超声科医师对胎儿闭合性脊柱裂诊断标准的掌握现状及影响因素分析

Analysis on mastery status of diagnostic criteria on fetal closed spina bifida by sonographers and influencing factors

目的探讨从事产前超声检查的超声科医师对胎儿闭合性脊柱裂诊断标准的掌握情况。方法2021年3月至2022年3月,在从事中孕期系统超声筛查工作的超声科医师中,发放关于胎儿闭合性脊柱裂产前筛查的调查问卷260份。初次问卷结束后,每周发放闭合性脊柱裂产前诊断及预后的相关资料,3个月后再次评估调查对象的掌握情况。统计学分析采用χ^(2)检验和二元Logistic回归分析。结果回收有效问卷237份,回收率91.2%(237/260)。单因素分析结果显示,年龄较大、从业年限较长、学历较高、有培训经历、检出过胎儿脊柱裂的超声科医师,对胎儿闭合性脊柱裂的掌握率较高(P值均<0.05)。二元Logistic回归模型分析结果显示,年龄、从业年限、学历、参与培训经历、检出过胎儿脊柱裂均为超声科医师掌握胎儿闭合性脊柱裂的影响因素(P值均<0.05)。相对于年龄<30岁者,30~<45岁(OR=4.351,95%CI:0.167~0.729)、≥45岁(OR=10.510,95%CI:0.225~0.823)的医师掌握程度更好;相对于从业年限<5年者,5~<10年(OR=4.624,95%CI:0.146~0.687)以及≥10年(OR=5.256,95%CI:0.224~0.895)的医师掌握程度更好;相对于本科以下学历者,本科(OR=2.424,95%CI:0.269~0.758)和本科以上(OR=5.819,95%CI:0.174~0.853)的医师掌握程度更好;相对于无培训经历者,有参与培训经历(OR=4.349,95%CI:0.294~0.801)的医师掌握程度更好;相对于未检出过胎儿脊柱裂者,检出过胎儿脊柱裂(OR=3.404,95%CI:0.182~0.836)的医师掌握程度更好。初次问卷调查中,超声科医师对闭合性脊柱裂的超声诊断标准掌握率为32.1%(76/237);培训3个月后,掌握率提高至88.6%(210/237)(χ^(2)=158.294,P<0.001)。结论从事产前超声检查工作的部分超声科医师未掌握胎儿闭合性脊柱裂的诊断标准,应加强专业培训和宣传推广。

Objective To explore the mastery of diagnostic criteria on fetal closed spina bifida by sonographers who work in prenatal ultrasonography.Method From March 2021 to March 2022,260 questionnaires on prenatal screening of fetal closed spina bifida were distributed among sonographers who engaged in systematic ultrasound screening during second trimester of pregnancy.After the initial questionnaire,data on the prenatal diagnosis and prognosis of closed spina bifida were distributed weekly,and their knowledge was evaluated again three months later.Chi-square test and binary Logistic regression were used for statistical analysis.Result 237 valid questionnaires were collected,with a recovery rate of 91.2%(237/260).The results of single factor analysis showed that sonographers with older age,longer years of practice,higher education,training experience and detection of fetal spina bifida had a higher rate of mastery of fetal closed spina bifida(P<0.05).Binary Logistic regression model analysis showed that age,working years,educational background,training experience,and detection of fetal spina bifida were all influencing factors for sonographers to master fetal closed spina bifida(P<0.05).Compared with those<30 years old,sonographers aged 30-<45 years old(OR=4.351,95%CI:0.167-0.729)and≥45 years old(OR=10.510,95%CI:0.225-0.823)had better mastery.Compared with those with less than 5 years of practice,sonographers with 5-<10 years(OR=4.624,95%CI:0.146-0.687)and≥10 years(OR=5.256,95%CI:0.224-0.895)had better mastery.Compared with those with less than bachelor's degree,those with bachelor's degree(OR=2.424,95%CI:0.269-0.758)and higher than bachelor's degree(OR=5.819,95%CI:0.174-0.853)had better mastery.Compared with those without training experience,sonographers with training experience(OR=4.349,95%CI:0.294-0.801)had better mastery.Those who had detected fetal spina bifida(OR=3.404,95%CI:0.182-0.836)had better mastery than those who had not.In the initial questionnaire survey,the mastery rate of ultrasound diagnostic criteria for closed spina bifida was 32.1%(76/237).After 3 months of training,the mastery rate increased to 88.6%(210/237)(χ^(2)=158.294,P<0.001).Conclusion Some sonographers who engage in prenatal ultrasonography do not master the diagnostic criteria of fetal closed spina bifida.Professional training and publicity should be strengthened.