耳鼻喉科临床医师对阻塞性睡眠呼吸暂停低通气综合征的认知度调查

发布时间：2018-03-16 18:25

本文选题：睡眠呼吸暂停　切入点：耳鼻喉科　出处：《山东大学》2012年硕士论文　论文类型：学位论文

【摘要】：[研究背景和目的] 阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)是指睡眠时上气道塌陷阻塞引起的通气不足和呼吸暂停,并伴有打鼾、睡眠结构紊乱、频发血氧饱和度下降、白天嗜睡、注意力不集中、性欲下降等病症。OSAHS是临床常见疾病,与心脑血管疾病、内分泌代谢紊乱等都有着密切关系,是多种全身疾病的独立危险因素,常表现为肥胖、白天困乏、入睡后呼吸道阻塞,并引起低氧血症。由于长期低氧血症和高碳酸血症,导致一系列的病理生理变化,造成多器官系统损伤,具有潜在危险性,重者还可能引起猝死。因此,临床医师应提高对OSAHS的认识,改善患者预后。本调查旨在分析耳鼻喉科临床医师对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的知识水平和自我态度评价,提高临床医师对阻塞性睡眠呼吸暂停低通气综合征的认知度。 [研究方法] 抽取山东省17个地市(济南、青岛、烟台、泰安、聊城、潍坊、临沂、东营、日照、莱阳、济宁、枣庄、莱芜、淄博、威海、德州、菏泽)41所省、市、县公立综合医院的耳鼻喉科临床医师作为研究对象,采用美国阻塞性睡眠呼吸暂停知识及态度问卷(Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire, OSAKA),以邮寄并回收问卷的方式进行调查。 [结果] 1.回收有效问卷334份,占95.70%。全部知识条目的平均正确率为：78%(74%±15%)；其中,61.38%的耳鼻喉科临床医师错误地认为“悬雍垂腭咽成型术可以治愈大多数OSAHS患者”,正确回答率最低,38.62%(0.39±0.49)；仅有41.02%(0.41±0.49)的临床医生能够正确回答“女性OSAHS患者可以仅仅只表现为疲乏”；仅有50.90%(0.51±0.50)的医师了解“成人睡眠中每小时呼吸暂停和/或低通气小于5次是正常的”。耳鼻喉科临床医师对OSAHS发病机制的知识了解较为全面,正确率较高,对OSAHS治疗的相关知识了解较为有限,回答正确率最低。 2.95%以上的被调查者认为：OSAHS作为一类临床疾病具有重要意义；鉴别诊断患者是否有OSAHS风险具有重要意义。约70%的临床医师表示对OSAHS的诊断有信心,但仅有不足60%的临床医师表示对OSAHS的治疗有信心。OSAHS相关知识总得分随着医师年龄及执业年限的增加而增高；随着耳鼻喉科临床医师对OSAHS疾病重要性的认识及诊疗自信心自我评价的增强而增高,即知识条目的回答正确率与临床医师对OSAHS疾病认知度之间呈线性正相关关系。 [结论] 1.耳鼻喉科临床医师对OSAHS发病机制的知识了解较为全面,回答正确率较高,对OSAHS治疗的相关知识了解较为有限,回答正确率最低。 2.知识条目的回答正确率与被调查者性别、学历、医师专业技术职称及医师所在单位的级别均无明显相关关系；与医师年龄、执业时间呈线性相关(P0.05),说明从事耳鼻喉科专业的高年医师随着临床工作经验的积累,对OSAHS专业知识有着更为全面的了解与掌握。 3.不同级别的被调查医院中,临床医师对OSAHS重要性的认识及诊疗自信心有所差异,随着医院级别的升高,临床医师对OSAHS鉴别诊断重要性的认识有所提高,对OSAHS患者的诊断、治疗及正确处理正压呼吸机患者的自信心有所增强。 4.知识条目的回答正确率也随着耳鼻喉科临床医师对OSAHS疾病重要性的认识及诊疗自信心自我评估的增强而增高,即知识条目的回答正确率与临床医师对OSAHS疾病认知度之间呈线性正相关关系。 [研究意义] 耳鼻喉科临床医师对OSAHS的重要性有所认识,但对诊断、特别是相关治疗知识的掌握仍有待提高,因此通过加强继续教育等各种方式全面提高临床相关专业人员对OSAHS的认知程度,是提高诊疗水平的关键。
[Abstract]:[research background and purpose]
Obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) refers to the obstruction of the upper airway during sleep caused hypoventilation and apnea, accompanied by snoring, sleep disorders, frequent decreased oxygen saturation, daytime drowsiness, inattention, decreased libido and other symptoms of.OSAHS are common clinical diseases. With cardiovascular and cerebrovascular diseases, endocrine and metabolic disorders are closely related, are independent risk factors for various systemic diseases, often showed obesity, daytime drowsiness, sleep after respiratory tract obstruction, and cause hypoxemia. Due to long-term hypoxia and hypercapnia, resulting in a series of pathological changes, resulting in multi organ injury and potentially dangerous, or it may cause sudden death. Therefore, clinicians should improve the understanding of OSAHS, improve the prognosis of the patients. The purpose of this study was to analyze the ear The knowledge level and self attitude of obstructive sleep apnea hypopnea syndrome (OSAHS) were evaluated by nasal and laryngology clinicians, so as to improve clinicians' recognition of obstructive sleep apnea hypopnea syndrome.
[research methods]
17 cities were selected in Shandong province (Ji'nan, Qingdao, Yantai, Tai'an, Liaocheng, Weifang, Linyi, Dongying, Rizhao, Laiyang, Jining, Zaozhuang, Laiwu, Zibo, Weihai, Dezhou, Heze) 41 provincial, city, county public hospital department of ENT physicians as the research object, using the United States obstructive sleep apnea knowledge and attitude questionnaire (Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire, OSAKA), were investigated by post and questionnaire way.
