基于制定中国血管超声检查专家共识若干问题的问卷调查分析

Analysis of questionnaire survey on several issues of vascular ultrasound referring to the formulation of Chinese expert consensuses

目的调查分析我国超声医师对制定中国颈部血管超声若干问题专家共识的必要性。方法以中国不同省市自治区的各级医院超声医师或相关专业医师为调查对象,采用微信手机端问卷方式对颈部血管超声若干问题是否需要制定专家共识进行调查分析。问题涉及颈动脉斑块的诊断与鉴别诊断(Q1~Q3)、易损斑块的评价与新技术展望(Q4、Q5)、颈动脉狭窄诊断标准及注意事项(Q6~Q8)、颈动脉发育异常或走行异常(Q9~Q11)4个方面的11个问题。问题回答设计包括亟需共识问答(A1)、一般需要共识回答(A2),和已有答案,不需要共识回答(A3)。不同级别医院问题回答结果的差异比较采用R×C列联表χ2检验,血管超声问题与其他因素的相关性分析采用Kendall′s tau-b分类变量。结果收回有效问卷3658份,涉及全国34个省市自治区等各级医院的医师。问卷响应率在地理分布、医院级别、职称类型等均有一定差异,其中华东区、三级甲等医院、主治医师响应率最高,分别为43.41%(1588/3658)、45.90%(1679/3658)和41.53%(1519/3658)。Q1~Q11问题有必要“共识”答复的累积响应率分别为81.00%(2963/3658)、91.94%(3363/3658)、85.24%(3118/3658)、96.61%(3534/3658)、87.64%(3206/3658)、92.62%(3388/3658)、86.80%(3175/3658)、90.08%(3295/3658)、84.53%(3092/3658)、95.02%(3476/3658)和89.99%(3292/3658)。问题Q1、Q2、Q3、Q5和Q8与地理分布呈负相关(r值分别为-0.032、-0.032、-0.030、-0.031和-0.030,均P<0.05);而Q3、Q7和Q9与医师职业呈负相关(r值分别为-0.030、-0.033和-0.040,均P<0.05);Q3、Q8和Q9、Q10与医院级别呈负相关(r值分别为-0.039、-0.042和-0.053、-0.035,均P<0.05);Q1、Q4、Q6、Q7、Q8和Q10与医师职称呈负相关(r值分别为-0.079、-0.032、-0.035、-0.030、-0.030和-0.052,均P<0.05)。结论颈部动脉超声若干问题均需要“专家共识”。“专家共识”的紧迫性与地理分布、医院级别、医师职称级别相关;“专家共识”有利于消除不同级别超声医师之间的认知差异性,统一标准,规范报告,实现质量控制。

Objective To investigate the necessity of several issues of vascular ultrasound referring to the formulation of Chinese expert consensuses for Chinese ultrasound doctors.Methods Ultrasound doctors or related professional doctors in hospitals at all levels over the country were taken as the research object,using the questionnaires survey by WeChat on the mobile phone to investigate and analyze whether expert consensus should be established on several problems of carotid vascular ultrasonography.The questions involved in the diagnosis and differential diagnosis of carotid artery plaques(Q1-Q3),the evaluation of ultrasonography for the vulnerable plaques(Q4 and Q5),the diagnostic criteria of carotid stenosis(Q6-Q8),and the abnormal development and course of the carotid artery(Q9-Q11).The R×C contingency table chi-square test was used to analyze the correlation of Kendall′s tau-b classification variables.Results All 3658 valid questionnaires were collected from various physicians at all levels of hospitals in 34 provinces,municipalities,and autonomous regions.The response rate of the questionnaire has some differences in the regional division,hospital level,and professional title.Among them,the highest responding rates were in east China,at the top three hospitals,and from the attending physicians,with the rates of 43.44%(1589/3658),45.90%(1679/3658)and 41.53%(1519/3658),respectively.The cumulative response rates for the necessary consensus from Q1 to Q11 were 81.00%(2963/3658),91.94%(3363/3658),85.24%(3118/3658),96.61%(3534/3658),87.64%(3206/3658),92.62%(3388/3658),86.80%(3175/3658),90.08%(3295/3658),84.53%(3092/3658),95.02%(3476/3658),and 89.99%(3292/3658),respectively.Q1,Q2,Q3,Q5,and Q8 were negatively correlated with geographic divisions(r=-0.032,-0.032,-0.030,-0.031,and-0.030,all P<0.05),while Q3,Q7,and Q9,were negatively correlated with occupations(r=-0.030,-0.033,and-0.040,all P<0.05),Q3,Q8,and Q9,Q10 were negatively correlated with hospital grades(r=-0.039,-0.042,and-0.053,-0.035,all P<0.05).Q1,Q4,Q6,Q7,Q8,and Q10 were negatively correlated with doctors′titles(r=-0.079,-0.032,-0.035,-0.030,-0.030,and-0.052,all P<0.05).Conclusions Several problems of carotid artery ultrasound need expert consensus.The urgency of expert consensus is related to the region,hospital level,and doctor title level.Expert consensus is conducive to eliminating the cognitive differences between different levels of ultrasound physicians,unifying standards,standardizing reports,and achieving quality control.