以實證為基礎的兒童氣喘急性發作之照護處理

Evidence-Based Management of Acute Asthma Exacerbation in Children

氣喘是台灣兒童常見的慢性疾病，急性發作常是氣喘兒童與父母最大的懼怕來源，也是兒科醫護人員在照護上的挑戰。本文回顧兒童氣喘急性發作之評估與處理的相關資訊，依據美國氣喘教育與預防計（National Asthma Education andPrevention Program, 2007）及參考全球氣喘創議組（Global Initiative for Asthma [GINA], 2010）所發展的氣喘指引建議，運用敏感度佳的氣喘嚴重度評估工具，並依據不同嚴重度所建議使用之氣喘藥物，將可降低兒童急診與住院次數。目前最常建議使用的氣喘急性發作用藥為速效型支氣管擴張劑合併系統性類固醇用藥，其他氣喘藥物仍需更多兒童族群之相關研究證實。教育父母自我處理，特別是給孩子正確的氣喘藥物是最重要影響氣喘復發急診之因素。有關兒童氣喘急性發作時兒童與父母的護理研究仍在質性研究之階段，待更多建立實證基礎之研究，才能發揮兒科護理人員在氣喘兒童的急性照護之獨立角色功能。

Asthma is a common chronic disease among children in Taiwan. Acute asthma exacerbation is a cause of strong concern for children and parents and represents a challenge for pediatric healthcare providers. This review summarizes the most up-to-date information on assessing and managing acute asthma exacerbations in children. The latest guidelines (National Asthma Education and Prevention Program, Expert Panel Report 3, 2007 and the Global Initiative for Asthma, 2010) recommend using sensitive instruments to assess asthma exacerbation severity and administering early treatment in order to avoid emergency outpatient visits and hospitalizations. SABA (short acting β-agonist) in combination with systematic cortisone is the most widely prescribed pharmaceutical intervention for acute asthma management. Other pediatric asthma medications are still in the trial stage. Educating parents on self-management techniques, especially with regard to the correct application of asthma medication on children, is crucial to reducing relapse incidents and visits to the emergency ward. Nursing studies addressing the issue of asthma exacerbation in children and parents are currently at the initial, qualitative stage. More evidence-based studies are necessary to explore and understand the independent role and function of nurses in acute pediatric asthma care.