伴和不伴自我管理计划的哮喘教育在住院患儿中的有效性
2010/02/23
背景：初级医疗机构正规宣教能减少哮喘的恶化。但在住院儿童中研究宣教对哮喘影响的研究很少，拉丁美洲更未见报道。
方法：本试验为前瞻性随机试验，旨在研究采用自我管理计划（ESM）的完整宣教在减少哮喘住院上是否优于无自我管理计划（E）的宣教。将5～15岁因哮喘住院的儿童分为2组：E组儿童接受医院常规宣教；ESM组患儿除医院常规宣教外，给予自我管理指导和益智游戏，后者能加强宣教的力度。患者每3个月访谈1次，每年电话随访1次。由访谈者记录哮喘住院次数、哮喘恶化次数、急诊就诊次数和口服糖皮质激素量陡增次数。
结果：88例儿童满足纳入标准。77例患儿（86％）完成了为期1年的随访（E组41例，ESM组36例）。1年后，总体住院率下降66％，糖皮质激素吸入治疗从36％增至79％。研究末，两组之间在恶化次数、急诊就诊次数、口服糖皮质激素量陡增次数和住院次数上未见显著差异。
结论：针对哮喘住院患儿的伴或不伴自我管理计划的哮喘教育能有效降低哮喘恶化、急诊就诊次数、口服糖皮质激素量陡增次数及未来再次住院次数。上述结果表明，对于因哮喘恶化而住院的患儿，有必要对其进行完整的哮喘宣教。
（林江涛 审校）
J Asthma. 2009 Nov;46(9):906-910.
Effectiveness of asthma education with and without a self-management plan in hospitalized children.
Espinoza-Palma T, Zamorano A, Arancibia F, Bustos MF, Silva MJ, Cardenas C, De La Barra P, Puente V, Cerda J, Castro-Rodriguez JA, Prado F.
Background. Formal education in primary care can reduce asthma exacerbations. However, there are few studies in hospitalized children, with none originating in Latin America. Methods. A prospective randomized study was designed to evaluate whether a full education with self-management plan (ESM) was more effective than an education without self-management plan (E) in reducing asthma hospitalization. Children (5 to 15 years of age) who were hospitalized for an asthma attack were divided in two groups. Children in the E group received general instructions based on a booklet. Those in the ESM group received the same booklet plus a self-management guide and a puzzle game that reinforces the lessons learned in the booklet. Patients were interviewed every 3 months, by telephone, for one year. Interviewers recording the number of hospitalizations, exacerbations, and emergency visits for asthma and oral steroid burst uses. Results. From 88 children who met the inclusion criteria, 77 (86%) completed one year of follow-up (41 from E and 36 from ESM group). Overall, after one year, the hospitalization decreased by 66% and the inhaled corticosteroids therapy increased from 36% to 79%. At the end of the study, there was no difference in exacerbations, emergency visits, oral steroid burst uses, or hospitalizations between the two groups. Conclusions. Asthma education with or without a self-management plan during asthma hospitalization were effective in reducing exacerbations, emergency visits, oral steroid burst uses, and future rehospitalizations. This evidence supports the importance of providing a complete asthma education plan in any patient who is admitted for asthma exacerbation.
J Asthma. 2009 Nov;46(9):906-10.
方法：本试验为前瞻性随机试验，旨在研究采用自我管理计划（ESM）的完整宣教在减少哮喘住院上是否优于无自我管理计划（E）的宣教。将5～15岁因哮喘住院的儿童分为2组：E组儿童接受医院常规宣教；ESM组患儿除医院常规宣教外，给予自我管理指导和益智游戏，后者能加强宣教的力度。患者每3个月访谈1次，每年电话随访1次。由访谈者记录哮喘住院次数、哮喘恶化次数、急诊就诊次数和口服糖皮质激素量陡增次数。
结果：88例儿童满足纳入标准。77例患儿（86％）完成了为期1年的随访（E组41例，ESM组36例）。1年后，总体住院率下降66％，糖皮质激素吸入治疗从36％增至79％。研究末，两组之间在恶化次数、急诊就诊次数、口服糖皮质激素量陡增次数和住院次数上未见显著差异。
结论：针对哮喘住院患儿的伴或不伴自我管理计划的哮喘教育能有效降低哮喘恶化、急诊就诊次数、口服糖皮质激素量陡增次数及未来再次住院次数。上述结果表明，对于因哮喘恶化而住院的患儿，有必要对其进行完整的哮喘宣教。
（林江涛 审校）
J Asthma. 2009 Nov;46(9):906-910.
Effectiveness of asthma education with and without a self-management plan in hospitalized children.
Espinoza-Palma T, Zamorano A, Arancibia F, Bustos MF, Silva MJ, Cardenas C, De La Barra P, Puente V, Cerda J, Castro-Rodriguez JA, Prado F.
Background. Formal education in primary care can reduce asthma exacerbations. However, there are few studies in hospitalized children, with none originating in Latin America. Methods. A prospective randomized study was designed to evaluate whether a full education with self-management plan (ESM) was more effective than an education without self-management plan (E) in reducing asthma hospitalization. Children (5 to 15 years of age) who were hospitalized for an asthma attack were divided in two groups. Children in the E group received general instructions based on a booklet. Those in the ESM group received the same booklet plus a self-management guide and a puzzle game that reinforces the lessons learned in the booklet. Patients were interviewed every 3 months, by telephone, for one year. Interviewers recording the number of hospitalizations, exacerbations, and emergency visits for asthma and oral steroid burst uses. Results. From 88 children who met the inclusion criteria, 77 (86%) completed one year of follow-up (41 from E and 36 from ESM group). Overall, after one year, the hospitalization decreased by 66% and the inhaled corticosteroids therapy increased from 36% to 79%. At the end of the study, there was no difference in exacerbations, emergency visits, oral steroid burst uses, or hospitalizations between the two groups. Conclusions. Asthma education with or without a self-management plan during asthma hospitalization were effective in reducing exacerbations, emergency visits, oral steroid burst uses, and future rehospitalizations. This evidence supports the importance of providing a complete asthma education plan in any patient who is admitted for asthma exacerbation.
J Asthma. 2009 Nov;46(9):906-10.
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反复吸入技术的指导课改善哮喘治疗的依从性
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检测患者哮喘知识：结果评价的系统综述
