【摘要】： 研究目的：通過以臨床醫(yī)師對(duì)兒童阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive sleep apnea hypopnea syndrome, OSAHS)流行病學(xué)、病理生理學(xué)機(jī)制、患者癥狀、診斷、并發(fā)癥和治療等六個(gè)方面掌握的程度為基本知識(shí)點(diǎn),對(duì)兒童OSAHS重要性以及診斷治療能力和自信狀況的自我評(píng)估作為認(rèn)識(shí)程度的等級(jí)分類,對(duì)臨床醫(yī)師進(jìn)行兒童OSAHS認(rèn)知度的調(diào)查。以期提高臨床醫(yī)師對(duì)兒童OSAHS的識(shí)別能力,確定適當(dāng)診斷程序,鑒別與兒童OSAHS相關(guān)的危險(xiǎn)因素,評(píng)價(jià)OSAHS治療方式的選擇。 研究方法：采用美國兒童阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive sleep apnea hypopnea syndrome, OSAHS)知識(shí)及態(tài)度問卷(OSA-KIDS)作為基本模式,于2009年5月-10月對(duì)山東省43所公立醫(yī)院的耳鼻喉科、小兒科共391名臨床醫(yī)師進(jìn)行問卷調(diào)查。 研究結(jié)果：1.臨床醫(yī)師對(duì)兒童OSAHS相關(guān)知識(shí)的掌握仍有待提高�；局R(shí)得分的順序依次為病理生理、并發(fā)癥、診斷、治療、流行病學(xué)、臨床表現(xiàn)。 2.只有五分之一多一點(diǎn)(24.30%)的臨床醫(yī)師知道兒童打鼾的強(qiáng)弱程度與OSAHS的嚴(yán)重程度無關(guān)；“嬰幼兒心臟呼吸監(jiān)測(cè)可作為中樞性與阻塞性呼吸暫停的可靠鑒別手段”的正確回答率只有16.11%。 3.耳鼻喉科和小兒科臨床醫(yī)師在兒童OSAHS相關(guān)知識(shí)的總得分方面無顯著性差異。但是在以下兩個(gè)條目的回答上有明顯統(tǒng)計(jì)學(xué)差異：“大約有2%的兒童患有OSAHS”耳鼻喉科醫(yī)師回答正確率較高,“兒童OSAHS可以導(dǎo)致肺動(dòng)脈高壓”小兒科醫(yī)師回答正確率較高。 4.臨床醫(yī)師在總體知識(shí)得分方面與男女性別無關(guān)。但女性在有關(guān)診斷知識(shí)得分方面明顯高于男性。 5.總體知識(shí)得分與學(xué)歷、職稱無顯著性相關(guān),與醫(yī)師所在醫(yī)院的級(jí)別有明顯相關(guān)關(guān)系：流行病學(xué)平均知識(shí)得分和診斷平均知識(shí)得分各級(jí)醫(yī)院醫(yī)師無顯著差異；省級(jí)醫(yī)院的醫(yī)師在總體知識(shí)得分的正確率、病理生理學(xué)知識(shí)平均得分正確率均高于縣級(jí)醫(yī)院的醫(yī)師；省級(jí)和縣級(jí)醫(yī)院的醫(yī)師在臨床表現(xiàn)方面的知識(shí)平均得分高于市級(jí)醫(yī)院的醫(yī)師；有關(guān)并發(fā)癥知識(shí)平均得分,省級(jí)、市級(jí)、縣級(jí)醫(yī)院依次降低。 6.總體知識(shí)回答正確率、自信心自我評(píng)價(jià)等級(jí)、態(tài)度總體平均分與醫(yī)師年齡和從事臨床工作的時(shí)間長短呈低度線性相關(guān)關(guān)系。 7.三分之二以上的醫(yī)師認(rèn)為“兒童OSAHS作為一種臨床疾病”“鑒別診斷兒童是否患有的OSAHS”重要、非常重要或極端重要,但是僅有不到三分之一的醫(yī)師對(duì)兒童OSAHS的診斷、治療感到自信；對(duì)疾病重要性的認(rèn)識(shí)與年齡、工作時(shí)間、職稱、學(xué)歷、性別無相關(guān)性；與診斷治療疾病的自信心之間呈等級(jí)相關(guān)關(guān)系。 8.耳鼻喉和小兒科醫(yī)師在“兒童OSAHS作為一種臨床疾病”和“鑒別診斷兒童是否患有的OSAHS”的重要性認(rèn)識(shí)上無顯著差異。但對(duì)于診斷兒童是否具有OSAHS風(fēng)險(xiǎn)和對(duì)于兒童OSAHS患者的治療條目的自我評(píng)價(jià)自信心方面,耳鼻喉科醫(yī)師自我評(píng)價(jià)自信心明顯高于小兒科醫(yī)師。 9.專家(主任醫(yī)師及副主任醫(yī)師)在自信心自我評(píng)價(jià)等級(jí)、總體態(tài)度等級(jí)均高于住院醫(yī)師；碩士、大學(xué)本科、�？飘厴I(yè)的醫(yī)師自信心自我評(píng)價(jià)等級(jí)明顯高于獲得博士學(xué)位的臨床醫(yī)師。 10.知識(shí)回答正確率、流行病、病理生理、臨床表現(xiàn)、診斷和治療基本知識(shí)平均得分與態(tài)度自我評(píng)價(jià)總得分、疾病重要性平均分呈低度線性正相關(guān)。上述幾項(xiàng)除病理生理知識(shí)平均得分外,其余皆與自信心平均得分呈低度線性正相關(guān)。說明對(duì)兒童OSAHS疾病知識(shí)掌握的越多,自我評(píng)價(jià)的認(rèn)知態(tài)度越積極。 11.對(duì)疾病診斷治療的自我評(píng)價(jià)自信心與臨床醫(yī)師的學(xué)歷高低呈等級(jí)相關(guān),與臨床職稱高低呈負(fù)等級(jí)相關(guān),即學(xué)歷越低,對(duì)疾病診斷治療的自信心自我評(píng)價(jià)越高；職稱越高,對(duì)疾病診斷治療的自我評(píng)價(jià)自信心越高。 12.在接受調(diào)查的臨床醫(yī)師中,有三分之二的人回答從未使用過CPAP,但仍有30.69%的臨床醫(yī)師表示對(duì)處理—接受CPAP治療的兒童OSAHS患者充滿自信或非常自信。對(duì)診斷治療兒童OSAHS越有信心者,處理接受CPAP治療的患兒也越有信心。處理接受CPAP治療患兒的自我信心評(píng)價(jià)與性別、學(xué)歷、工作單位無關(guān),與專業(yè)技術(shù)職稱有負(fù)等級(jí)相關(guān)關(guān)系。耳鼻喉科醫(yī)師和兒科醫(yī)師在處理接受CPAP治療的患兒自信心上無顯著差異。 結(jié)論：1.各級(jí)臨床醫(yī)師對(duì)兒童OSAHS的相關(guān)知識(shí)需加強(qiáng)學(xué)習(xí),尤其是在睡眠呼吸紊亂的臨床表現(xiàn)、睡眠呼吸監(jiān)測(cè)和CPAP治療方面。 2.隨著臨床醫(yī)師年齡和工作時(shí)間的增加,其對(duì)疾病的認(rèn)識(shí)和處理能力都相應(yīng)增強(qiáng)。臨床醫(yī)師對(duì)兒童OSAHS疾病越重視,態(tài)度越積極,知識(shí)得分也越高。 3.兒童OSAHS的繼續(xù)教育在基層醫(yī)院的臨床醫(yī)師中需加強(qiáng)。 4.應(yīng)加強(qiáng)臨床醫(yī)師對(duì)扁桃體和／或腺樣體切除術(shù)手術(shù)風(fēng)險(xiǎn)的評(píng)估。 5.小兒科醫(yī)師需提高對(duì)兒童OSAHS診斷和治療方面的自信心。 6.應(yīng)加強(qiáng)無創(chuàng)正壓呼吸機(jī)(CPAP)對(duì)兒童OSAHS治療有效性的廣泛宣傳,使各級(jí)臨床醫(yī)師了解CPAP治療的適應(yīng)癥、并發(fā)癥對(duì)提高兒童OSAHS治療的有效率有積極意義。
