山西省基层医院医生慢性阻塞性肺疾病认知状况的问卷调查研究  

Perceptions of chronic obstructive pulmonary disease among doctors in primary hospitals in Shanxi province

作　　者：盖晓燕[1] 陈钢钢[2] 王锐英 李楠[4] 周璐 乐艳青 孙永昌[1] Gai Xiaoyan;Chen Ganggang;Wang Ruiying;Li Nan;Zhou Lu;Le Yanqing;Sun Yongchang(Department of Respiratory and Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China;Department of Otolaryngology Head&Neck Surgery,the First Hospital of Shanxi Medical University,Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer,Taiyuan 030001,China;Department of Pulmonary and Critical Care Medicine,Shanxi Dayi Hospital,Taiyuan 030001,China;Clinical Epidemiology Center of Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院呼吸与危重症医学科,100191 [2]山西医科大学第一医院耳鼻咽喉头颈外科,山西省耳鼻咽喉头颈肿瘤重点实验室,太原030001 [3]山西大医院呼吸与危重症医学科,太原030001 [4]北京大学第三医院临床流行病中心,100191

出　　处：《中华全科医师杂志》2020年第12期1130-1135,共6页Chinese Journal of General Practitioners

基　　金：国家自然科学基金面上项目(81970041);国家自然科学基金青年基金项目(81800038)。

摘　　要：目的调查山西省基层医院(县医院及乡镇医院)的内科/呼吸科医师对慢性阻塞性肺疾病(慢阻肺)的基本认知和管理现状。方法设计调查问卷,2018年8月20—30日,采用基于方便样本的横断面调查,通过山西省基层医生联盟网络发放问卷,对山西省基层医院的内科/呼吸科医生进行慢阻肺认知水平调查,包括疾病特征、流行病学、诊治和管理等内容。统计回答问题的准确率,并比较乡镇医院与县医院医生、内科医生与呼吸科医生回答问题的准确率。结果收到问卷1162份,有效问卷共1100份,882份来自县医院,218份来自乡镇医院。1100名医生中,768人(69.8%)认为吸烟和接触生物燃料是慢阻肺最主要的危险因素,639人(58.1%)认为慢阻肺患者需要戒烟。334人(30.4%)表示其慢阻肺知识来源于指南。764人(69.5%)知晓"肺功能是诊断慢阻肺的金标准",但对肺功能具体指标回答正确者仅407人(37.0%),对重度慢阻肺诊断标准回答正确者仅98人(8.9%)。乡镇医院与县医院医生相比,慢阻肺知识来源于指南者更少[23.9%(52/218)比32.0%(282/882),χ^2=5.450,P<0.05],更多医生表示在慢阻肺诊治中存在困难,所在医院肺量计配备不足[59.6%(130/218)比45.2%(399/882),χ^2=14.509,P<0.01],慢阻肺药物配备不足[42.7%(93/218)比34.2%(302/882),χ^2=5.385,P<0.05]。内科医生与呼吸专科医生相比,对慢阻肺患者开展肺功能检查的比例更低(χ^2=12.638,P<0.01),对疾病严重度分级标准回答正确率更低[6.6%(46/692)比12.7%(52/408),χ^2=11.760,P<0.01]。结论目前山西省基层医生对慢阻肺认知不足,有待加强教育及推广指南学习;基层医院肺量计及慢阻肺药物不足,影响慢阻肺的早期诊断与治疗,有待改善。Objective To investigate the basic knowledge of chronic obstructive pulmonary disease(COPD)among physicians in primary hospitals(county and township hospitals)in Shanxi province.Methods A electronic questionnaire survey that included questions on basic knowledge,epidemiology,diagnosis and management of COPD was conducted.The questionnaire was distributed through Wechat communication by convenient sampling among physicians and respiratory specialists in primary hospitals in Shanxi province.Results A total of 1162 questionnaires were collected,among which 1100 were valid(882 from county hospitals and 218 from township hospitals).The results showed that 768(69.8%)considered that smoking and biomass fuel exposure were the main risk factors of COPD,while 639(58.1%)thought that COPD patients needed to quit smoking.Only 334 respondents(30.4%)indicated that their COPD knowledge was derived from guidelines;764 respondents(69.5%)considered pulmonary function tests as the gold standard for diagnosing COPD,but only 407(37.0%)provided correct answers for the specific criteria of pulmonary function,and only 98 respondents(8.9%)correctly identified the diagnostic criteria for severe COPD.In comparison with the county hospital group,fewer doctors in the township hospitals received their COPD knowledge from guidelines[23.9%(52/218)vs.32.0%(282/882),χ^2=5.450,P<0.05];more doctors in the township hospitals experienced difficulties in the diagnosis and treatment of COPD,including inadequate spirometers in their hospitals[59.6%(130/218)vs.45.2%(399/882),χ^2=14.509,P<0.01]and significantly inadequate COPD medications[42.7%(93/218)vs.34.2%(302/882),χ^2=5.385,P<0.05].Significantly lower proportions of general physicians performed pulmonary function tests for COPD patients(χ^2=12.638,P<0.01)and provided correct answers for the diagnostic criteria for severe COPD[6.6%(46/692)vs.12.7%(52/408),χ^2=11.760,P<0.01]in comparison with respiratory specialists.Conclusions Doctors in primary hospitals in Shanxi have an inadequate knowledge of

关 键 词：肺疾病 慢性阻塞性 问卷调查 认知 

分 类 号：R574.62[医药卫生—消化系统]