van Koolwijk L M E, Uiterwaal C S P M, van der Laag J, Hoekstra J H, Gulmans V A M, van der Ent C K
University Medical Centre Utrecht, Department of Paediatric Pulmonology, The Netherlands.
Acta Paediatr. 2002;91(9):972-7; discussion 894-5. doi: 10.1080/080352502760272687.
Owing to a lack of longitudinal studies, the effect of centralization of care on pulmonary function and survival remains unclear. Three different levels of involvement of centralized care in the treatment of paediatric cystic fibrosis patients were compared with regard to longitudinal pulmonary function and nutritional and microbiological status in a 3-y period, and the literature was reviewed on the possible advantages and disadvantages of centralized care. The study included 105 paediatric patients attending the Cystic Fibrosis Centre between January 1997 and January 2001. Twenty-three patients were treated by local paediatricians according to the protocol of the Centre and were seen only once a year at the Centre, for an annual check-up (local care). Forty-one patients were treated at the Centre only (centralized care). The remaining 41 patients were treated in close cooperation between the Centre and local hospitals, with patients visiting the doctors alternately (shared care). The mean annual changes in pulmonary function and body mass index from all patients, as well as a microbiological survey, were reviewed. No significant differences were found between the three groups for annual changes in FEV1, FVC and body mass index, nor did the review of microbial colonization show any significant differences between the groups. Because the groups in this study were relatively small, the results might have been influenced by lack of power.
In this relatively small group, no differences in pulmonary function, nutritional status or microbiological colonization between the three levels of involvement of centralized care could be found. This could signify that local paediatricians have a special role in the care for patients with cystic fibrosis, in close cooperation with the specialists at the Centre.
由于缺乏纵向研究，集中式护理对肺功能和生存率的影响仍不明确。在3年期间，比较了集中式护理在小儿囊性纤维化患者治疗中的三种不同参与水平对纵向肺功能、营养和微生物状况的影响，并对集中式护理可能的优缺点进行了文献综述。该研究纳入了1997年1月至2001年1月期间在囊性纤维化中心就诊的105例儿科患者。23例患者由当地儿科医生按照中心的方案进行治疗，每年仅在中心接受一次年度检查（当地护理）。41例患者仅在中心接受治疗（集中式护理）。其余41例患者在中心与当地医院密切合作下接受治疗，患者交替就诊于医生（共享护理）。回顾了所有患者肺功能和体重指数的年均变化以及微生物学调查情况。三组在第一秒用力呼气容积（FEV1）、用力肺活量（FVC）和体重指数的年均变化方面未发现显著差异，微生物定植情况的回顾也未显示组间有任何显著差异。由于本研究中的组相对较小，结果可能受到检验效能不足的影响。
在这个相对较小的组中，未发现集中式护理的三种参与水平在肺功能、营养状况或微生物定植方面存在差异。这可能意味着当地儿科医生在与中心专家密切合作下，在囊性纤维化患者的护理中发挥着特殊作用。