[Abstract]:Objective: To study the epidemiology of obstructive sleep apnea-hypopnea syndrome (OSAHS), the mechanism of pathophysiology, the symptoms, diagnosis, complications and treatment of the patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). The importance of OSAHS for children and the self-assessment of diagnosis and treatment capacity and self-confidence were classified as a level of awareness, and a survey of the child OSAHS awareness was conducted to the clinician. In order to improve the ability of the clinician to identify the OSAHS of the child, determine the appropriate diagnostic procedure, identify the risk factors associated with the OSAHS of the child, and evaluate the choice of the OSAHS treatment. Methods: Using the knowledge and attitude questionnaire (OSA-KIDS) of obstructive sleep apnea-hypopnea syndrome (OSAHS) in the United States as the basic model, the ears of 43 public hospitals in Shandong province from May to October 2009 were adopted. A total of 391 clinicians in the nasopharynx and pediatrics Volume survey. Results of the study:1. Clinician's knowledge about OSAHS in children Mastery is still to be improved. The order of the basic knowledge score is the pathophysiology, the complication, the diagnosis, the treatment, the epidemic 2. A more than one-fifth (24.30%) of the clinicians know that the degree of snoring is not related to the severity of the OSAHS; the correct "The monitoring of infant's heart respiration can be used as a reliable identification of central and obstructive sleep apnea." The response rate was only 16.11%.3. Otolaryngology and pediatric clinician in the children's OSAHS phase There was no significant difference in the overall score of the knowledge. However, there was a statistically significant difference in the responses to the following two entries: approximately 2% of the children had an OSAHS "otolaryngologist" answer to a higher rate, "Children's OSAHS can cause pulse hypertension" pediatrician answers high accuracy.4. The bed physician is independent of the gender of the male and female in the overall knowledge score. 5. There is no significant correlation between the overall knowledge score and the educational background and the professional title, and there is a clear correlation with the level of the hospital in which the doctor is located: the epidemiology average knowledge score and the diagnosis average knowledge score are not available at all levels of the hospital doctor significant difference; the accuracy of the general knowledge score of the physician in the provincial hospital is higher than that of the doctor in the county level hospital; the average score of the physician in the provincial and county level hospital is higher than that of the doctor in the municipal hospital; and the related and average score, provincial, municipal and county level hospitals.6. The overall knowledge response accuracy, self-evaluation grade of self-confidence, overall average attitude 7. More than two-thirds of the physicians believe that the "Children OSAHS as a clinical disease" differential diagnosis of the OSAHS is important, very important, or extremely important, but less than one-third of the physicians are interested in the OS of the child AHS diagnosis and treatment feel confident ; Recognition and age, working time and title of the importance