COPD规范化培训对基层医院COPD规范化诊治的提升作用的研究

发布时间：2018-06-10 11:15

本文选题：COPD + 规范化诊治　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的：慢性阻塞性肺疾病（chronicobstructivepulmonarydisease，COPD）是呼吸系统的常见病、多发病。有报告显示，我国2000年因COPD死亡人数达到128万，致残人数超过500万。2005年发表的一项流行病学研究显示，我国部分农村地区15岁以上人群的患病率为3％，40岁以上人口中，COPD的发生率为8.2%。据2007年卫生部公布的全国城乡居民死亡的十大病因中，呼吸系统疾病（主要是COPD）占农村人口死亡原因第3位、城市人口死亡原因第4位，已被列为卫生部15年疾病防治规划（至2020年）的五大重点疾病之一。由于我国农村居民存在广大的吸烟人群、城乡结合部城市化进程及城市的经济发展所带来的难以避免的空气、环境污染问题以及职业粉尘、感染、社会经济地位等因素，COPD在最近的几十年中将成为一个严峻的公共卫生问题，而主要挑战在农村。基层医务人员对该病的认知度、规范化诊治的执行力度将直接决定农村COPD患者的控制水平。本研究的目的则是了解农村基层医院在接受COPD规范化培训后对COPD规范化诊治的提升情况，从而达到跟好的控制COPD。方法：随机抽取重庆市某家县级医院COPD病历50份进行质量评分，评分内容包括：病历中患者病史特点、既往史特点；相关辅助检查；急性发作期及缓解期规范化治疗情况；健康教育、预防复发告知情况等内容，总分100分。针对其存在的问题进行COPD规范化诊治培训，培训方式以组织上级医院专家到医院进行COPD防治指南讲解、查房及科室组织讨论等形式进行。培训后再次对COPD病历评分，前后结果进行对比分析。结果：培训前50份病历，每份综合平均得分57.94+7.16分，通过规范化培训后再次抽查病历，每份平均得分77.02+10.17分。比较规范化培训前后病历平均得分，两者有显著差异，具有统计学意义（t=10.852，P0.01）。COPD病历评分（包括规范化诊断、规范化治疗及长期健康教育等方面）经规范化培训后均有显著提高，培训前后有明显差异（p0.01）。表明规范化培训后COPD病历质量及规范化诊治水平有显著提高。经过COPD规范化培训后，，基层医生在描述COPD患者最近一年的发病情况、病情严重程度、以往住院情况、COPD危险因素接触史、基本的辅助检查及急性期规范化治疗用药方面均有显著改善，但在COPD分级治疗、抗生素规范使用及COPD缓解期的治疗方面仍有待进一步改进提高。结论：综合以上分析发现，规范化培训COPD知识对基层医院呼吸科COPD规范化诊治有明显提升作用。为进一步提高农村COPD规范化诊治，应继续加强对农村基层医院COPD规范化培训。
[Abstract]:Objective: chronicobstructivepulmonarydisease (COPD) is a common and frequently occurring disease of the respiratory system. A report shows that in 2000, the number of deaths from COPD in China reached 1 million 280 thousand, and the number of disabled persons over 5 million.2005 years showed that the prevalence rate of people over 15 years old in some rural areas of our country For 3%, among the population aged 40 and above, the incidence of COPD was 8.2%., the ten major cause of death in the country's urban and rural residents according to the Ministry of health in 2007. Respiratory diseases (mainly COPD) accounted for third causes of death in rural population and fourth causes of urban population death, which had been listed as the five major diseases of the Ministry of health for 15 years of disease prevention and control planning (to 2020). One of the diseases is that the COPD has become a serious public health problem in recent decades because of the large number of smokers in rural areas, the urbanization process in urban and rural areas and the unavoidable air, environmental pollution and occupational dust, infection and social and economic status. The goal of this study is to understand the improvement of the standardized diagnosis and treatment of the COPD in the rural grass-roots hospitals after the COPD standardized training, so as to achieve the good control of the COPD. in the rural grass-roots hospitals. The purpose of this study is to achieve a good control of the COPD in rural grass-roots hospitals.
Methods: the quality score of 50 COPD medical records in a county hospital in Chongqing was randomly selected. The contents included the medical history characteristics of patients in the medical record, the characteristics of previous history, the related auxiliary examination, the standardized treatment of acute attack and remission period, health education, and the total score of 100. COPD standardized diagnosis and treatment of training, training methods to organize higher hospital experts to the hospital to the hospital for COPD prevention guide explanation, the rounds and the department organization discussion and other forms. After training again the COPD medical records score, the results were compared and analyzed.
Results: the first 50 medical records were 57.94+7.16 scores, and the average score was 77.02+10.17 after standardized training. The average scores of the medical records before and after the standardized training were compared. There were significant differences between the two cases. There was a statistically significant (t=10.852, P0.01).COPD record score (including standardized diagnosis and normalization. After standardized training, there were significant improvements in the treatment and long-term health education, and there were significant differences (P0.01) before and after the training. It showed that the quality of COPD medical records and the standard of diagnosis and treatment after standardized training were significantly improved. After the standardized training of COPD, the primary doctors were describing the incidence of the patients in the last year and the severity of the disease, In the past, the history of hospitalization, the history of COPD risk factors, the basic auxiliary examination and the standardized treatment of acute phase have improved significantly, but the treatment of COPD grading, the use of antibiotics and the treatment of COPD remission still need to be improved.
Conclusion: the comprehensive analysis shows that the standardized training of COPD has an obvious effect on the standardized diagnosis and treatment of COPD in the Department of respiration in the grass-roots hospital. In order to further improve the standardized diagnosis and treatment of rural COPD, the standardized training of the rural primary hospital COPD should be continued.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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