论著
ENGLISH ABSTRACT
呼吸专科医师慢性阻塞性肺疾病诊断和评估工具应用状况调查
孙永昌
张静
陈亚红
褚红玲
作者及单位信息
·
DOI: 10.3760/cma.j.cn112147-20211119-00818
A survey on the application of diagnostic and evaluation tools for chronic obstructive pulmonary disease among respiratory physicians
Sun Yongchang
Zhang Jing
Chen Yahong
Chu Hongling
Authors Info & Affiliations
Sun Yongchang
Department of Respiratory and Critical Care Medicine Peking University Third Hospital, Beijing 100191, China
Zhang Jing
Department of Respiratory and Critical Care Medicine Peking University Third Hospital, Beijing 100191, China
Chen Yahong
Department of Respiratory and Critical Care Medicine Peking University Third Hospital, Beijing 100191, China
Chu Hongling
Clinical Epidemiology Center of Peking University Third Hospital, Beijing 100191, China
·
DOI: 10.3760/cma.j.cn112147-20211119-00818
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摘要

目的调查分析我国呼吸专科医师临床实践中对于门诊稳定期慢性阻塞性肺疾病(慢阻肺)诊断和评估工具应用现状,为推广实施诊疗规范提供参考资料。

方法通过问卷星平台对中国慢阻肺联盟(含94家单位)、北京市慢阻肺联盟(含108家单位)和中国基层呼吸疾病联盟(覆盖除港澳台及西藏外30个省市自治区)的呼吸专科医师发放和回收由研究者自行编制的问卷,调查我国呼吸专科医师对于门诊稳定期慢阻肺诊断和评估工具的应用情况,对结果进行汇总分析。

结果共回收有效问卷3 204份。71.7%(2 297/3 204)的受访医师来自三级医院。75.4%(2 415/3 204)的医师依据吸入支气管舒张剂后的肺功能结果诊断慢阻肺,且三级医院高于二级医院(78.7%比66.9%, P<0.01)。99.3%的医师在诊断过程中会询问/评估呼吸困难症状,但26.8%的医师未使用评分系统(慢阻肺评估测试问卷和改良版英国医学研究委员会呼吸问卷)进行量化评估。尽管83.8%的医师会在工作中使用指南推荐的综合评估(即ABCD分组),但只有45.1%完全依据分组制订初始治疗方案。另外,28.5%的受访医师没有常规检查血嗜酸粒细胞计数,20.1%的医师没有主动询问肺结核病史。

结论虽然大多数呼吸专科医师在临床实践中能够基本依照指南对门诊稳定期慢阻肺患者进行诊断和评估,但在评估工具的使用上仍有所不足,在诊治规范的推广和培训中应予以重点关注。

肺疾病,慢性阻塞性;问卷调查;诊断;评估工具
ABSTRACT

ObjectiveTo investigate the current status of the application of diagnostic and assessment tools for chronic obstructive pulmonary disease(COPD) by respiratory physicians in China.

MethodAn on-line questionnaire was designed to address the common questions in COPD diagnosis and evaluation, and this survey was conducted through Wechat.

ResultA total of 3 204 valid questionnaires were collected. 71.7% of the physicians were from tertiary hospitals. 75.4% of the physicians diagnosed COPD strictly on the basis of lung function results after inhaled bronchodilators, and this percentage was higher in tertiary hospitals than in secondary hospitals(78.71% vs. 66.92%, P<0.01). 99.3% of the physicians evaluated symptoms of dyspnea, but 26.8% of physicians did not use a scoring system(CAT or mMRC) for quantitative assessment. Although 83.8% of physicians would use the guideline-recommended comprehensive assessment(ABCD classification), only 45.1% of them chose initial therapy exactly according to the classification. In addition, 28.3% of physicians did not routinely order blood eosinophil counts and 20.1% did not inquire the history of tuberculosis.

ConclusionsAlthough most respiratory physicians followed the guidelines in the diagnosis and evaluation of COPD, the use of assessment tools was inadequate, which should be addressed in educational programs for COPD management.

Pulmonary disease, chronic obstructive;Questionnaires;Diagnosis;Evaluation tools
Sun Yongchang, Email: nc.defudabe.umjbynus
引用本文

孙永昌,张静,陈亚红,等. 呼吸专科医师慢性阻塞性肺疾病诊断和评估工具应用状况调查[J]. 中华结核和呼吸杂志,2022,45(04):362-367.

DOI:10.3760/cma.j.cn112147-20211119-00818

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*以上评分为匿名评价
慢性阻塞性肺疾病(简称慢阻肺)是我国最常见的慢性气道疾病。对于慢性疾病的管理,专业指南有助于规范临床医师的诊疗行为,提高临床诊疗水平,促进疾病管理同质化。中华医学会呼吸病学分会组织专家从1997年开始编写制定我国的《慢性阻塞性肺疾病诊治指南》,历经数次修订,并在2021年发表了《慢性阻塞性肺疾病诊治指南(2021年修订版)》 1。虽然《慢性阻塞性肺疾病诊治指南》的制定及推广使临床医师对于慢阻肺的认知程度和诊疗水平有明显提高 2 , 3 , 4,但在临床实践中专业医师的诊疗行为与指南建议之间的一致性,仍缺乏代表性调查数据。为此,本研究拟通过问卷调查我国呼吸专科医师对于门诊稳定期慢阻肺诊断和评估工具(技术)的应用情况,分析与指南不一致的诊疗行为,为慢阻肺指南的进一步推广提供参考资料。
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备注信息
A
孙永昌,Email: nc.defudabe.umjbynus
B

孙永昌:酝酿和设计实验、起草文章、对文章的知识性内容作批评性审阅;张静:实施研究、采集、分析并解释数据、起草文章、统计分析;陈亚红:酝酿和设计实验、采集数据、支持性贡献;褚红玲:酝酿和设计实验、统计分析、对文章的知识性内容作批评性审阅

C

孙永昌, 张静, 陈亚红, 等. 呼吸专科医师慢性阻塞性肺疾病诊断和评估工具应用状况调查[J]. 中华结核和呼吸杂志, 2022, 45(4): 362-367. DOI: 10.3760/cma.j.cn112147-20211119-00818.

D
所有作者声明无利益冲突
E
国家自然科学基金 (82170048)
首都卫生发展科研专项 (2020-2Z-40917)
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