呼吸科医生对慢性血栓栓塞性肺动脉高压的认知与诊疗现状调查  

Awareness and management of chronic thromboembolic pulmonary hypertension among respiratory physicians revealed by a questionnaire analysis

作　　者：谢万木[1] 甄凯元 张萌 万钧[1] 陶新曹[1] 张帅[1] 翟振国[1] 王辰[2] Xie Wanmu;Zhen Kaiyuan;Zhang Meng;Wan Jun;Tao Xincao;Zhang Shuai;Zhai Zhenguo;Wang Chen(Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,National Clinical Research Center for Respiratory Diseases,Beijing 100029,China;Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中日友好医院呼吸中心呼吸与危重症医学科,中国医学科学院呼吸病学研究院,国家呼吸疾病临床研究中心,100029 [2]中国医学科学院,北京协和医学院,100730

出　　处：《中华结核和呼吸杂志》2020年第8期677-680,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家重点研发计划(2016YFC0905600);中国医学科学院医学与健康科技创新工程(2018-I2M-1-003)。

摘　　要：目的了解呼吸科医生对慢性血栓栓塞性肺动脉高压(CTEPH)的认知情况与诊治现状。方法根据CTEPH诊治中的相关问题设计问卷,针对774家全国肺栓塞与肺血管病防治协作组、中日友好医院呼吸专科医联体单位的负责医生和联络医生进行问卷调查,收回有效问卷1038份(1038/1211,85.7%),并对结果进行汇总分析。结果多数(769/1038,74.1%)参与调查医生就职于三级及以上医院,中级及以上职称占88.5%(919/1038)。绝大多数医院常规开展超声心动图(99.3%)和CTPA检查(94%),部分医院可进行肺通气灌注(V/Q)扫描(31.3%)和右心导管检查(38.5%),仅少数医院开展CTEPH肺动脉血栓内膜剥脱手术(8.0%)与球囊肺动脉成形术(10.4%),不同级别医院之间差异有统计学意义(P<0.01)。9.6%的医生自我评价熟悉CTPA的影像学阅读方法,19.9%医生熟悉V/Q扫描的阅读。88.5%的医生赞同CTPA是CTEPH患者的首选筛查方法,指南符合率仅3.9%。53.9%医生的观点符合指南,认为CTPA阴性可以除外CTEPH。79%的医生支持CTEPH患者终生抗凝治疗,70.8%的医生认为CTEPH应首先评估是否适合手术治疗。结论目前在CTEPH诊治中存在以下问题:V/Q及右心导管开展不足,肺动脉血栓内膜剥脱手术及球囊肺动脉成形治疗尚不普及,呼吸科医生不熟悉CTEPH相关影像学解读方法与治疗指征等,有必要针对以上问题进一步推广CTEPH的规范化诊治方法。Objective To evaluate the awareness and management status of chronic thromboembolic pulmonary hypertension(CTEPH)among respiratory physicians and therefore to provide for establishing clinical guidelines on CTEPH.Methods A questionnaire was designed to address the common questions in CTEPH management.The responses were collected online and the data were analyzed.Totally,1038 valid questionnaires were collected.Results 74.1%of the responders were from tertiary hospitals and 88.5%were attending physicians.Only a few hospitals could carry out ventilation-perfusion scintigraphy(31.3%)and right heart catheterization(38.5%).For the treatment of CTEPH,pulmonary endarterectomy and balloon pulmonary angioplasty(BPA)were only performed in 8.0%and 10.4%of the hospitals respectively,and mostly in tertiary hospitals,P<0.01.49.6%of the physicians were familiar with the interpretation of CTPA,while only 19.9%of V/Q scan.88.5%of the physicians choose CTPA as the screening tool for CTEPH,but only 3.9%were consistent with the guidelines.79%of the physicians agreed with lifelong anticoagulation for CTEPH,and 70.8%supported operability should be evaluated in all CTEPH patients.Conclusions This questionnaire study showed that there was a gap between the guidelines and the real world practice in CTEPH management.Efforts should be made to improve the awareness and standardization of the management of CTEPH.

关 键 词：高血压 肺性 肺栓塞 血栓栓塞 

分 类 号：R544.1[医药卫生—心血管疾病]