摘要
目的了解我国不同地区、不同级别医院呼吸科医生对门诊慢性阻塞性肺疾病(慢阻肺)急性加重相关知识的认知情况及管理现状,为进一步提高全体呼吸科医生对慢阻肺急性加重风险管理能力提供依据。方法本调研为现况调查,采用多阶段分层随机抽样方法,于2022年9-12月对全国29个省、自治区和直辖市的57家二级医院和63家三级医院(综合医院或呼吸专科医院)的800位主治及以上职称的呼吸科医生进行线上问卷调研,问卷内容包括医生基本信息、慢阻肺急性加重相关知识认知和模拟病例诊疗判别。结果共发放问卷800份,实际回收794份,其中有效问卷697份(信息填写不完整或未在规定时间内完成的为不合格问卷),有效率为87.8%(697/794)。有效问卷中,以秦岭淮河一线为界,南、北部调研对象分布相当[53.9%(376/697),46.1%(321/697)],三级医院医生占比略高于二级医院[58.2%(406/697),41.8%(291/697)],主任医师、副主任医师与主治医师占比分别为29.6%(206/697)、31.9%(222/697)、38.6%(269/697)。在对慢阻肺急性加重认知方面,93.3%(650/697)的临床医生常规进行症状评估,仅62.8%(438/697)会询问患者1年内急性加重病史情况,相比于南部地区,北部地区询问率较高[66.9%(214/320)比59.4%(224/377),χ^(2)=8.96,P=0.030]。既往1年≥2次中度急性加重病史(74.7%,521/697)和既往1年≥1次重度急性加重病史(68.6%,478/697)是临床医生普遍认可的判断未来急性加重风险的重要因素。临床医生推荐或建议使用含糖皮质激素吸入药物的主要因素为合并支气管哮喘(哮喘)或具备哮喘特征(92.1%,642/697)、有重度急性加重病史(88.7%,618/697)和外周血嗜酸性粒细胞计数≥300个/μl占(88.5%,617/697)。考虑给予三联吸入药物作为初始治疗的主要因素为肺功能重度或极重度受损(77.0%,537/697)和有哮喘病史或哮喘特征(66.4%,463/697)。模拟病例调研结果显示,二级医院�
Objective To explore the pulmonary physicians′knowledge about and management of acute exacerbation of chronic obstructive pulmonary disease(COPD)in hospitals of different levels in different areas of China,so as to provide basis for further improving all respiratory physicians′ability to manage the risks of acute exacerbation of COPD.Methods This study was a status quo investigation.Multi-stage stratified random sampling method was adopted to conduct an online questionnaire survey in 800 attending and above level respiratory doctors in 57 secondary hospitals and 63 tertiary hospitals(including general hospitals or specialized respiratory hospitals)in 29 provinces,autonomous regions,and municipalities across China from September 2022 to December 2022.The questionnaire content includes basic information of the physicians and physicians′knowledge of pulmonary acute exacerbation and diagnosis and treatment of simulated cases.Results Of 800 questionnaires given out,794 were answered.A total of 697 were valid after ruling out the unqualified ones(due to incomplete information),yielding a validity rate of 87.8%(697/794).In the valid questionnaire,the line of Qinling Mountains and Huaihe River was taken as the division,and the survey subjects in the south and north were equally distributed(53.9%[376/697]vs 46.1%[321/697]).The proportion of doctors in tertiary hospitals was slightly higher than that in secondary hospitals(58.2%[406/697]vs 41.8%[291/697]).The proportion of chief physicians,deputy chief physicians,and attending physicians was 29.6%(206/697),31.9%(222/697),and 38.6%(269/697),respectively.In terms of perception of COPDs,93.3%(650/697)clinicians routinely evaluated symptoms,but only 62.8%(438/697)asked patients about the history of acute exacerbations within 1 year,which was higher in the northern region than in the southern region(66.9%[214/320]vs 59.4%[224/377],χ^(2)=8.96,P=0.030).A history of≥2 moderate acute exacerbations in the past 1 year(74.7%,521/697)and a history of≥1 severe acute exacerbat
作者
门诊慢性阻塞性肺疾病急性加重识别调研协助专家组
陈荣昌
The Expert Group in the Identification of Acute Exacerbations of Chronic Obstructive Pulmonary Disease in Outpatient Clinic;Chen Rongchang(不详;Department of Respiratory and Critical Care Medicine,Shenzhen People′s Hospital,Shenzhen 518020,China)
出处
《国际呼吸杂志》
2024年第4期397-404,共8页
International Journal of Respiration
基金
国家自然科学基金面上项目(82170042)。
关键词
肺疾病
慢性阻塞性
急性加重
诊疗观念
Pulmonary disease,chronic obstructive
Acute exacerbation
Perception of diagnosis and treatment
