临床医师对儿童阻塞性睡眠呼吸暂停低通气综合症的认知度调查

发布时间：2019-07-10 10:26

【摘要】： 研究目的：通过以临床医师对儿童阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea hypopnea syndrome, OSAHS)流行病学、病理生理学机制、患者症状、诊断、并发症和治疗等六个方面掌握的程度为基本知识点,对儿童OSAHS重要性以及诊断治疗能力和自信状况的自我评估作为认识程度的等级分类,对临床医师进行儿童OSAHS认知度的调查。以期提高临床医师对儿童OSAHS的识别能力,确定适当诊断程序,鉴别与儿童OSAHS相关的危险因素,评价OSAHS治疗方式的选择。研究方法：采用美国儿童阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea hypopnea syndrome, OSAHS)知识及态度问卷(OSA-KIDS)作为基本模式,于2009年5月-10月对山东省43所公立医院的耳鼻喉科、小儿科共391名临床医师进行问卷调查。研究结果：1.临床医师对儿童OSAHS相关知识的掌握仍有待提高。基本知识得分的顺序依次为病理生理、并发症、诊断、治疗、流行病学、临床表现。 2.只有五分之一多一点(24.30%)的临床医师知道儿童打鼾的强弱程度与OSAHS的严重程度无关；“婴幼儿心脏呼吸监测可作为中枢性与阻塞性呼吸暂停的可靠鉴别手段”的正确回答率只有16.11%。 3.耳鼻喉科和小儿科临床医师在儿童OSAHS相关知识的总得分方面无显著性差异。但是在以下两个条目的回答上有明显统计学差异：“大约有2%的儿童患有OSAHS”耳鼻喉科医师回答正确率较高,“儿童OSAHS可以导致肺动脉高压”小儿科医师回答正确率较高。 4.临床医师在总体知识得分方面与男女性别无关。但女性在有关诊断知识得分方面明显高于男性。 5.总体知识得分与学历、职称无显著性相关,与医师所在医院的级别有明显相关关系：流行病学平均知识得分和诊断平均知识得分各级医院医师无显著差异；省级医院的医师在总体知识得分的正确率、病理生理学知识平均得分正确率均高于县级医院的医师；省级和县级医院的医师在临床表现方面的知识平均得分高于市级医院的医师；有关并发症知识平均得分,省级、市级、县级医院依次降低。 6.总体知识回答正确率、自信心自我评价等级、态度总体平均分与医师年龄和从事临床工作的时间长短呈低度线性相关关系。 7.三分之二以上的医师认为“儿童OSAHS作为一种临床疾病”“鉴别诊断儿童是否患有的OSAHS”重要、非常重要或极端重要,但是仅有不到三分之一的医师对儿童OSAHS的诊断、治疗感到自信；对疾病重要性的认识与年龄、工作时间、职称、学历、性别无相关性；与诊断治疗疾病的自信心之间呈等级相关关系。 8.耳鼻喉和小儿科医师在“儿童OSAHS作为一种临床疾病”和“鉴别诊断儿童是否患有的OSAHS”的重要性认识上无显著差异。但对于诊断儿童是否具有OSAHS风险和对于儿童OSAHS患者的治疗条目的自我评价自信心方面,耳鼻喉科医师自我评价自信心明显高于小儿科医师。 9.专家(主任医师及副主任医师)在自信心自我评价等级、总体态度等级均高于住院医师；硕士、大学本科、专科毕业的医师自信心自我评价等级明显高于获得博士学位的临床医师。 10.知识回答正确率、流行病、病理生理、临床表现、诊断和治疗基本知识平均得分与态度自我评价总得分、疾病重要性平均分呈低度线性正相关。上述几项除病理生理知识平均得分外,其余皆与自信心平均得分呈低度线性正相关。说明对儿童OSAHS疾病知识掌握的越多,自我评价的认知态度越积极。 11.对疾病诊断治疗的自我评价自信心与临床医师的学历高低呈等级相关,与临床职称高低呈负等级相关,即学历越低,对疾病诊断治疗的自信心自我评价越高；职称越高,对疾病诊断治疗的自我评价自信心越高。 12.在接受调查的临床医师中,有三分之二的人回答从未使用过CPAP,但仍有30.69%的临床医师表示对处理—接受CPAP治疗的儿童OSAHS患者充满自信或非常自信。对诊断治疗儿童OSAHS越有信心者,处理接受CPAP治疗的患儿也越有信心。处理接受CPAP治疗患儿的自我信心评价与性别、学历、工作单位无关,与专业技术职称有负等级相关关系。耳鼻喉科医师和儿科医师在处理接受CPAP治疗的患儿自信心上无显著差异。结论：1.各级临床医师对儿童OSAHS的相关知识需加强学习,尤其是在睡眠呼吸紊乱的临床表现、睡眠呼吸监测和CPAP治疗方面。 2.随着临床医师年龄和工作时间的增加,其对疾病的认识和处理能力都相应增强。临床医师对儿童OSAHS疾病越重视,态度越积极,知识得分也越高。 3.儿童OSAHS的继续教育在基层医院的临床医师中需加强。 4.应加强临床医师对扁桃体和／或腺样体切除术手术风险的评估。 5.小儿科医师需提高对儿童OSAHS诊断和治疗方面的自信心。 6.应加强无创正压呼吸机(CPAP)对儿童OSAHS治疗有效性的广泛宣传,使各级临床医师了解CPAP治疗的适应症、并发症对提高儿童OSAHS治疗的有效率有积极意义。
[Abstract]:Objective: To study the epidemiology of obstructive sleep apnea-hypopnea syndrome (OSAHS), the mechanism of pathophysiology, the symptoms, diagnosis, complications and treatment of the patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). The importance of OSAHS for children and the self-assessment of diagnosis and treatment capacity and self-confidence were classified as a level of awareness, and a survey of the child OSAHS awareness was conducted to the clinician. In order to improve the ability of the clinician to identify the OSAHS of the child, determine the appropriate diagnostic procedure, identify the risk factors associated with the OSAHS of the child, and evaluate the choice of the OSAHS treatment. Methods: Using the knowledge and attitude questionnaire (OSA-KIDS) of obstructive sleep apnea-hypopnea syndrome (OSAHS) in the United States as the basic model, the ears of 43 public hospitals in Shandong province from May to October 2009 were adopted. A total of 391 clinicians in the nasopharynx and pediatrics Volume survey. Results of the study:1. Clinician's knowledge about OSAHS in children Mastery is still to be improved. The order of the basic knowledge score is the pathophysiology, the complication, the diagnosis, the treatment, the epidemic 2. A more than one-fifth (24.30%) of the clinicians know that the degree of snoring is not related to the severity of the OSAHS; the correct "The monitoring of infant's heart respiration can be used as a reliable identification of central and obstructive sleep apnea." The response rate was only 16.11%.3. Otolaryngology and pediatric clinician in the children's OSAHS phase There was no significant difference in the overall score of the knowledge. However, there was a statistically significant difference in the responses to the following two entries: approximately 2% of the children had an OSAHS "otolaryngologist" answer to a higher rate, "Children's OSAHS can cause pulse hypertension" pediatrician answers high accuracy.4. The bed physician is independent of the gender of the male and female in the overall knowledge score. 