关于内科医师对慢性阻塞性肺疾病诊疗行为的调查  

Survey on diagnosis and treatment of chronic obstructive pulmonary disease in physicians working in local hospitals in Shanghai

作　　者：张海琴[1,2] 李燕芹[1] 秦慧[1] 刘斌[1] 

机构地区：[1]上海交通大学医学院附属仁济医院呼吸内科,200127 [2]上海中医药大学附属普陀医院呼吸内科

出　　处：《上海医学》2008年第11期806-811,共6页Shanghai Medical Journal

摘　　要：目的调查上海市各级医院内科医师对慢性阻塞性肺疾病(COPD)的基本认识和诊治行为现状。方法设计调查问卷,对上海市6个区共13所医院的内科医师进行COPD基本知识和诊治行为的问卷调查,问卷按答题者所在医院级别、科室、职称进行分类统计,应用SAS6.12统计学软件对收集的有效问卷进行统计分析。结果共回收有效问卷117份。92.3%(108/117)的医师了解当前COPD的流行率;30.8%(36/117)了解疾病特征,其中呼吸专业组为46.2%(18/39),显著高于非呼吸专业组的23.1%(18/78,P<0.05);仅26.5%(31/117)能全面认识发病高危因素。以临床症状及肺功能情况诊断疾病者占26.5%(31/117),其中呼吸专业组为48.7%(19/39),显著高于非呼吸专业组的15.4%(12/78,P=0.001);仅以临床症状诊断疾病者占73.5%(86/117)。稳定期药物治疗基本符合指南建议,使用吸入型糖皮质激素者占82.1%(96/117);对氧疗知识的认识不足,一、二级医院非呼吸专业的不了解率达100.0%。加重期治疗基本符合指南原则,但对无创通气、致病原的认识尚不足,尤其是基层医院、非呼吸专科和资历较低的医师。结论加强对医师的宣传教育及推广指南应用仍是今后COPD临床防治工作的重点。Objective To investigate the knowledge and diagnosis and treatment of chronic obstructive pulmonary disease （COPD） among physicians in local hospitals of Shanghai. Methods Questionnaire was designed and used to investigate the knowledge and diagnosis and treatment of COPD among the physicians in 13 hospitals located in 6 districts of Shanghai. The data obtained by the questionnaire was analyzed according to the class, department and technical titles of the physicians using SAS 6.12 software Results A total of 117 effective questionnaires were collected and 92.3% （108/117） were acquainted with the prevalence of COPD and 30.8% （36/117） acquainted with the characteristics of COPD, with the number of physicians of respiration （46. 2% [18/39]） significantly higher than that of non-respination physicians （23.1%[18/78] ,P〈0.05）. Only 26.5% （31/117） knew about all the risk factors of COPD. A total of 26.5% （31/117） physicians made diagnosis according to clinical symptoms and pulmonary status, including 48.7% （19/39） of respiration physicians, which was significantly higher than that of the non-respiration physicians （15.4% [12/78], P = 0. 001）. A total of 73.5% （86/117） physicians made diagnosis only based on clinical symptoms. Pharmacotherapy of stable COPD was basically conformed to the treatment guidelines, and 82.1% （96/117） of physicians recommended inhaled glucocorticosteroids. There was disparity in oxygen therapy, especially among non-respiration physicians of primary/secondary hospitals. Exacerbation managements were basically conformed to treatment guidelines. There was disparity in knowledge of noninvasive intermittent positive pressure ventilation （NIPPV） and microorganisms, especially among physicians of primary hospitals and non-respiration physicians and physicians of lower ranks. Conclusion To enhance the education of physicians and promote treatment based on guideline are the keys in clinical prevention and treatment of COPD.

关 键 词：慢性阻塞性肺疾病 问卷调查 内科医师 

分 类 号：R563.9[医药卫生—呼吸系统]