我国新生儿科医师对超早产儿的救治态度:横断面调查

Attitudes of neonatologists towards treatment of extremely preterm infants in China:a cross-sectional survey

目的:了解我国新生儿科医师对超早产儿的救治态度。方法:采用横断面调查方式,制定调查问卷后于2021年6~7月通过问卷星app网络分发。调查对象主要为各省市新生儿科医师。调查内容包括参加调查者基本信息,超早产儿救治经验,对超早产儿的救治态度和对我国早产儿定义认同情况等。对所得数据采用描述性统计分析方法或χ^(2)检验进行统计学分析。结果:共收回1066位新生儿科医师的有效问卷。参加调查的医师中,男性322人,女性744人,副高职称以上占78.1%(832/1066),来自三级医院者占82.8%(882/1066),83.0%(885/1066)有过救治超早产儿经历。63.0%(672/1066)的受调查医师认为应积极复苏的超早产儿胎龄下限为25周或更低,57.1%(609/1066)认为我国目前早产儿定义为胎龄28周及以上不合适,75.2%(458/609)认为早产儿定义的胎龄下限应该为≤25周,或不设下限。54.3%(579/1066)医师认为其所在医院超早产儿放弃治疗常见或非常常见,83.3%(888/1066)认为放弃治疗的主要原因为家属担忧预后。71.6%(763/1066)医师曾因是否救治超早产儿而纠结,83.9%(640/763)纠结的原因为对预后没有把握,或担心预后不良引发医疗纠纷。32.7%(349/1066)本人或同事陷入过因超早产儿是否该救治引发的医疗纠纷。74.8%(797/1066)认为超早产儿是否救治应由早产儿父母决定。结论:我国大部分新生儿科医师对超早产儿持积极救治态度,并认为现行早产儿定义的胎龄下限应该调低,但对超早产儿救治的纠结态度仍较为普遍。对预后的不确定仍是关注焦点。

Objective To investigate the attitude of neonatologists toward the treatment of extremely preterm infants(EPIs)in China.Methods A cross-sectional survey was conducted using a questionnaire designed and posted on Wenjuanxing,a web-based survey platform,from June to July 2021.The respondents were neonatal physicians in various provinces and cities in China.The questionnaire covered the basic information,treatment experience and attitude towards EPIs,and opinions on the current definition of the preterm infant in China.The results were described or analyzed using the Chi-square test.Results A total of 1066 valid replies were collected.The respondents included 322 males and 744 females,among whom 78.1%(832/1066)were assistant director physicians or director physicians,82.8%(882/1066)were from tertiary hospitals,and 83.0%(885/1066)had the experiences of treating EPIs.In terms of the attitude toward the treatment of EPIs,63.0%(672/1066)of the respondents suggested that the lower limit of gestational age for EPIs requiring active resuscitation should be defined at 25 gestational weeks or less.Moreover,57.1%(609/1066)considered that the current domestic definition of preterm infants as 28 gestational age or above was inappropriate,and 75.2%(458/609)considered that the lower limit defined as preterm infants should be 25 gestational weeks or less.Concerning the treatment experience in EPIs,54.3%(579/1066)of the respondents suggested that in their hospital,withdrawing treatment in EPIs was common or very common,and 83.3%(888/1066)considered that the main reason for withdrawing treatment was family members'concerns about the prognosis.Those who hesitated about treating the EPIs accounted for 71.6%(763/1066),and 83.9%(640/763)hesitated due to the poor prognosis and possible medical disputes.Moreover,32.7%(349/1066)of the respondents or their colleagues had been involved in medical disputes about whether to treat EPIs,and 74.8%(797/1066)believed that the patients should be the decision-maker on whether to treat EPIs or not.Conclusion Most neonatal physicians in this survey hold a positive attitude toward the treatment of EPIs and believe that the lower limit of gestational age for preterm infants should be lowered.However,a hesitating attitude to the care of EPIs is still common,and uncertainty about the prognosis of EPIs remains a concern.