儿童哮喘测试问卷评分由（19.24±3.49)分提升至（24.25±2.47)分;完全控制哮喘的患儿由61.8%上升到78.6%,未控制哮喘的患儿由11%下降至6.4% ;生存质量评分由（69.92±13.56)分上升至（76.37±9.44)分;医疗支出由[2519.04 (750.00,3750.00)]元/半年降低到[1338.00(643.75,1 718.75)]元/半年,差异均具有统计学意义（p<0.05)。结论 哮喘门诊规范化管理能有效提高哮喘患儿及家长的哮喘管理意识、知识和技术,在提高哮喘控制水平和生存质量的 同时,降低医疗支出,缓解家庭的经济压力。     

基层医院支气管哮喘规范化治疗的推广

支气管哮喘(简称哮喘)是当今世界最常见的慢性疾病之一，随着哮喘气道慢性炎症学说的提出，哮喘病的治疗和管理发生了根本性变化。而在儿童和老年中，诊断不明确和治疗不彻底的现象在我国，特别是边远及少数民族地区仍十分严重，本院所处怀化，属经济欠发达地区。同样存在此问题。     

儿童哮喘防治形式的探讨

哮喘是儿童常见的慢性呼吸道过敏性疾病 ,严重影响儿童的身心健康 ,哮喘的现代治疗强调“预防胜于治疗”。有关哮喘基本知识的宣传教育是哮喘预防、护理的重要措施之一。哮喘儿童的夏令营活动为这种预防措施的实施提供了机会。其主要内容包括 :普及哮喘基本知识的教育 ;适度的体育锻炼能增强体质 ;加强哮喘儿童的自我管理意识 ;哮喘的家庭防护意识 ;开展多种形式的健康娱乐活动等。为长期有效的控制哮喘奠定良好的基础 ,使患儿及家长树立起战胜疾病的信心。 1年随访表明 ,绝大部分患儿均得到良好的控制。哮喘夏令营能融治疗、预防、锻炼、自我管理于一体 ,对哮喘防治、护理探索了一条新的途径 ,也是医学护理模式改变的一次有效的尝试。     

儿童哮喘防治形式的探讨

哮喘是儿童常见的慢性呼吸道过敏性疾病,严重影响儿童的身心健康,哮喘的现代治疗强调"预防胜于治疗".有关哮喘基本知识的宣传教育是哮喘预防、护理的重要措施之一.哮喘儿童的夏令营活动为这种预防措施的实施提供了机会.其主要内容包括:普及哮喘基本知识的教育;适度的体育锻炼能增强体质;加强哮喘儿童的自我管理意识;哮喘的家庭防护意识;开展多种形式的健康娱乐活动等.为长期有效的控制哮喘奠定良好的基础,使患儿及家长树立起战胜疾病的信心.1年随访表明,绝大部分患儿均得到良好的控制.哮喘夏令营能融治疗、预防、锻炼、自我管理于一体,对哮喘防治、护理探索了一条新的途径,也是医学护理模式改变的一次有效的尝试.     

规范化治疗对哮喘患儿生活质量的影响

小儿支气管哮喘的长期反复发作对患儿的生活质量产生不容忽视的影响,对哮喘治疗的目的已不再局限于病情发作时的控制和症状的缓解,而是要在尽量控制发作的同时尽可能提高生活质量.正规抗哮喘药物的应用是控制哮喘发作的重要治疗措施.为了解正规治疗对哮喘患儿生活质量的影响,作者采用儿童哮喘患者生活质量调查问券(PAQLQ)作了一次调查,结果报告如下.     

哮喘控制测试在儿童哮喘中的应用研究

目的:探讨哮喘控制测试量表在儿童临床工作中应用的可行性。方法:对65名儿童支气管哮喘患者按GINA治疗规范于治疗初期、1个月、3个月时测定FEV1%、PEF%并同时填写哮喘控制测试量表(12岁以上)或儿童哮喘控制测试量表(4～11岁),并以FEV1%和PEF%数据分组进行统计学处理,比较儿童哮喘控制测试与FEV1%和PEF%的趋同性和一致性,分析儿童哮喘控制测试与FEV1%和PEF%的相关程度和可信度检验。结果:儿童哮喘控制测试和FEV1%、PEF%具有良好的趋同性和一致性(P<0.01),具有明显相关性,且儿童哮喘控制测试与PEF%的相关性较FEV1%相关性高。结论:儿童哮喘控制测试完全可应用于儿童临床工作中,可与肺功能监测联合应用,并可在基层无肺功能医疗机构单独应用于评价哮喘状况。     

Exercise for preventing childhood obesity

Childhood obesity is a key public health issue in the United States and around the globe in developed and developing countries. Obese children are at increased risk of acute medical illnesses and chronic diseases-in particular, osteoarthritis, diabetes mellitus, and cardiovascular disease, which can lead to poor quality of life; increased personal and financial burden to individuals, families, and society; and shortened lifespan. Physical inactivity and sedentary lifestyle are associated with being overweight in children and adults. Thus it is imperative to consider exercise and physical activity as a means to prevent and combat the childhood obesity epidemic. Familiarity with definitions of weight status in children and health outcomes like metabolic syndrome is crucial in understanding the literature on childhood obesity. Exercise and physical activity play a role in weight from the prenatal through adolescent time frame. A child's family and community impact access to adequate physical activity, and further study of these upstream issues is warranted. Recommended levels of physical activity for childhood obesity prevention are being developed.     

Differences between adult and childhood asthma

During the last 2 decades, we have gained new insights into the pathogenesis of asthma; consequently, new therapeutic agents and approaches to therapy have emerged. Nevertheless, significant gaps remain in our understanding of this disease. Important new treatment issues affect childhood (the usual time of asthma onset), and researchers have recently described increases in asthma incidence in children. Yet, most clinical studies have been performed with adults, and our knowledge about major determinants of childhood asthma remains incomplete. Major challenges in pediatric asthma include methods of easily assessing lung function and noninvasive methods of assessing asthma's inflammatory nature. Research that addresses the mechanisms responsible for disease onset is also critical to decrease the prevalence of asthma. What we know about adult asthma cannot be used in the treatment of children without further study, but it is now clear that effective treatment should begin during childhood. (J Allergy Clin Immunol 2000;106:S153-7.)     

Acute asthma attacks in childhood

The diagnosis of an acute asthmatic attack in a child is made on a clinical basis. The severity of the exacerbation can be assessed by physical examination and measurement of the transcutaneous oxygenation saturation. A blood gas analysis can be helpful in this assessment. A child with a severe asthma exacerbation should be promptly referred to an emergency department of a hospital. Oxygen should be given to keep the oxygen saturation above 92% and short-acting, selective beta-2 agonists should be administered. Beta-2 agonists can be delivered by intermittent nebulization, continuous nebulization or by metered dose inhaler (MDI) with a spacer They can also be given intravenously in patients who are unresponsive to escalating therapy. The early administration of systemic corticosteroids is essential for the management of acute asthma in children. When tolerated, systemic corticoseroids can be given orally but inhaled corticosteroids are not recommended. Oxygen delivery, beta-2 agonists and steroid therapy are the mainstay of emergency treatment. Hypovolemia should be corrected either intravenously or orally. Administration of multiple doses of ipratropium bromide has been shown to decrease the hospitalization rate in children and adolescents with severe asthma. Clinical response to initial treatment is the main criterion for hospital admission. Patients with failure to respond to treatment should be transferred to an intensive care unit. A critical aspect of management of the acute asthma attack in a child is the prevention of similar attacks in the future.