上海市浦东新区全科医生慢性心力衰竭规范化诊治现状调查  

Status of knowledge and performance of chronic heart failure guideline in general practitioners of Shanghai Pudong communities

作　　者：倪岚[1] 赵辉[1] 薛锦花[1] 徐奇[1] 陈凤媛[2] 

机构地区：[1]上海市浦东新区沪东社区卫生服务中心全科,200129 [2] 复旦大学附属上海市第五人民医院消化内科

出　　处：《中华全科医师杂志》2015年第5期351-357,共7页Chinese Journal of General Practitioners

基　　金：上海市浦东新区科技发展基金创新基金（医疗卫生）（PKJ2012Y37）;上海市浦东新区卫生系统学科带头人培养计划（PWRd2013-05）

摘　　要：目的 调查全科医生对2014《中国心力衰竭诊断和治疗指南》的掌握和执行情况,探讨社区医院在心力衰竭（心衰）患者规范化治疗上的不足和改进方法.方法 结合《中国心力衰竭诊断和治疗指南》自拟问卷,内容包括3个方面：心衰的诊断、鉴别诊断;心衰的药物治疗;非药物治疗.于2014年4-5月对浦东新区入组的390名全科医生进行调查.结果 共发放调查问卷390份,回收有效问卷数385份,应答率为98.7％.心衰诊断和鉴别诊断方面：373名（96.9％）医生主要依据“病史与体检”对心衰患者进行诊断;171名（44.4％）医生“从未用过”B型利钠肽（BNP）/N末端B型利钠肽原（NTProBNP）;280名（72.7％）医生不知道如何鉴别收缩性心衰与舒张性心衰;86名（22.3％）医生会“根据射血分数（EF）值”进行鉴别.药物治疗方面：284名（73.8％）医生使用β受体阻滞剂的比例为“10％～30％”;149名（38.7％）医生因“对禁忌证不清楚,所以不敢用”;289名（75.1％）医生使用酒石酸美托洛尔的最大剂量为“25 ～50 mg”,没有人用到指南推荐的“101～200mg”;242名（62.9％）医生“不知道靶剂量是多少”;330名（85.7％）医生使用血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体拮抗剂（ARB）的比例在“10％ ～ 30％”,258名（67.0％）医生在剂量上为“会增加剂量,但不明确靶剂量”,在酒石酸美托洛尔、ACEI/ARB未达靶剂量的原因上第1位均是“不知道靶剂量是多少”.在非药物治疗方面：240名（62.3％）医生“从未听说过”心脏再同步治疗（CRT）;271名（70.4％）医生“从未听说过”植入型心律转复除颤器（ICD）.高级职称的全科医生对指南的掌握情况明显好于初、中级人员.结论 全科医生需要进一步学习心衰指南,药物治疗方面应作为以后需改善和提高的重点,同时也要关注心衰诊治新进展知识.Objective To investigate the status of knowledge and performance on Chinese Heart Failure Diagnosis and Treatment Guideline （2014 version） in general practitioners of Shanghai Pudong communities.Methods The survey was conducted from April to June in 2014 with a self-designed questionnaire.Total 390 general practitioners （GPs） in Pudong New Area were selected by cluster sampling method.The contents of questionnaire included：diagnosis and differential diagnosis,drug therapy,non drug therapy of chronic heart failure.Result Total 385 questionnaires were retrieved with a response rate of 98.7% （385/390）.The results showed that in aspect of diagnosis and differential diagnosis,373 （96.9%） Gps made the diagnosis based on history and physical examination,171 （44.4%）Gps never used BNP or NTPro-BNP tests,280 （72.7%）GPs did not know how to identify systolic or diastolic heart failure,86 （22.3%）Gps made the differential diagnosis according to the EF value.In aspects of drug therapy,the rate of beta blockers use was 10%-30% in 284 （73.8%） Gps,149 （38.7%） Gps did not use beta blockers because of not knowing the contraindications,289 （75.1%） Gps used a maximum dose of betaloc for 25-50 mg,no one used 101-200 mg,242 （62.9%）Gps did not know the target dose of betaloc,the rate of ACEI/ARB use was 10%-30% in 330 （85.7%） Gps,258 （67.0%） Gps would increase the dose but not knowing the target dose.The main reason for not using the target dose of Betaloc and ACEI/ARB was not knowing the dose.In aspect of non-drug therapy：240 （62.3%）Gps never heard of cardiac resynchronization therapy （CRT） and 271 （70.4%）Gps never heard of implantable cardioverter defibrillator （ICD）.The senior rank GPs grasped the guideline much better than Gps with primary and intermediate professional ranks.Conclusion General practitioners in community health centers should further study the guideline of heart failure,particularly need to strengthen the knowledge and ability of drug therapy.

关 键 词：心力衰竭 诊断 治疗 全科医生 

分 类 号：R541.6[医药卫生—心血管疾病]