探讨强化家庭干预对改善长期鼻饲致胃食管反流诱发支气管哮喘急性发作的效果。

选取2010年1月至2014年1月山东省荣成市人民医院收治的49例有哮喘病史留置胃管时间1个月以上，且由于胃食管反流刺激出现1次以上哮喘急性发作而需要社区医疗救助的患者，其中观察组24例（3例退出），对照组25例（1例退出）。由社区医护人员组成家庭管理小组，以集中培训、电话随访、家庭访视等形式，对观察组患者及其家属进行教育、培训、指导、督导；对照组按照社区医疗服务常规电话随访1次/月，家庭访视1次/6个月。干预结束后，对两组患者的反流症状评分、哮喘用药方式、哮喘控制情况及照顾者负担评分进行比较分析。两组间反流症状及照顾者负担评分的比较采用t检验，主要给药方式的比较采用χ²检验，症状控制情况的比较采用秩和检验。

经1年的强化家庭干预，观察组患者胃食管反流评分明显低于对照组（2.7±0.4，3.5±0.8；t=4.15，P<0.01）；观察组控制哮喘的主要用药方式为粉剂吸入和雾化吸入，对照组主要为口服；观察组哮喘控制水平明显优于对照组（观察组控制、部分控制、未控制分别为7、14、0例，对照组分别为0、14、10例；r=16.93，P<0.01）；观察组家庭照顾者个人负担、角色负担、总负担评分均明显优于对照组（27.9±6.4、10.2±3.4、38.9±5.1，32.6±5.1、12.7±4.1、43.2±7.4；t=2.74、2.22、2.24，P<0.05或0.01）。

强化家庭干预能提高家庭照顾者的照顾和管理能力，减轻患者胃食管反流症状，减少患者哮喘急性发作次数，明显减轻家庭照顾者负担。

To investigate the effect of family intervention on acute attack of bronchial asthma induced by gastroesophageal reflux which caused by long-term nasal feeding.

Patients hospitalized in the People’s Hospital of Rongcheng city From January 2010 to January 2014 with acute asthma attacks and indwelling gastric tube 1 month above, and who need to continue intervention in community were chosen. Forty-nine patients were divided into two groups, the observation groups (n=21) and control groups (n=24).The family intervention group was established by community health care workers, they gave the observation group gather-training, telephone follow-up, family visit and so on. The control group received routine telephone follow-up of once a month and family visit once 6 months. After 12 months of intervention, the scores of symptom of gastroesophageal reflux, methods for application of asthma, controlling situation of asthma and caregiver burden were compared between the two groups. T test was used to compare the scores between symptom of gastroesophageal reflux and caregiver burden, chi-square test was used to compare the methods for application of asthma, rank sum test was used to compare controlling situation of asthma between two groups.

After 1 years of intervention, the scores of symptoms of gastroesophageal reflux in the observation group was significantly lower than the control group (2.7±0.4, 3.5±0.8. t=4.15,P<0.01). Methods for application of asthma in observation group were powder inhalation and atomization inhalation, and the control group was mainly oral. It turns out that the observation group was significantly better than the control group (χ²=16.93,P<0.01). In the observation group, the individual burden, the role burden and the total burden of family caregivers were significantly better than those in the control group (27.9±6.4, 10.2±3.4, 38.9±5.1, 32.6±5.1, 12.7±4.1, 43.2±7.4. t=2.74, 2.22, 2.24,P<0.05 or 0.01).

Family intervention can improve the care and management capabilities of family caregivers, alleviate the symptoms of gastroesophageal reflux, reduce the times of patients with acute attacks of asthma, and significantly reduce the burden of family caregivers.