Weinstein A G, Faust D S, McKee L, Padman R
Department of Pediatrics, Alfred I. duPont Institute, Wilmington, Del. 19899.
J Allergy Clin Immunol. 1992 Jul;90(1):66-75. doi: 10.1016/s0091-6749(06)80012-6.
This study presents results of a family-centered, short-term residential program in which medical, behavioral, and treatment assessments were provided to the child with severe asthma and the family. After a median stay of 15 days, forty-four consecutively admitted children with severe asthma achieved a 93% reduction in hospital days (median, 7 hospital days for the year before treatment versus median 0 hospital days per patient per year at 20 1/2-month follow-up; p less than 0.001) and an 81% reduction in emergency care (median, 4 visits for the year previously versus median, 0.4 visits per patient per year at follow-up; p less than 0.01). There was also a significant reduction in corticosteroid bursts and improvement in FEV1. Unique to this program was mandatory family participation focusing on the child's and family's adaptation to severe asthma and development of family-specific interventions to promote compliance with the treatment regimen. Child and family functioning was assessed at admission and follow-up. Hospital use at follow-up was greater for children from dysfunctional families. Families demonstrating difficulties in disciplining the child with asthma required more hospital days both before admission and at follow-up. Short-term hospitalization for children with severe asthma is associated with significant improvement in pulmonary morbidity when the family of the child is included in assessment and treatment.
本研究展示了一个以家庭为中心的短期住院项目的结果，该项目为患有重度哮喘的儿童及其家庭提供医疗、行为和治疗评估。在平均住院15天后，连续收治的44名重度哮喘儿童的住院天数减少了93%（治疗前一年的中位数为7个住院日，而在20个半月的随访中，每位患者每年的中位数为0个住院日；p<0.001），急诊护理减少了81%（之前一年的中位数为4次就诊，随访时每位患者每年的中位数为0.4次就诊；p<0.01）。皮质类固醇突击治疗也显著减少，第一秒用力呼气量有所改善。该项目的独特之处在于强制家庭参与，重点是儿童及其家庭对重度哮喘的适应，以及制定针对家庭的干预措施以促进对治疗方案的依从性。在入院时和随访时对儿童及家庭功能进行了评估。功能失调家庭的儿童在随访时的住院使用率更高。在管教患有哮喘的儿童方面存在困难的家庭，在入院前和随访时都需要更多的住院天数。当将患有重度哮喘儿童的家庭纳入评估和治疗时，短期住院与肺部发病率的显著改善相关。
