中国儿科医师对胸闷变异性哮喘的认知和诊治现状调查  

Investigation on cognition,diagnosis and treatment status of chest tightness variant asthma among Chinese pediatricians

作　　者：华雯[1] 殷菊[2] 张敏[1] 黄华琼[1] 陈如冲[3] 应颂敏[4] 陈星 刘瀚旻[6] 尚云晓[7] 农光民[8] 张旻 黄克武[10] 赖克方[3] 刘辉国[11] 申昆玲[2,12] 沈华浩 Hua Wen;Yin Ju;Zhang Min;Huang Huaqiong;Chen Ruchong;Ying Songmin;Chen Xing;Liu Hanmin;Shang Yunxiao;Nong Guangmin;Zhang Min;Huang Kewu;Lai Kefang;Liu Huiguo;Shen Kunling;Shen Huahao(Key Laboratory of Respiratory Disease of Zhejiang Province,Department of Respiratory and Critical Care Medicine,Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Department 1 of Respiratory,Beijing Children′s Hospital,Capital Medical University,China National Clinical Research Center of Respiratory Diseases,National Center for Children′s Health,Beijing 100045,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,National Respiratory Medicine Center,Guangzhou Institute of Respiratory Health,State Key Laboratory of Respiratory Disease,Guangzhou 510120,China;Institute of Respiratory Diseases,Zhejiang University,Hangzhou 310009,China;Department of Pediatric Respiratory,the Affiliated Provincial Hospital of Shandong First Medical University,Jinan 250021,China;Department of Pediatric Pulmonology and Immunology,West China Second University Hospital,Sichuan University,Chengdu 610041,China;Department of Pediatric Respiratory,Shengjing Hospital Affiliated to China Medical University,Shenyang 110004,China;Department of Pediatrics,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Respiratory and Critical Care Medicine,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Department of Respiratory and Critical Care Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Department of Respiratory and Critical Care Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China;Department of Respiratory Diseases,Shenzhen Children′s Hospital,Shenzhen 518038,China)

机构地区：[1]浙江省呼吸疾病诊治及研究重点实验室浙江大学医学院附属第二医院呼吸与危重症医学科,杭州310009 [2]首都医科大学附属北京儿童医院呼吸一科国家呼吸系统疾病临床研究中心国家儿童医学中心,北京100045 [3]广州医科大学附属第一医院呼吸与危重症医学科国家呼吸医学中心广州呼吸健康研究院呼吸疾病全国重点实验室,广州510120 [4]浙江大学呼吸疾病研究所,杭州310009 [5]山东第一医科大学附属省立医院小儿呼吸科,济南250021 [6]四川大学华西第二医院小儿呼吸免疫科,成都610041 [7]中国医科大学附属盛京医院小儿呼吸内科,沈阳110004 [8]广西医科大学第一附属医院儿科,南宁530021 [9]上海交通大学医学院上海第一人民医院呼吸与危重症医学科,上海200080 [10]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京100020 [11]华中科技大学同济医学院附属同济医院呼吸与危重症医学科,武汉430000 [12]深圳市儿童医院呼吸内科,深圳518038

出　　处：《中华医学杂志》2023年第34期2727-2732,共6页National Medical Journal of China

基　　金：浙江大学医学院附属第二医院多中心RCT项目(RCT-2023-006A)

摘　　要：目的评价我国儿科医师对胸闷变异性哮喘(CTVA)的认识和诊疗现状。方法采用方便抽样方法,于2021年1月16日至2月4日,通过微信邀请30个省份不同级别医院的主治医师及以上职称儿科医师进行在线问卷调查,儿科医师通过扫描二维码完成小程序中的电子问卷。问卷内容包括对CTVA的认识、诊断以及治疗情况,并且比较二级医院与三级医院儿科医师相关指标的差异。结果共有1529名儿科医师参与调查,1484(97.06%)名儿科医师完整填写问卷并纳入分析,其中男性420名(28.30%)。儿科医师对CTVA的知晓率为77.83%(1155/1484)。与二级医院的儿科医师相比,三级医院的儿科医师知晓率更高[81.86%(898/1097)比66.41%(257/387),P<0.001],对指南推荐的诊断标准遵循情况更好[89.15%(978/1097)比79.59%(308/387),P<0.001]。共有93.06%(1381/1484)的儿科医师一线处方含吸入性糖皮质激素(ICS)治疗CTVA;和二级医院的儿科医师相比,三级医院儿科医师中使用含ICS方案一线治疗CTVA的比例更高[94.90%(1041/1097)比87.86%(340/387),P<0.001]。CTVA良好控制率为32.08%(476/1484),二级医院低于三级医院[17.31%(67/387)比37.28%(409/1097),P<0.001]。结论大多数儿科医师知晓CTVA。二级医院与三级医院的儿科医师之间在CTVA认识、诊断和治疗等临床实践上存在一定差距。Objective To evaluate the awareness,diagnosis and treatment of chest tightness variant asthma(CTVA)among pediatricians in China.Methods The survey was conducted by convenient sampling method.Pediatricians with professional title of attending physician and above from different grades hospitals in 30 provinces were invited to conduct online questionnaire surveys through WeChat,pediatricians scan QR codes to complete electronic questionnaires in the mini program from January 16th to February 4th,2021.The contents of questionnaire included the awareness,diagnosis and treatment of CTVA,and comparing the differences between pediatricians in secondary hospitals and tertiary hospitals.Results A total of 1529 pediatricians participated in the survey,and 1484(97.06%)pediatricians completed the questionnaire and included in the analysis,including 420 males(28.30%).The awareness rate of CTVA among pediatricians was 77.83%(1155/1484).Pediatricians in tertiary hospitals had higher rates of awareness of CTVA than pediatricians in secondary hospitals[81.86%(898/1097)vs 66.41%(257/387),P<0.001]and had better execution of the guidelines[89.15%(978/1097)vs 79.59%(308/387),P<0.001].A total of 93.06%(1381/1484)of pediatricians′first-line treatment included inhaled corticosteroids(ICS)for CTVA.Among them,a higher proportion of pediatricians in tertiary hospitals used ICS included regimens for first-line treatment of CTVA compared with pediatricians in secondary hospitals[94.90%(1041/1097)vs 87.86%(340/387),P<0.001].The reported well control rate of CTVA was 32.08%(476/1484),which was significantly lower in secondary hospitals than that in tertiary hospitals[17.31%(67/387)vs 37.28%(409/1097),P<0.001].Conclusion Most pediatricians are well aware of CTVA,among which there is a certain gap in clinical practice between pediatricians in secondary hospitals and tertiary hospitals in terms of understanding,diagnosis,and treatment of CTVA.

关 键 词：哮喘 胸闷变异性哮喘 调查和问卷 三级医院 二级医院 横断面研究 

分 类 号：R562.25[医药卫生—呼吸系统] R192.3[医药卫生—内科学]