本文選題：慢性阻塞性肺疾病 + 診斷　； 參考：《中南大學(xué)》2012年碩士論文

【摘要】：目的：了解COPD短期教育對二級醫(yī)院內(nèi)科醫(yī)師COPD相關(guān)基本知識掌握水平的影響；了解短期教育后配備肺功能儀對二級醫(yī)院內(nèi)科醫(yī)師診治COPD水平的影響。方法：隨機(jī)抽取湖南省8家未配備肺功能儀的二級醫(yī)院,首先,在這些醫(yī)院召集自愿參加COPD短期教育的門診部和住院部內(nèi)科醫(yī)師,對他們進(jìn)行關(guān)于COPD指南的教育講座,并在教育前、后對內(nèi)科醫(yī)師進(jìn)行COPD知識問卷測試,最后比較短期教育前、后問卷平均分和各題正確率之間的差異；第二階段,COPD短期教育后立即在4家二級醫(yī)院門診免費(fèi)配備肺功能儀1個月,研究者在門診收集符合入選／排除標(biāo)準(zhǔn)的受試患者,并在受試患者就診內(nèi)科醫(yī)師前為其行肺功能檢查。在內(nèi)科醫(yī)師閱讀肺功能報告前、后,他們需分別在問卷上回答受試患者是否患有COPD,若有COPD,則繼續(xù)回答COPD嚴(yán)重程度分級及為COPD患者開處方等問題。最后比較內(nèi)科醫(yī)師閱讀肺功能報告前、后對各題回答的差異。 結(jié)果：第一階段,207名內(nèi)科醫(yī)師參與了COPD短期教育講座,并在教育前、后分別完成COPD知識問卷測試,教育前COPD知識問卷平均分為53.14±21.73分,教育后平均分為93.33±9.75分,差異具有統(tǒng)計學(xué)意義(P0.001)；短期教育前、后COPD知識問卷各題正確率比較,經(jīng)χ2檢驗差異有統(tǒng)計學(xué)意義(P0.0001)。第二階段,共18名門診內(nèi)科醫(yī)師、307名受試患者參加了本研究,119名受試患者被診斷COPD,患病率為38.76%(119/307),其中,無呼吸系統(tǒng)癥狀COPD受試者人數(shù)為39人(32.77%)。閱讀肺功能報告前、后,內(nèi)科醫(yī)師對受試者診斷的正確率分別為76.55%(235/307)和97.39%(299/307),差異有統(tǒng)計學(xué)意義(P0.0001)；漏診率分別為28.57%(34/119)和1.68%(2/119),差異有統(tǒng)計學(xué)意義(P0.0001)；誤診率分別為20.21%(38/188)和3.19%(6/188),差異有統(tǒng)計學(xué)意義(P0.0001)；對COPD嚴(yán)重程度分級診斷的正確率分別為25.21%(30/119)和87.39%(104/119),差異有統(tǒng)計學(xué)意義(P0.0001)；對COPD嚴(yán)重程度分級診斷的低估率分別為40.34%(48/119)和6.72%(8/119),差異有統(tǒng)計學(xué)意義(P0.0001)；對COPD受試患者開具處方治療的正確率分別為18.49%(22/119)和84.03%(100/119),差異有統(tǒng)計學(xué)意義(P0.0001)。 結(jié)論：COPD短期教育能有效地提高內(nèi)科醫(yī)師對COPD相關(guān)基本知識的掌握水平；COPD短期教育聯(lián)合配備肺功能儀可以提高內(nèi)科醫(yī)師對COPD勺正確診斷能力及對COPD嚴(yán)重程度正確分級的能力,開具COPD處方正確性與診斷COPD嚴(yán)重程度分級正確性密切正相關(guān)。
[Abstract]:Objective: to understand the influence of short term education on the level of basic knowledge of COPD among physicians in second level hospitals and the effect of equipping pulmonary function instrument on the level of diagnosis and treatment of COPD. Methods: eight second-level hospitals without pulmonary function instrument were randomly selected. First of all, physicians of outpatient and inpatient departments who volunteered to participate in short-term education of COPD were gathered in these hospitals, and they were given educational lectures on COPD guidelines. Before and after education, physicians were tested with COPD knowledge questionnaire. Finally, the differences of average score and correct rate of each question before and after short-term education were compared. The second stage of COPD short-term education immediately after the four level II hospital outpatient clinic free of charge equipped with pulmonary function instrument for one month, the researchers in the outpatient service to collect patients who meet the inclusion / exclusion criteria. The pulmonary function of the patients was examined before they were treated by a physician. Before and after the physicians read the pulmonary function report, they were asked to answer questions about whether the patients had copd and, if there was, to continue answering questions such as the severity of COPD and prescribing for COPD patients. Results: in the first stage, 207 physicians participated in the short term education lecture on COPD, and before and after the education, they completed the COPD knowledge questionnaire test, respectively. The average score of COPD knowledge questionnaire before and after education was 53.14 鹵21.73 and 93.33 鹵9.75, respectively, the difference was statistically significant (P 0.001), and the correct rate of COPD knowledge questionnaire before and after short term education was significantly higher than that before and after education (P 0.0001). In the second stage, a total of 18 outpatient physicians and 307 patients participated in this study. 119 of the patients were diagnosed with COPD.The prevalence rate was 38.76 / 307. The number of COPD subjects without respiratory symptoms was 38.76 / 307. The number of subjects with COPD without respiratory symptoms was 32.77g. Read the lung function report before, after, The diagnostic accuracy of physicians to the subjects were 76.55 / 235 / 307) and 97.39% respectively. The difference was statistically significant (P 0.0001); the missed diagnosis rates were 28.5757 / 34 / 119) and 1.68 / 2 / 119, respectively (P 0.0001); the misdiagnosis rates were 20.21 1 / 38 / 188) and 3.19% / 188%, respectively. The difference was statistically significant. The accuracy rates of grading diagnosis were 25.21% and 87.39% respectively, the difference was statistically significant (P 0.0001); the underestimation rate of COPD severity grading diagnosis was 40.34% 48 / 119) and 6.72% / 119 respectively, the difference was statistically significant (P 0.0001); the correct rate of prescribing treatment for COPD patients was significantly higher than that of control group (P < 0.05), and the difference was statistically significant (P < 0.05), and the difference was statistically significant (P < 0.05); the correct rate of prescribing treatment for COPD patients was significantly higher than that of control group (P < 0.05), and the difference was significant (P < 0.01). The difference is statistically significant (P 0.0001). Conclusion Short-term education of COPD can effectively improve physicians' mastery of basic knowledge related to COPD and the combination of short-term education with pulmonary function instrument can improve physicians' accuracy in COPD. Diagnostic ability and ability to correctly grade the severity of COPD, The correctness of prescribing COPD is closely related to the classification accuracy of COPD severity.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R563.9

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本文編號：2009338