Strunk R C, Fukuhara J T, LaBrecque J F, Mrazek D A
Department of Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, Denver, Colo.
J Allergy Clin Immunol. 1989 Jan;83(1):17-25. doi: 10.1016/0091-6749(89)90473-9.
Children whose asthma continues to be poorly controlled with outpatient management are often referred to a long-term hospital program for care. Although these programs have been in existence since the 1950s, there has been no systematic study of their effectiveness. The purpose of the present study was to determine outcome in 103 children discharged consecutively after a long-term hospitalization. These children had both severe asthma and significant psychologic problems. Eighty-three of the 103 children had required continuous or frequent intermittent steroids for asthma control. In the year before admission, they had been hospitalized for asthma a mean of 2.6 times for 11.8 days and had had 4.6 visits to emergency rooms and 6.6 visits to physician offices for acute wheezing. Use of medical resources for asthma decreased significantly in the year after long-term hospitalization compared to the year before hospitalization (hospitalization: -34%, p less than 0.0001; hospital days: -39%, p less than 0.0002; emergency room visits: -46%, p less than 0.00001; physician office visits for acute asthma, -42%; p less than 0.00001; and a composite score giving increasing weight to more intensive and costly care: -30%, p less than 0.0001). Long-term hospitalization for children with asthma not responsive to outpatient management is associated with improvement in their use of medical resources.
哮喘门诊治疗控制不佳的儿童常常被转诊至长期住院治疗项目。尽管这些项目自20世纪50年代就已存在，但尚未对其有效性进行系统研究。本研究旨在确定103名长期住院后连续出院的儿童的治疗结果。这些儿童患有重度哮喘且存在严重心理问题。103名儿童中有83名需要持续或频繁间歇性使用类固醇来控制哮喘。入院前一年，他们因哮喘平均住院2.6次，共11.8天，因急性喘息到急诊室就诊4.6次，到医生办公室就诊6.6次。与住院前一年相比，长期住院后一年哮喘医疗资源的使用显著减少（住院次数：-34%，p<0.0001；住院天数：-39%，p<0.0002；急诊室就诊次数：-46%，p<0.00001；急性哮喘到医生办公室就诊次数：-42%，p<0.00001；一个对更强化和昂贵治疗给予更大权重的综合评分：-30%，p<0.0001）。对门诊治疗无反应的哮喘儿童长期住院与医疗资源使用的改善相关。
