妇产科医师对患者血液管理认知调查研究

Investigation on the cognition of obstetricians and gynecologists regarding patient blood management

目的探讨国内妇产科医师对患者血液管理(PBM)的认知情况。方法选择2023年3月至6月采用便利抽样法抽取的全国29个省市330名妇产科医师为调查对象(以下简称为被调查对象)。采取线上与线下方式,对被调查对象采用本研究自行设计的《患者血液管理认知度调查问卷》进行调查。该问卷主要包括以下3个方面内容。①被调查对象的一般资料;②被调查对象对PBM的认知水平及态度。③PBM中患者贫血评估与治疗相关内容。对不同年龄、专业技术职称、工作年限被调查对象的PBM熟悉程度进行统计学分析,组间比较采用χ2检验,进一步两两比较,采用Bonferroni法调整检验水准。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①本研究共计发放调查问卷339份,回收有效问卷330份,有效问卷回收率为97.3%。②本研究330名被调查对象中,非常了解/了解PBM者为208名(63.0%),听说过PBM/但是不了解者为111名(33.6%),从未听说过PBM者为11名(3.3%);阅读过PBM相关指南者为168名(50.9%),其中阅读过中国PBM相关指南者最多(162名,96.4%),阅读过澳洲PBM相关指南者最少(9名,5.4%)。319名了解PBM的被调查对象中,通过学术会议了解者(213名,66.8%)排名第1,通过在线课程了解者(75名,23.5%)排名为最后1名。③不同年龄段、专业技术职称、工作年限被调查对象对PBM熟悉程度分别比较,差异均有统计学意义(χ^(2)=39.30、46.91、31.00,P<0.001)。进一步两两比较结果显示,年龄为31~40岁、41~50岁、≥51岁被调查对象对PBM的熟悉程度,均优于21~30岁者,并且差异均有统计学意义(P<0.001);正高级、副高级专业技术职称者对PBM熟悉程度,均高于初、中级专业技术职称者,中级专业技术职称者对PBM熟悉程度优于初级专业技术职称者,并且差异均有统计学意义(P≤0.002);工作年限>20年、16~20年、11~15年者对PBM熟悉程度,均优于工作年限为0~5年者,工作年限>20年者对PBM熟悉程度,优于工作年限为6~10年者,并且差异均有统计学意义(P≤0.004)。④99.4%(328/330)被调查对象认为,有必要实施PBM;100.0%(330/330)表示,新型冠状病毒疾病(COVID-19)疫情导致血液资源愈发紧张,临床对PBM应更加重视;96.1%(317/330)和93.9%(310/330)被调查对象认为,积极组织PBM知识科普与培训、积极开展PBM技能培训,将有利于临床对PBM的实施。结论国内妇产科医师对PBM的认知水平有待提高,有必要建立PBM知识教育和培训体系,加大对国内专业技术职称低的年轻妇产科医师及基层妇产科医师的教育和培训力度,规范临床对PBM诊疗实践。

Objective To explore the cognition of patient blood management(PBM)among obstetricians and gynecologists in China.Methods Through convenience sampling,330 obstetricians and gynecologists(hereafter referred as surveyed subjects)from 29 provinces and cities were surveyed from March to June 2023 using a self-designed questionnaire on Patient Blood Management Cognition Survey,administered both online and offline.The questionnaire consisted of three main sections:general information of the survey participants,their knowledge and attitude towards PBM,and evaluation and treatment of anemia in PBM.Differences in PBM familiarity among surveyed subjects of different ages,professional titles,and years of practice were analyzed by chi-square test,and further pairwise comparisons were conducted by Bonferroni method to adjust the significance level.The study adhered to the ethical guidelines of the World Medical Association Declaration of Helsinki revised in 2013.Results①Out of 339 distributed questionnaires,330 were validly returned,yielding a response rate of 97.3%.②Of 330 surveyed subjects,208(63.0%)were very familiar or familiar with PBM,111(33.6%)had heard of PBM but lacked understanding,and 11(3.3%)had never heard of it.A total of 168 surveyed subjects(50.9%)had read PBM-related guidelines,predominantly Chinese PBM-related guidelines(162 surveyed subjects,96.4%),and least frequently Australian PBM-related guidelines(9 surveyed subjects,5.4%).Among 319 surveyed subjects who knew PBM,academic conferences were the most cited source of PBM knowledge(213 surveyed subjects,66.8%),with online courses being the least(75 surveyed subjects,23.5%).③There were statistical differences in familiarity with PBM among surveyed obstetricians and gynecologists with different ages,professional titles,and years of practice(χ^(2)=39.30,46.91,31.00;P<0.001).Further pairwise comparisons revealed that physicians aged 31-40 years,41-50 years,≥51 years showed greater familiarity with PBM compared to those aged 21-30 years,and the differences all were statistically different(P<0.001);surveyed subjects with senior and associate senior professional titles were more familiar with PBM compared to those with junior and intermediate professional titles,and surveyed subjects with intermediate professional titles were more familiar with PBM than those with junior professional titles,and these differences were statistically significant(P≤0.002);surveyed subjects with more than 20 years,16-20 years,11-15 years of practice all were more familiar with PBM than those with 0-5 years of practice,and surveyed subjects with more than 20 years of practice were more familiar with PBM than those with 6-10 years of practice,and all differences were statistically significant(P≤0.004).④A significant majority(99.4%,328/330)recognized the necessity of implementing PBM;all respondents(100%,330/330)agreed on the heightened importance of PBM in the context of the COVID-19 pandemic and the resulting strain on blood resources.Moreover,96.1%(317/330)and 93.9%(310/330)believed that organizing PBM knowledge promotion and skill training sessions would facilitate PBM implementation.Conclusions The level of cognition and understanding of PBM among obstetricians and gynecologists needs to be improved.Establishing a PBM knowledge education and training system is essential,with increased focus on educating and training young physicians,those with lower professional titles,and primary care physicians,to standardize PBM treatment practices.