基层医院慢性阻塞性肺疾病的诊治现状研究

摘要

目的：了解基层医院对慢性阻塞性肺疾病（COPD）的诊断状况及内科医师对COPD相关知识的认知程度，为基层医院提高诊治水平提供必要依据。方法：2010年7月-2013年6月符合COPD诊断的291例患者资料进行回顾性分析，了解漏诊、误诊情况并分析原因，同时采用问卷调查方式对30名内科医师进行COPD相关知识的调查，内容包括临床症状、诊断标准、诊断手段等共10道选择题，统计总体正确率。结果：291例COPD患者误诊率为11.34%，漏诊率为10.08%；基层医院内科医师对COPD的诊疗知识选择正确率前三位分别为COPD的主要临床表现、COPD的诊断标准、气流受限的诊断标准，分别占56.67%、53.33%和40.00%，正确率最低的问题为COPD给患者的最大影响，仅为13.33%。结论：基层医院对于COPD的漏诊、误诊率较高，主要受到经济条件、医疗人才配备及医师在职学习积极性等因素的影响。内科医师对COPD的认知程度普遍较低，建议通过讲座、培训等措施来改进基层内科医师的疾病诊疗认知水平，减少COPD的漏诊、误诊发生率，全面提高医疗质量。%Objective:To understand the primary hospital for chronic obstructive pulmonary disease (COPD) in the diagnosis and the department of internal medicine physicians knowledge on COPD, than provide the necessary basis for improve the level of diagnosis and treatment in primary hospital.Method: The clinical data of 291 patients with diagnosis of COPD from July 2010 to June 2013 were analyzed retrospectively,the missed diagnosis ,misdiagnosis and its reasons were analyzed.At the same time, the investigation method of the questionnaire about the survey of COPD related knowledge was given for the 30 Department of internal medicine physician, including clinical symptoms, diagnostic criteria, diagnostic methods and so on, a total of 10 multiple-choice questions, the overall correct rate was statisticed. Result: 291 patients with misdiagnosis rate of COPD was 11.34%, the missed diagnosis rate was 10.08%;department of internal medicine physicians in grass-roots hospitals of COPD correct diagnosis rate for the top three respectively was COPD clinical manifestations of 56.67%, COPD diagnostic criteria of 53.33%and airflow limitation of 40.00%,the lowest rate of correct problem was maximum effect for COPD patients, only 13.33%.Conclusion:Primary hospital for COPD misdiagnosis and the misdiagnosis rate are higher, mainly due to economic conditions, the influence of physicians with medical on-the-job learning enthusiasm and other factors.Department of internal medicine physicians cognition of COPD is generally low, suggestions through lectures, training and other measures to improve the primary physician disease diagnosis and treatment of cognitive level, reduce the incidence of missed diagnosis and misdiagnosis of COPD and improve medical quality.