摘要
目的 了解海南省综合医院医务人员对《第六次全国幽门螺杆菌感染处理共识报告(非根除治疗部分)》(以下简称国六共识)和《2022中国幽门螺杆菌感染治疗指南》(以下简称指南)的认知与应用现状.方法 2023年2月20日至5月7日对海南省15家综合医院共1 463名医务人员进行幽门螺杆菌(H.pylori)感染诊疗相关的问卷调查.调查问卷结合国六共识与指南拟定,包括对H.pylori及H.pylori相关性疾病的认知,对H.pylori检测的认知,以及对H.pylori根除、预防方法、根除影响因素的认知等6大版块.统计学方法采用卡方检验.结果 共回收有效问卷1 463份,问卷有效率为100.00％.1 463名调查对象包括225名消化内科医师与1 238名其他岗位医务人员(包括503名其他内科医师,264名外科医师,471名医技药学医务人员).78.67％(177/225)的消化内科医师认为我国H.pylori总体感染率＞20％,认知率高于其他岗位医务人员[其他内科65.41％(329/503)、外科61.74％(163/264)、医技药学60.30％(284/471),以下数据均以此岗位排序],差异有统计学意义(x2=30.97,P＜0.001).51.11％(115/225)的消化内科医师认为H.pylori血清学抗体检测不可以作为现症感染的诊断方法,认知率高于其他岗位医务人员[22.07％(111/503)、14.02％(37/264)、12.31％(58/471)],差异有统计学意义(x2=152.66,P＜0.001).关于质子泵抑制剂和钾离子竞争性酸阻滞剂在尿素呼气试验前应停用2周、抗菌药物和铋剂应停用4周,消化内科医师的认知率均高于其他岗位医务人员[38.67％(87/225)比 23.26％(117/503)、19.70％(52/264)、18.47％(87/471),60.89％(137/225)比 26.64％(134/503)、25.76％(68/264)、23.78％(112/471)],差异均有统计学意义(x2=133.70、165.51,均 P＜0.001).对于难治性H.pylori感染,98.67％(222/225)的消化内科医师认同进行细菌培养和抗菌药物药敏试验或耐药基因检测指导下的H.pylori感染个体化诊治,认知率高于其他岗位医务人员[91.85％(462/503)、93.56％(247/264)、93.21％(439/471)],差异有统计学意义(x2=20.55,P=0.002)o 70.67％(159/225)的消化内科医师推荐铋剂四联方案,80.44％(181/225)支持10～14 d的H.pylori根除疗程,认知率均高于其他岗位医务人员[46.92％(236/503)、33.33％(88/264)、32.91％(155/471),67.20％(338/503)、59.09％(156/264)、53.93％(254/471)],差异均有统计学意义(x2=111.25、59.99,均 P＜0.001).消化内科医师对国六共识的了解率为85.33％(192/225),高于其他岗位医务人员[64.21％(323/503)、66.67％(176/264)、57.96％(273/471)],差异有统计学意义(x2=85.47,P＜0.001).结论 海南省综合医院消化内科医师比其他岗位医务人员更了解国六共识和指南,但对内容的深入掌握仍欠缺,需要进一步加强医务人员对国六共识和指南的学习和应用.
Abstract
Objective To investigate the knowledge of Sixth Chinese national consensus report on the management of Helicobacter pylori infection(treatment excluded)(hereinafter referred to as sixth national consensus)and 2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment(hereinafter referred to as the guideline)among medical staff from general hospitals in Hainan.Methods From February 20 to May 7,2023,a questionnaire survey on the diagnosis and treatment of Helicobacter pylori(H.pylori)infection was conducted among 1 463 medical staff from 15 general hospitals in Hainan Province.The questionnaire was drawn up according to the sixth national consensus and the guideline,covering knowledge of 6 sections,induding H.pylori related diseases,detection of H.pylori,eradication,prevention and influence factors of eradication of H.pylori,etc.Chi-square test was used for statistical analysis.Results A total of 1 463 valid questionnaires were collected with the effective responsive rate of 100.00％.The 1 463 subjects included 225 gastroenterologists and 1 238 other medical staff(including 503 physicians from other departments,264 surgeons and 471 medical technologists and pharmacists).About 78.67％(177/225)of gastroenterologists agreed that the overall infection rate of H.pylori in China was more than 20％,the awareness rate was higher than that of other medical staff(physicians from other departments 65.41％(329/503),surgeons 61.74％(163/264),medical technologists and pharmacists 60.30％(284/471);the following datas were sorted by this position),and the difference was statistically significant(x2=30.97,P＜0.001).About 51.11％(115/225)of gastroenterologists considered that H.pylori serological antibody test could not be used as a diagnostic method for current infection,the awareness rate was higher than that of other medical staff(22.07％(111/503),14.02％(37/264),12.31％(58/471)),and the difference was statistically significant(x2=152.66,P＜0.001).Proton pump inhibitor and potassium-competitive acid blocker should be discontinued for 2 weeks,and antibiotics and bismuth should be discontinued for 4 weeks before urea breath test,and the awareness rates of gastroenterologists were higher than those of other medical staff(38.67％(87/225)vs.23.26％(117/503),19.70％(52/264),18.47％(87/471);60.89％(137/225)vs.26.64％(134/503),25.76％(68/264),23.78％(112/471)),and the differences were statistically significant(x2=133.70 and 165.51,both P＜0.001).For refractory H.pylori infection,98.67％(222/225)of gastroenterologists agreed with the individualized diagnosis and treatment of H.pylori infection should be guided by bacterial culture,antibiotic susceptibility test or drug resistance gene test,and the awareness rate was higher than that of other medical staff(91.85％(462/503),93.56％(247/264),93.21％(439/471)),and the difference was statistically significant(x2=20.55,P=0.002).About 70.67％(159/225)of gastroenterologists recommended a bismuth containing quadruple regimen,80.44％(181/225)supported a 10 to 14 day H.pylori eradication course,and the awareness rates were higher than other medical staff(46.92％(236/503),33.33％(88/264),32.91％(155/471);67.20％(338/503),59.09％(156/264),53.93％(254/471)),and the differences were statistically significant(X2=111.25 and 59.99,both P＜0.001).The understanding rates of the sixth national consensus and the guideline in gastroenterologists was 85.33％(192/225),which was higher than that of other medical staff(64.21％(323/503),66.67％(176/264),57.96％(273/471)),and the difference was statistically significant(x2=85.47,P＜0.001).Conclusions Gastroenterologists from general hospitals in Hainan Province have a better understanding of the sixth national consensus and the guideline than other medical staff.However,there is still a lack of deep understanding of the sixth national consensus and the guideline,and it is necessary to further strengthen the learning and application of the sixth national consensus and the guideline.
基金项目
海南省自然科学基金高层次人才项目(823RC603)
海南省卫生健康行业科研项目(20A200456)
海南省卫生健康行业科研项目(22A200319)
NETL
NSTL
万方数据