直立倾斜试验操作医师累计工作量对血管迷走性晕厥诊断结果的影响性分析  

Impact of Physician Cumulative Workload on the Diagnostic Results of the Head-up Tilt Test for Vasovagal Syncope

作　　者：陈晓胜 何佳 苏艳东 杨海涛[2] 樊晓寒 CHEN Xiaosheng;HE Jia;SU Yandong;YANG Haitao;FAN Xiaohan(Department of Cardiology,Chest Hospital of Zhengzhou University,Henan Provincial Chest Hospital,Zhengzhou 450003,China;Department of Cardiology,Central China Fuwai Hospital of Zhengzhou University,Fuwai Central China Cardiovascular Hospital,Henan Provincial People's Hospital Heart Center,Zhengzhou 451464,China;Center of Cardiac Function,Chinese Academy of Medical Sciences and Peking Union Medical College,National Center for Cardiovascular Diseases,Fuwai Hospital,Beijing 100037,China;Department of Cardiology,The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学附属胸科医院、河南省胸科医院心血管内科,郑州450003 [2]郑州大学华中阜外医院、阜外华中心血管病医院、河南省人民医院心脏中心心血管内科,郑州451464 [3]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院功能检测中心,北京100037 [4]郑州大学第五附属医院心血管内科,郑州450052

出　　处：《中国循环杂志》2024年第11期1103-1109,共7页Chinese Circulation Journal

摘　　要：目的:探讨直立倾斜试验操作医师累计工作量对诊断报告结果的影响。方法:回顾性连续纳入中国医学科学院阜外医院自2016年1月1日至2022年12月31日进行直立倾斜试验检查的操作医师和患者资料。根据从本院开展倾斜试验至研究结束这一阶段医师的累计工作量,将医师分为低累计工作量组(累计50~100例)、中等累计工作量组(累计101~350例)、高累计工作量组(累计1000~4000例;无医师累计工作量在351~999例),以及按医师的的性别、学历、职称分别进行分组,分析不同分组内和不同分组间医师倾斜试验报告诊断率的差异。结果:共纳入22名医师操作的6122例患者,22名医师个体之间的阳性、可疑阳性和阴性报告率差异均具有统计学意义(P均<0.001)。中等累计工作量组平均可疑阳性报告率显著高于低累计工作量组和高累计工作量组(3.21%vs.1.09%vs.1.62%,P=0.001),女性医师可疑阳性报告率高于男性医师(2.25%vs.1.07%,P=0.017),本科学历医师可疑阳性报告率高于研究生学历医师(2.46%vs.1.52%,P=0.013),初级职称医师可疑阳性报告率高于中级和高级职称医师(3.40%vs.1.75%vs.2.53%,P=0.024)。多因素Logistic回归分析显示,不论以阴性还是阳性作参照,中等累计工作量均是可疑阳性报告的影响因素(P均<0.05)。结论:不同操作医师个体之间的倾斜试验诊断报告率存在一定差异,中等累计工作量组操作医师更易出具可疑阳性诊断报告。Objectives:The purpose of this study is to evaluate the impact of the cumulative workload of HUTT testing physicians on diagnostic outcomes.Methods:This study retrospectively and consecutively included the data of testing physicians and patients who underwent HUTT at Fuwai Hospital,Chinese Academy of Medical Sciences,from January 2016 to December 2022.Based on the cumulative workload of physicians during the period from the initiation of tilt tests at the hospital to the end of the study,the physicians were categorized into low(50-100 sases),moderate(100-350 sases),and high(1000-4000 sases)cumulative workload groups,the cumulatie workload of no physician is 351-999 sases.Additionally,physicians were grouped by sex,educational background,and professional title to analyze differences in diagnostic rates of tilt table test reports within and between these groups.Results:The study included 22 testing physicians and 6122 patients.There were statistically significant differences in the rates of positive,suspicious positive,and negative reports among the 22 physicians(P<0.001).The average suspicious positive report rate in the moderate cumulative workload group was significantly higher than in the low and high cumulative workload groups(3.21%vs.1.09%vs.1.62%,P=0.001).The suspicious positive report rate was higher in the female physician group compared to the male physician group(2.25%vs.1.07%,P=0.017),in the undergraduate physician group compared to the postgraduate physician group(2.46%vs.1.52%,P=0.013),and in the junior title group compared to the intermediate and senior title groups(3.40%vs.1.75%vs.2.53%,P=0.024).Multivariate logistic regression analysis showed that a moderate cumulative workload was an influencing factor for suspicious positive reports,regardless of whether negative or positive was used as the reference(all P<0.05).Conclusions:There are certain differences in the diagnostic report rates of HUTT among different individual physicians.Physicians with a moderate cumulative workload are more likely to is

关 键 词：直立倾斜试验 血管迷走性晕厥 诊断结果 累计工作量 回顾性研究 

分 类 号：R54[医药卫生—心血管疾病]