中国西部地区内科医生抗凝知识知晓及抗凝药物使用情况的调查研究  

Investigation on knowledge of anticoagulant and use of anticoagulant drugs by physicians in western China

作　　者：芦颜美[1] 汤宝鹏[1] 商鲁翔 薛小临[2] 刘兵 刘兴斌[4] 范洁[5] 俞杉[6] 蔡琳[7] 郑强荪 付华[4] 陶建虹[9] 张钲[10] 贾绍斌 边惠萍 任澎[13] 王忠[14] 姜述斌[15] 格桑罗布[16] Lu Yanmei;Tang Baopeng;Shang Luxiang;Xue Xiaolin;Liu Bing;Liu Xingbin;Fan Jie;Yu Shan;Cai Lin;Zheng Qiangsun;Fu Hua;Tao Jianhong;Zhang Zheng;Jia Shaobin;Bian Huiping;Ren Peng;Wang Zhong;Jiang Shubin;Gesang Luobu(Department of Pacing and Electrophysiology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Cardiology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Cardiology,Xijing Hospital,Air Force Medical University of PLA,Xi’an 710032,China;Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Cardiology,The First Hospital of Yunnan Province,Kunming 650032,China;Department of Cardiology,Guizhou Provincial People’s Hospital,Guiyang 550002,China;The Third People’s Hospital of Chengdu,Chengdu 610031,China;Department of Cardiology,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Cardiology,People’s Hospital of Sichuan Province,Chengdu 610072,China;Department of Cardiology,the First Hospital of Lanzhou University,Lanzhou 730000,China;Heart Center,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Cardiology,Qinghai Cardio-Cerebrovescular Hospital,Xining 810012,China;Department ofCardiology,Xinjiang Uygur Autonomous Region People’s Hospital,Urumqi 830000,China;Department of Cardiology,the First Affiliated Hospital,School of Medicine,Shihezi University,Shihezi 832000,China;Department of Cardiology,Xinjiang Autonomous Region Traditional Chinese Medical Hospital Affiliated to Xinjiang Medical University,Urumqi 830000,China;Department of Cardiology,People’s Hospital of Tibet Autonomous Region,Lhasa 850000,China)

机构地区：[1]新疆医科大学第一附属医院起搏电生理科,乌鲁木齐830054 [2]西安交通大学第一附属医院心血管内科,710061 [3]空军军医大学西京医院心血管内科,西安710032 [4]四川大学华西医院心血管内科,成都610041 [5]云南省第一人民医院心血管内科,昆明650032 [6]贵州省人民医院心内科,贵阳550002 [7]成都市第三人民医院心内科,610031 [8]西安交通大学第二附属医院心内科,710004 [9]四川省医学科学院,四川省人民医院心内科,成都610072 [10]兰州大学第一医院心内科,730000 [11]宁夏医科大学总医院心脏中心,银川750004 [12]青海省心脑血管病专科医院心内科,西宁810012 [13]新疆维吾尔自治区人民医院心内科,乌鲁木齐830000 [14]石河子大学医学院第一附属医院心内科,832000 [15]新疆维吾尔自治区中医医院,新疆医科大学附属中医医院心内科,乌鲁木齐830000 [16]西藏自治区人民医院心血管科,拉萨850000

出　　处：《中华心律失常学杂志》2019年第5期424-429,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家精准医学研究重点专项项目(心血管疾病专病队列研究)(2016YFC0900900)。

摘　　要：目的调查中国西部地区的内科医生对抗凝知识的知晓情况及抗凝药物的使用情况,为规范抗凝治疗提供科学依据。方法自2017年9月至2018年9月,采用问卷调查方式对中国西部地区(新疆维吾尔自治区、青海、甘肃、宁夏回族自治区、陕西、西藏自治区、四川、重庆、云南、贵州)的内科医生的人口学特征、工作及学习经历、抗凝知识知晓、抗凝药物使用情况(职称专业、工作年限、对抗凝药物以认识等)进行调查。结果共发放问卷2671份,回收有效问卷2436份,应答率为91.2%。CHA2DS2-VASc评分总体知晓率为81.9%,HAS-BLED评分总体知晓率为71.6%,各地知晓率差异有统计学意义(P<0.001)。Logistic回归分析显示学历、科室、参加讲座频率与脑卒中评分知晓具有相关性。一级及社区医院、二级医院、三级医院使用抗凝评分作为抗凝治疗依据的比例分别为26.7%、45.0%、59.4%,认为抗血小板治疗可替代抗凝治疗的比例分别为76.6%、45.6%、33.7%,差异具有统计学意义(P均<0.05)。Logistic回归分析显示,学历、科室、参加讲座频率与非维生素K拮抗剂口服抗凝药(NOACs)知晓具有相关性。甘肃省、四川省内科医生倾向使用华法林,而培训学习频率越高,越倾向于使用NOACs。结论中国西部地区内科医生的抗凝知识知晓及抗凝药物使用存在着明显的地域、学历及医院等级差异;而多次培训学习可强化内科医生的抗凝知识的知晓及NOACs的使用。Objective To investigate the knowledge of anticoagulant knowledge and the use of anticoagulant drugs by physicians in western China,and to provide scientific basis for the standardization of anticoagulant treatment.Methods We conducted a questionnaire survey to investigate demographic chaoalteristics,work and study experience,the knowledge and use of anticoagulant drugs of physicians in ten provinces in western China(Xinjiang,Qinghai,Gansu,Shanxi,Xizang,Sichuan,Chongqing,Yunnan,Guizhou,Ningxia)from September 2017 to September 2018.Results A total of 2671 questionnaires were issued and 2436 valid questionnaires were recovered,with a response rate of 91.2%.The overall awareness rate were 81.9%and 71.6%with regard to CHA2DS2-VASc score and HAS-BLED score,respectively,with statistically significant differences among different provinces(P<0.001).Logistic regression analysis showed that education level,department and lecture frequency were correlated with stroke score awareness.The proportion of primary and community hospitals,secondary hospitals and tertiary hospitals using anticoagulation score as the basis for anticoagulation therapy was 26.7%,45.0%and 59.4%,respectively.The proportion that antiplatelet therapy could replace anticoagulation therapy was 76.6%,45.6%and 33.7%,respectively,with statistically significant differences(allP<0.05).Logistic regression analysis showed that non-vitamin K antagonist oral anticoagulants(NOACs)awareness was correlated with academic departments and lecture frequency.Physicians in Gansu and Sichuan regions tend to use warfarin,while the higher of training and learning,the more likely they were to use NOACs use.Conclusion There are obvious regiond,education background and hospital level in physicians,knowledge of anticoagulant and the use of anticoagulant drugs among physicians in western China.Multiple training and learning can strengthen physicians’knowledge of anticoagulation and the use of NOACs.

关 键 词：心房颤动 抗凝治疗 现况调查 

分 类 号：R47[医药卫生—护理学]