of the disease 8. There was no significant difference in the importance of otolaryngology and pediatrician in children's OSAHS as a "clinical disease" and for children's OSAHS as a "clinical disease", but for the diagnosis of children OSAHS risk and treatment for children with OSAHS In the aspect of self-evaluation of self-confidence, the self-evaluation of the otorhinolaryngologist is significantly higher than that of the pediatrician. and the overall attitude level is higher than the resident doctor in the self-evaluation grade of the self-confidence; The degree of self-evaluation of self-confidence of a doctor who is a master's degree, a college degree or a special degree is significantly higher than that of a clinician who has a doctor's degree.10. Knowledge The average score of the basic knowledge of the correct rate, the epidemic, the pathophysiology, the clinical manifestation, the diagnosis and the treatment basic knowledge, the total score of the self-evaluation of the attitude and the mean score of the disease was positively correlated with the low degree of linearity. In addition to the score, the rest is the average of self-confidence The more positive the knowledge of the children's OSAHS disease, the more positive the cognitive attitude of self-evaluation. The grade is related, and is related to the negative grade of the clinical title. The lower the degree of education, the higher the self-evaluation of self-confidence in the diagnosis and treatment of the disease, the higher the professional title, the diagnosis of the disease. The higher the self-evaluation of the break-out therapy.12. In the clinician receiving the survey, two-thirds of the patients responded to the never-used CPAP, but 30.69% of the clinicians indicated that the OSAHS patient who was treated with CPAP treatment was full of self-confidence or very self-confidence. OSAH for the diagnosis and treatment of children The more confidence the S is, the more confident the child treated with CPAP is treated. The self-confidence evaluation of the patients treated with CPAP is independent of the gender, the degree of work and the work unit. There is a negative level of relationship with the professional technical title. The otorhinolaryngologist and the pediatrician are at the office There was no significant difference in the self-confidence of the children treated with CPAP. Conclusion:1. The relevant knowledge of the grade clinicians on the OSAHS of the child needs to be enhanced, especially in the aspects of the clinical presentation of the sleep disordered breathing, the sleep apnea monitoring and the CPAP treatment. . As the Clinician Year The increase of age and working time is corresponding to the knowledge and processing ability of the disease. The more important the bed doctor attaches to the children's OSAHS disease, the more positive the attitude is, the higher the knowledge score 3. The continuing education of the children's OSAHS is in the clinician of the grass-roots hospital Need to be strengthened.4. The assessment of the risk of the operation of the tonsils and/ or adenoidectomy should be enhanced by the clinician.5. The pediatrician needs to improve the self-confidence in the diagnosis and treatment of the OSAHS in the child.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R766

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