基层医生的儿童功能性便秘诊疗能力研究  

Capacity of Diagnosis and Treatment of Childhood Functional Constipation among Primary-level Doctors

作　　者：刘宇春 阴丽霞 高丽平 丁兰[1] 丁静[1] 杜雪平[1] 于爽 LIU Yuchun;YIN Lixia;GAO Liping;DING Lan;DING Jing;DU Xueping;YU Shuang(Yuetan Community Health Center,Fuxing Hospital,Capital Medical University,Beijing 100045,China;Department of Pediatrics,the People's Hospital of Chiping District,Liaocheng 252100,China)

机构地区：[1]首都医科大学附属复兴医院月坛社区卫生服务中心,北京市100045 [2]山东省聊城市茌平区人民医院儿科,252100

出　　处：《中国全科医学》2022年第25期3150-3156,共7页Chinese General Practice

基　　金：首都卫生发展科研专项(首发2020-2-7023)——中医全科医师参与的“以患者为中心的医疗之家”(PCMH)模式下小儿功能性便秘的效果评价。

摘　　要：背景功能性便秘(FC)是儿童常见健康问题,也是儿童父母在基层医疗卫生机构门诊就诊中咨询频率较高的问题。尽管便秘不是急症,但如果处理不当,可能会引起严重的并发症,进而影响儿童及其家庭的生活质量。目的了解基层医生的儿童FC诊疗水平,为针对性提高基层医生的儿童FC诊疗与管理能力提供依据。方法于2020年7月,在北京市西城区基层医疗卫生机构中选取在日常诊疗中能接触到儿童患者的医生130例。采用本研究组自行设计的问卷对纳入医生开展调查,内容包括对≥6个月儿童FC诊断中常见症状的认知,以及对儿童FC的推荐治疗方法、推荐治疗药物、药物治疗时机及治疗持续时间等。结果108例(83.1%)基层医生的问卷被有效回收,其中全科医生34例(31.5%)、儿科医生30例(27.8%)、中医科医生30例(27.8%),平均每月门诊接触儿童患者(10.1±4.4)例。对于儿童FC的诊断:当≥6个月患儿出现排便次数少、大便坚硬、排便时出血、大便失禁、排便困难、排出稠便前哭泣症状时,分别有40.7%(44/108)、39.8%(43/108)、23.1%(25/108)、9.3%(14/108)、39.8%(43/108)、23.1%(25/108)的基层医生会考虑将其诊断为FC;51.9%(56/108)的基层医生认为同时存在排便次数少、排便困难两种症状时可诊断为FC;25.0%(27/108)的基层医生认为,同时存在排便次数少、大便坚硬、排便时出血、排便困难4种症状时可诊断为FC。对于儿童FC的治疗:37.0%(40/108)的基层医生推荐将药物治疗作为儿童FC的首选治疗方法;63.0%(68/108)的基层医生推荐将非药物治疗作为首选治疗方法,其中88.2%(60/68)推荐腹部按摩,85.3%(58/68)推荐高纤维饮食,82.4%(56/68)推荐如厕训练,72.1%(49/68)推荐增加液体摄入量。75.9%(82/108)的基层医生推荐使用乳果糖治疗;27.8%(30/108)的基层医生推荐联合应用柠檬酸钠、十二烷基磺基乙酸钠、山梨糖醇的微灌肠为直肠治疗方法,64.8%(70Background Functional constipation(FC)is a common health problem in children and a high frequency of consultations among parents of children in outpatient clinics of primary medical and health institutions.Although constipation is not an emergency,it may cause serious complications if not managed properly,which then can affect the quality of life of children and their families.Objective To understand the capacity of primary-level doctors'diagnosis and treatment in children's FC,and provide a basis for improving primary-level doctors' capacity of diagnosis and management of children's FC. Methods In July 2020,130 doctors who had access with children's patients in their daily diagnosis and treatment were selected from primary-level medical and health institutions in Xicheng District,Beijing. A self-designed questionnaire from our research group was administered to the included physicians. The content included awareness of the common symptoms of FC diagnosis for children ≥ 6 months of age,and the recommended treatment methods,recommended treatment drugs,medication timing and treatment duration for children with FC. Results Questionnaires from 108(83.1%) basic medical doctors were validly returned,including 34(31.5%) from general practitioners,30(27.8%) from pediatricians,30(27.8%) from traditional Chinese medicine doctors,and the average monthly outpatient volume with pediatric patients(10.1±4.4) cases was obtained. For the diagnosis of FC in children:when children aged ≥ 6 months presented with less frequent bowel movements, hard stools,bleeding during defecation,fecal incontinence,difficulty in defecating,and crying symptoms before passing thick stools,40.7%(44/108),39.8%(43/108),23.1%(25/108),9.3%(14/108),39.8%(43/108),23.1% (25/108) of the basic medical doctors would consider the diagnosis of FC;51.9%(56/108) of the physicians considered FC to be diagnosed when two symptoms,including low frequency of defecation and difficulty in defecating,existed simultaneously;according to 25.0%(27/108) of the physicians,

关 键 词：便秘 儿童保健服务 社区卫生服务 临床工作能力 如厕训练 直肠给药 

分 类 号：R442.2[医药卫生—诊断学] R179[医药卫生—临床医学]