儿科医师婴幼儿牛奶蛋白变态反应临床诊疗的知识-态度-行为现状调查与影响因素分析  

Survey on current status of knowledge-attitudes-practices of clinical diagnosis and treatment of infant cow's milk protein allergy among pediatricians and analysis of its influencing factors

作　　者：王旖旎 杨凡[1] 唐梅[1] 向韵 伍晋辉 罗红[1] Wang Yini;Yang Fan;Tang Mei;Xiang Yun;Wu Jinhui;Luo Hong(Department of Child Health Care,Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西第二医院儿童保健科、出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《中华妇幼临床医学杂志（电子版）》2024年第4期420-430,共11页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家重点研发计划子课题(2019YFC0840702)。

摘　　要：目的探讨儿科医师婴幼儿牛奶蛋白变态反应(CMPA)临床诊疗的知识-态度-行为(K-A-P)现状及其影响因素。方法结果①本研究共计回收问卷554份,其中有效问卷546份,有效问卷回收率为98.6%。②被调查者对婴幼儿CMPA临床诊疗的K-A-P维度得分分别为(13.3±3.2)分、(27.5±3.6)分、(51.7±9.8)分。在K维度中,被调查者回答错误率>50%的条目共8项。在A维度中,得分最低的条目是反向题“母亲孕期回避牛奶和鸡蛋,会降低子代变态反应性疾病发生率”,31.9%(174/564)被调查者选择“非常同意及同意”。在P维度中,34.2%(187/564)被调查者“有时、偶尔或从不”依据CMPA相关指南指导轻、中度非免疫球蛋白(Ig)E介导的CMPA患儿在家庭中进行“牛奶蛋白梯度引入”。③单因素分析结果显示,被调查者的最高学历、职称、所在医院等级与科室,可能是影响其婴幼儿CMPA临床诊疗K维度得分的因素(P<0.05);被调查者所在医院等级与科室,可能是影响其A维度得分的因素(P<0.05);被调查者的职称、工作年限、所在医院等级与科室,可能是影响其P维度得分的因素(P<0.05)。④多重线性逐步回归分析结果显示,被调查者对婴幼儿CMPA临床诊疗的K-A-P维度得分的多重线性回归方程分别为y K=13.087+1.612 dep1+2.208 dep2-4.113 dep3,y A=27.697+0.895 dep1+1.770 dep2,y P=51.970+2.623 dep1+5.904 dep2,其中y K、y A、y P分别指被调查者对婴幼儿CMPA临床诊疗的K-A-P维度得分,dep1、dep2、dep3分别指被调查者所在科室为儿童保健科、小儿消化科、耳鼻喉科。结论被调查儿科医师对婴幼儿CMPA临床诊疗的K-A-P存在不足,表现为知识掌握误区较多、诊疗态度上欠缺信心、诊疗行为不够规范。儿科医师所在科室为其对婴幼儿CMPA临床诊疗的K-A-P维度得分的共同影响因素。建议根据儿科医师所在科室的特点和需求,设计和实施精准的教培计划,鼓励跨科室间交流合作,促�Objective To investigate the current status and influencing factors of knowledgeattitudes-practices(K-A-P)among pediatricians regarding the clinical diagnosis and treatment of infant cow's milk protein allergy(CMPA).Methods A total of 546 pediatricians from medical institutions at various levels in Sichuan Province from November to December 2022 were selected as survey subjects by convenient sampling method.A self-designed questionnaire on K-A-P Regarding the Clinical Diagnosis andTreatment of Infant CMPA was administered to these pediatricians.Independent-samples t test or one-way ANOVA were used for univariate analysis of influencing factors of K-A-P scores of clinical diagnosis and treatment of infant CMPA,and multiple linear stepwise regression analysis was used for multivariate analysis.This study complied with the requirements of the HelsinkiDeclaration of the WorldMedical Association Results①A total of 554 questionnaires were collected,of which 546 were valid,with a valid questionnaire collection rate of 98.6%.②The scores of K-A-P dimensions of clinical diagnosis and treatment of infant CMPA were(13.3±3.2)points,(27.5±3.6)points,and(51.7±9.8)points,respectively.In the K dimension,there were 8 items with a wrong answer rate of>50%.The lowest score in the A dimension was for the reverse question&quot;Avoiding milk and eggs during maternal pregnancy reduces the incidence of allergic diseases in offspring&quot;,with 31.9%(174/546)respondents choosing&quot;strongly agree or agree&quot;.In the P dimension,34.2%(187/546)respondents&quot;sometimes,occasionally,or never&quot;followed CMPA-related guidelines for the home-based&quot;gradual introduction of milk proteins&quot;in children with mild to moderate non-immunoglobulin(Ig)E mediated CMPA.③Univariate analysis showed that the highest educational level,professional title,hospital level,and department were potential influencing factors for scores of K dimension of clinical diagnosis and treatment of infant CMPA(P<0.05);hospital level and department were

关 键 词：牛奶蛋白变态反应 食物变态反应 诊疗模式 医师 知识 态度 行为 儿科医师 

分 类 号：R714[医药卫生—妇产科学]