基于PCCM分级的肺科医生使用吸入性激素治疗慢性阻塞性肺疾病认知程度的调查研究

Investigation on the cognition degree of pulmonologists using inhaled corticosteroidto treat COPD based on PCCM classification

目的 调查重庆地区肺科医生按照慢性阻塞性肺疾病(简称慢阻肺)全球倡议(GOLD)推荐的吸入性激素(ICS)适应证使用ICS治疗慢阻肺患者的情况,探讨差异原因及解决方案。方法 2022年4-10月采用便利抽样法通过重庆市呼吸质控中心选取重庆地区公立医疗机构呼吸病学相关科室医生为研究对象。通过问卷调查,收集调查对象的一般情况、对GOLD的熟悉程度、ICS适应证的学习及思考,各项指征的参考得分,血嗜酸性粒细胞(EOS)依从情况等。结果 该研究共纳入381份有效问卷。GOLD总体阅读率为90.3%(344/381),肺科医生在门诊及病房工作时EOS的参考得分明显低于其他指征(P<0.05),呼吸与危重症医学科(PCCM)分级达标及以上单位的肺科医生能更好地遵循GOLD参考EOS(P<0.05)。门诊工作时36.5%(139/381)的肺科医生认为慢阻肺患者EOS水平稳定性差和EOS水平升高者少。结论 重庆地区肺科医生对ICS适应证的认知与PCCM规范化建设情况相关,应针对性加强指南宣教,积极推进PCCM规范化建设,进一步明确EOS的分界值。

Objective To describe the use of inhaled corticosteroid(ICS)of pulmonologists in Chongqing according to the indications recommended by the Global Initiative for Chronic Obstructive Pulmonary Disease(GOLD),and to explore the causes and solutions of the differences.Methods From April to October,2022,doctors from respiratory departments of public medical institutions in Chongqing were selected by convenient sampling method through Chongqing Respiratory Quality Control Center as the research object.Through the questionnaire survey,the general situation of the respondents,their familiarity with GOLD,their study and thinking on ICS indications,the reference scores of various indications,and the compliance of blood eosinophils(EOS)were collected.Results A total of 381 valid questionnaires were included in this study.The overall reading rate of GOLD was 90.3%(344/381),and the reference score of EOS for pulmonologists working in outpatient and ward was significantly lower than other indicators(P<0.05).The pulmonologist in units with Pulmonary and Critical Care Medicine(PCCM)grade up to standard and above can better follow the GOLD reference EOS(P<0.05).36.5%(139/381)of pulmonary doctors who worked in the outpatient department thought that the EOS level in patients with COPD was unstable and the EOS level increased less.Conclusion The cognition of pulmonologist in Chongqing on ICS indications is related to the PCCM standardization construction.We should strengthen the guidance and education,actively promote the PCCM standardization construction,and further clarify the demarcation value of EOS.