5. There is no significant correlation between the overall knowledge score and the educational background and the professional title, and there is a clear correlation with the level of the hospital in which the doctor is located: the epidemiology average knowledge score and the diagnosis average knowledge score are not available at all levels of the hospital doctor significant difference; the accuracy of the general knowledge score of the physician in the provincial hospital is higher than that of the doctor in the county level hospital; the average score of the physician in the provincial and county level hospital is higher than that of the doctor in the municipal hospital; and the related and average score, provincial, municipal and county level hospitals.6. The overall knowledge response accuracy, self-evaluation grade of self-confidence, overall average attitude 7. More than two-thirds of the physicians believe that the "Children OSAHS as a clinical disease" differential diagnosis of the OSAHS is important, very important, or extremely important, but less than one-third of the physicians are interested in the OS of the child AHS diagnosis and treatment feel confident ; Recognition and age, working time and title of the importance of the disease 8. There was no significant difference in the importance of otolaryngology and pediatrician in children's OSAHS as a "clinical disease" and for children's OSAHS as a "clinical disease", but for the diagnosis of children OSAHS risk and treatment for children with OSAHS In the aspect of self-evaluation of self-confidence, the self-evaluation of the otorhinolaryngologist is significantly higher than that of the pediatrician. and the overall attitude level is higher than the resident doctor in the self-evaluation grade of the self-confidence; The degree of self-evaluation of self-confidence of a doctor who is a master's degree, a college degree or a special degree is significantly higher than that of a clinician who has a doctor's degree.10. Knowledge The average score of the basic knowledge of the correct rate, the epidemic, the pathophysiology, the clinical manifestation, the diagnosis and the treatment basic knowledge, the total score of the self-evaluation of the attitude and the mean score of the disease was positively correlated with the low degree of linearity. In addition to the score, the rest is the average of self-confidence The more positive the knowledge of the children's OSAHS disease, the more positive the cognitive attitude of self-evaluation. The grade is related, and is related to the negative grade of the clinical title. The lower the degree of education, the higher the self-evaluation of self-confidence in the diagnosis and treatment of the disease, the higher the professional title, the diagnosis of the disease. The higher the self-evaluation of the break-out therapy.12. In the clinician receiving the survey, two-thirds of the patients responded to the never-used CPAP, but 30.69% of the clinicians indicated that the OSAHS patient who was treated with CPAP treatment was full of self-confidence or very self-confidence. OSAH for the diagnosis and treatment of children The more confidence the S is, the more confident the child treated with CPAP is treated. The self-confidence evaluation of the patients treated with CPAP is independent of the gender, the degree of work and the work unit. There is a negative level of relationship with the professional technical title. The otorhinolaryngologist and the pediatrician are at the office There was no significant difference in the self-confidence of the children treated with CPAP. Conclusion:1. The relevant knowledge of the grade clinicians on the OSAHS of the child needs to be enhanced, especially in the aspects of the clinical presentation of the sleep disordered breathing, the sleep apnea monitoring and the CPAP treatment. . As the Clinician Year The increase of age and working time is corresponding to the knowledge and processing ability of the disease. The more important the bed doctor attaches to the children's OSAHS disease, the more positive the attitude is, the higher the knowledge score 3. The continuing education of the children's OSAHS is in the clinician of the grass-roots hospital Need to be strengthened.4. The assessment of the risk of the operation of the tonsils and/ or adenoidectomy should be enhanced by the clinician.5. The pediatrician needs to improve the self-confidence in the diagnosis and treatment of the OSAHS in the child.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R766

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