[results]
1. valid questionnaires were 334, accounted for 95.70%. of all knowledge to the average accuracy rate is 78% (74% + 15%); among them, 61.38% Department of ENT physicians mistakenly believe that "UPPP can cure most patients with OSAHS, the correct answer to the lowest rate of 38.62% (0.39 + 0.49); only 41.02% (0.41. 0.49) clinicians correctly answered" female OSAHS patients can only show fatigue; only 50.90% (0.51 + 0.50) physicians understand "adult sleep apnea per hour and / or low ventilation is less than 5 is normal. Department of ENT, clinicians on the pathogenesis of OSAHS knowledge is more comprehensive, higher right rate is limited to OSAHS therapy related knowledge, the correct answer rate is the lowest.
More than 2.95% of the respondents think that the significance of OSAHS as a kind of clinical disease; differential diagnosis of patients with OSAHS is of significant importance. About 70% of clinicians expressed confidence in the diagnosis of OSAHS, but only less than 60% of physicians said on the treatment of OSAHS has the confidence of.OSAHS related knowledge score increased with the physician age and years of practice; increased with the enhancement of the Department of ENT clinicians to awareness of the importance of the diagnosis and treatment of OSAHS disease self-confidence self assessment of the knowledge that a correct answer rate and clinicians was linear positive correlation between the OSAHS awareness of the disease.
[Conclusion]
1. Department of ENT clinicians have a comprehensive understanding of the pathogenesis of OSAHS. The correct rate is relatively high. The knowledge about OSAHS treatment is relatively limited, and the correct rate is the lowest.
2. knowledge to the correct answer rate and respondents' sex, education, had no obvious correlation between the physician and physician professional unit level; and physician age, showed a linear correlation (P0.05), that time practicing in the Department of ENT professional senior physicians with clinical work experience, professional knowledge of OSAHS have a more comprehensive understanding and grasp.
3. different levels are investigated in the hospital, doctors on the importance of OSAHS knowledge and diagnostic confidence difference, with the increase of the level of hospital, doctors to recognize the importance of OSAHS in differential diagnosis of improved diagnosis of OSAHS patients, treatment and correct treatment of positive airway pressure in patients with increased confidence.
4., the accuracy of knowledge item answer is also increased with the Department of ENT physicians' understanding of the importance of OSAHS disease and the self assessment of self confidence in diagnosis and treatment. That is, there is a positive linear correlation between the correct rate of knowledge entry and clinician's recognition of OSAHS disease.
[research significance]
The importance of the understanding of the OSAHS clinical department of ENT, but for diagnosis, especially the treatment of knowledge still needs to be improved, so to strengthen the continuing education through various ways such as raising awareness of clinical professionals of OSAHS, is the key to improve the level of diagnosis and treatment.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R766

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