上海市医务人员对幽门螺杆菌感染诊疗的认知情况调查

Awareness and knowledge of Helicobacter pylori infection among medical staff in Shanghai

目的了解上海市医护人员对＂第四次全国幽门螺杆菌（Helicobacter pylori，Hp）感染处理共识报告＂（简称＂第四次共识＂）的认知及执行情况。方法2014年10月至2015年9月对上海市消化科医生、全科医生和消化科护士共316人进行问卷调查。调查问卷结合＂第四次共识＂拟定，包括4个方面内容：对＂第四次共识＂的了解和应用情况（8个问题）、Hp根除治疗的适应症（8个问题）、Hp感染的检测（7个问题）和Hp根除治疗的方法（6个问题），共29个问题。结果共收回有效问卷数300份，应答率为94.9%（300/316）。消化科医生、全科医生和消化科护士对＂第四次共识＂知晓率分别为81.1%（60/74）、57.6%（91/158）和26.4%（18/68），差异有统计学意义（χ^2＝43.67，P＝0.001）。消化科医生对于消化性溃疡、胃黏膜相关淋巴组织淋巴瘤、早期胃肿瘤内镜或手术切除后以及有胃癌家族史等为Hp根除适应证的知晓率均明显高于全科医生和消化科护士（χ2值分别为16.68、35.60、33.46和39.22，P值均〈0.05）。被调查者检测患者Hp感染的常用方法为C14或C13呼气试验[消化科医生97.3%（72/74）、全科医生47.5%（75/158）和消化科护士82.1%（55/68），χ^2＝72.38，P＝0.001]、胃黏膜组织快速尿素酶试验[消化科医生70.3%（52/74）、全科医生13.9%（22/158）和消化科护士25.4%（17/68），χ^2＝78.22，P＝0.001]、血清学检查[消化科医生58.1%（43/74）、全科医生20.9%（33/158）和消化科护士44.8%（30/68），χ^2＝40.30，P＝0.001]和胃黏膜组织切片染色镜检[消化科医生56.8%（42/74）、全科医生13.3%（21/158）和消化科护士22.4%（15/68），χ^2＝50.35，P＝0.001]。71.6%（53/74）消化科医生、47.5%（75/158） 全科医生和40.3%（25/62）消化科护士使用铋剂四联疗法，差异有统计学意义（χ^2＝15.93，P＝0.001），27.0%（20/74）消化科医生、51.3%（81/158）全科医生和42.0%（26/62）消化科护士使用三联疗法，差异有统计学意义（χ^2＝12.42，P＝0.002），78.4%（58/74）消化科医生、78.5%（124/158）全科医生和67.6%（46/68）消化科护士使用10或14 d方案，差异无统计学意义（χ^2＝3.36，P＝0.186）。结论上海市消化科医生比全科医生和消化科护士更遵循＂第四次共识＂进行Hp感染诊治，但实践与共识间仍存在差距，需要进一步在全科医生和消化科护士中推广和应用指南与共识。

ObjectiveTo survey the awareness and knowledge of Helicobacter pylori （Hp） infection among medical staff in Shanghai.MethodsA questionnaire survey was conducted among 316 medical staff in Shanghai, including 74 gastroenterologists（GI）, 158 general practitioners（GP）, and 68 gastroenterology nurses（GN）, from October 2014 to September 2015. The questionnaire was designed according to the Fourth Helicobacter Pylori Infection Treatment Consensus Report of China （the Consensus） . There were 4 parts and 29 questions in the questionnaire, including the knowledge and performance of the Consensus（8 questions）, the indications of Hp eradication（8 questions）, detection methods of Hp infection（7 questions）and the therapy of Hp eradication（6 questions）.ResultsTotal 300 valid questionnaires were received with a response rate of 94.9%（300/316）. The awareness rate of the Consensus in GI, GP and GN groups was 81.1%（60/74）, 57.6%（91/158）and 26.4%（18/68）, respectively（χ^2=43.67, P=0.001）. GI had higher awareness rate than GP and GN in indications of Hp eradications （for peptic ulcer, mucosa-associated lymphoid malignancies, post-resection patients of early gastric cancer, and family history of gastric cancer, the χ^2 values were 16.68, 35.60, 33.46 and 39.22, respectively; all P〈0.05）. In part of Hp infection detection methods, the responses of GI, GP and GN groups in C14 or C13 urea breathing test were 97.3% （72/74）, 47.5% （75/158）and 82.1%（55/68）, respectively （χ^2=72.38, P=0.001）; in gastric mucosa tissue rapid urease test were 70.3% （52/74）, 13.9% （22/158）and 25.4%（17/68）, respectively （χ2=78.22, P=0.001）; in serological test were 58.1% （43/74）, 20.9% （33/158）and 44.8%（30/68）, respectively （χ^2=40.30, P=0.001）; in gastric mucosa tissue section staining were 56.8% （42/74）, 13.3% （21/158）and 22.4%（15/68）, respectively （χ^2=50.35, P=0.00）. In part of Hp eradication therapy the responses of GI, GP and GN groups in recommended bismuth quadruple therapy were 71.6% （53/74）, 47.5%（75/158） and 40.3% （25/62）, respectively （χ^2=15.93, P=0.001）; in triple therapy were 27.0% （20/74）, 51.6%（81/158）and 42.0%（26/62）, respectively（χ^2=12.42, P=0.002）; in 10 or 14 d for treatment duration were 78.4%（58/74）, 78.5%（124/158）and 67.6% （46/68）, respectively （χ^2=3.36, P=0.186）.ConclusionGastroenterologists are more likely to adhere with the Consensus than general practitioners and gastroenterological nurses in the management of Hp infection. The survey suggests that more attention should be paid for popularization and implementation of Hp infection guidelines and consensus among Shanghai medical staff, especially for GP and nurses.