基层医院慢性心力衰竭治疗现状调查

摘要

目的 调查基层医院慢性心力衰竭患者的治疗现状及相关影响因素.方法 于2015年6月对聊城市各县区县级医院和乡镇医院进行调查,纳入各县的县级医院1个,共纳入7个县级医院,并在各县内采用随机数字表法抽取2个乡镇医院,共纳入14个乡镇医院.以调查当天的值班医生为调查对象,调查患者为所调查医生近3个月治疗的心力衰竭住院患者.自行设计医生调查问卷,包括性别、年龄、获得医师资格年限、对心力衰竭指南的态度、是否取得心内科医师资格、缺乏心力衰竭指南的学习资料、医生对心力衰竭指南的掌握程度、医院的硬件设施以及是否重视心力衰竭患者的规范化治疗.统计调查医生近3个月治疗的心力衰竭住院患者的病历,包括患者基本信息、症状、体征、辅助检查结果及出院时心力衰竭药物的应用情况.结果 共调查医生64名,其中县级医院26名,乡镇级医院38名.两者性别、年龄、获得医师资格年限、对心力衰竭指南的态度得分比较,差异均无统计学意义(P>0.05).县级医院取得心内科医师资格所占比例、有足够心力衰竭指南学习资料所占比例、医生对心力衰竭指南的掌握程度得分、医院得分均高于乡镇级医院(P0.05),but higher percentage of doctors from county-level hospitals were cardiovascular physicians, adequacy of study materials about CHF guidelines,scored higher in mastering the CHF guidelines(P<0.05).Comprehensive scores of county-level hospitals were higher compared with township hospitals(P<0.05).Totaled 339 patients were enrolled, 290 them from county-level hospitals,and other 49 from township hospitals.The diastolic pressure value,prevalence of hypertension,coronary heart disease,arrhythmia,and enlargement of the heart,rates of serum BNP,creatinine,and electrolyte measurement,rate of undergoing echocardiography,and status of NYHA class were all different between the two groups(P<0.05).In terms of medication,154(45.4%) used cardiac stimulants,268(79.0%) used diuretics,201 (59.3%) used spironolactone,130(38.3%) used beta-blockers,and 150(44.2%) used ACEI/ARB.The use rate of cardiac stimulants,diuretics,spironolactone,beta-blockers,or ACEI/ARB differed significantly between the two groups (P<0.05).Conclusion CHF patients from township hospitals in Liaocheng could not receive standardized treatment,which may be associated with poor hardware facilities,doctors' lack of study materials,and hospitals paying insufficient attention to the treatment.In contrast,the county-level hospitals have conditions for treating CHF,but the medication prescribed for patients was not standardized.