特发性肌张力障碍的医生认知现状  

Status quo of awareness and knowledge about idiopathicdystonia among physicians in China

作　　者：潘有贵 何怡婧[1,2] 苏俊辉 潘丽珍 管强[1,2] 靳令经 PAN You-gui;HE Yi-jing;SU Jun-hui;PAN Li-zhen;GUAN Qiang;JIN Ling-jing(Neurotoxin Research Center,School of Medicine,Tongji University,Shanghai 200092,China;Dept.of Neurology,Tongji Hospital,School of Medicine,Tongji University,Shanghai 200065,China;Neurological Rehabilitation Center,Shanghai Yangzhi Rehabilitation Hospital(Shanghai Sunshine Rehabilitation Center),School of Medicine,Tongji University,Shanghai 201619,China)

机构地区：[1]同济大学医学院神经毒素研究中心,上海200092 [2]同济大学附属同济医院神经内科,上海200065 [3]同济大学附属养志康复医院神经康复中心,上海201619

出　　处：《同济大学学报（医学版）》2021年第6期839-845,共7页Journal of Tongji University(Medical Science)

基　　金：国家重点研发计划(2018YFC1314700);上海市优秀学术/技术带头人计划(20XD1403400)。

摘　　要：目的调查国内医生对特发性肌张力障碍的认知现状,从医务人员角度分析特发性肌张力障碍延误诊治的相关因素,探讨影响医生规范、持续开展针对性治疗的主要原因。方法选自2019年10月至2020年3月通过中国肌张力障碍联盟、中国神经科学学会神经毒素分会成员单位相关科室的医生进行随机横断面调查,问卷内容包括医生的基本情况、诊治特发性肌张力障碍的经验、对相关诊疗规范及区域专科设置的了解情况、开展肉毒毒素治疗过程中遭遇的困难等。通过线上匿名方式填写,数据导入SPSS 21.0统计软件进行建库分析。结果共收集有效问卷311份,来自可能诊治过特发性肌张力障碍患者的医生。绝大多数调查对象来自三级医院,60.1%的医生为神经内科医生,其中43.7%的医生专攻运动障碍病亚专业。参与调查的所有医生几乎都诊治过特发性肌张力障碍的患者,其中最常诊治的肌张力障碍类型是眼睑痉挛,有75.2%的医生正在开展肉毒毒素治疗肌张力障碍诊疗工作。区域设置运动障碍专科对于医生了解肌张力障碍诊疗规范(P<0.001)及肉毒毒素注射技术(P<0.05)具有显著影响。25.1%的医生因“未经培训、技术有难度”难以初次开展肉毒毒素治疗,影响医生持续开展肉毒毒素治疗的主要因素为收费低廉、药占比高。结论国内医生对特发性肌张力障碍的认知水平有待提高,设置运动障碍专科可显著提高当地医生对肌张力障碍诊疗规范及肉毒毒素的了解程度,技术瓶颈、收费低廉、药占比高等是限制医生无法规律开展肉毒毒素治疗的主要原因。Objective To survey the status quo of the awareness and knowledge about idiopathic dystonia among physicians in China.Methods A randomized cross-sectional survey was conducted from October 2019 to March 2020 among physicians in relevant departments of the member hospitals of the Chinese Dystonia Consortium and the Chinese Society of Neuroscience-Neurotoxin Branch.The questionnaire included basic information of the participants,their experience in the diagnosis and treatment of idiopathic dystonia,their knowledge of relevant treatment standards and regional specialty settings,and the difficulties of carrying out botulinum toxin treatment.The data were online filled out anonymously and analyzed with SPSS 21.0 statistical software.Results A total of 311 valid questionnaires were collected from physicians who may have seen patients with idiopathic dystonia.The vast majority of participants were from tertiary care hospitals,and 60.1%of the physicians were neurologists and 43.7%of them specializing in movement disorder subspecialties.Almost all physicians who participated in the survey had treated patients with idiopathic dystonia,the most common type of dystonia was blepharospasm,and 75.2%of the physicians used botulinum toxin for dystonia.The regional setting of movement disorders had a significant impact on physicians knowledge of dystonia treatment standard(P<0.001)and botulinum toxin injection techniques(P<0.05);25.1%of doctors had difficulty in starting botulinum toxin therapy for dystonia due to lack of training.The main factors affecting doctors to continue to carry out botulinum toxin therapy were low treatment charge and high drug share in total hospital revenue.Conclusion The survey reveals that the awareness and knowledge of idiopathic dystonia among physicians in China needs to be improved,and the technical bottlenecks,low fees and high drug share are the main reasons to restrict doctors from carrying out botulinum toxin therapy.

关 键 词：特发性肌张力障碍 医生 延误诊治 肉毒毒素 影响因素 

分 类 号：R741[医药卫生—神经病学与精神病学]