CAJ | 학술논문

目的比较综合医院与社区医院医师对良性前列腺增生(BPH)患者诊治策略的差异,为诊治规范化提供科学依据. 方法对我国各地城市综合和社区医院进行分层抽样,随机抽取了于2010年12月至2011年12月在门诊就诊的BPH患者进行调查,共收集127325份问卷,剔除不符合BPH诊断或年龄不合要求的问卷718份,得到有效问卷126607份,其中综合医院115909份,社区医院10698份,总有效率99.44％. 结果患者平均年龄(67.8±8.6)岁,综合医院和社区医院BPH患者的IPSS评分、前列腺体积、尿流率和直肠指诊结果均不相同.除IPSS评分外,其他诊断方法的使用率在两类医院医师中均不相同,且地区差异大,其中华北地区综合医院的直肠指诊率高于社区医院,而超声与尿流率检查率低于社区；华东地区与华北完全相反；华南地区直肠指诊和尿流率检查应用率极低,而超声检查较高,且社区高于综合医院.药物治疗是BPH患者的首要治疗方法(97.53％),两类医院医生联合用药的比例差异有统计学意义但均接近75％.社区医院中,重度症状和体征患者等待观察的比例低于中度症状患者,但手术治疗比例未显著增加；而在综合医院中,重度症状和体征患者手术治疗的比例高于中度症状患者,但等待观察的比例却无降低. 结论两类医院医师诊断方法的应用不同,且存在地区差异；治疗策略与症状或体征的严重程度相关,两类医院医师的用药策略接近.
목적 비교종합의원여사구의원의사대량성전렬선증생(BPH)환자진치책략적차이,위진치규범화제공과학의거. 방법 대아국각지성시종합화사구의원진행분층추양,수궤추취료우2010년12월지2011년12월재문진취진적BPH환자진행조사,공수집127325빈문권,척제불부합BPH진단혹년령불합요구적문권718빈,득도유효문권126607빈,기중종합의원115909빈,사구의원10698빈,총유효솔99.44％. 결과 환자평균년령(67.8±8.6)세,종합의원화사구의원BPH환자적IPSS평분、전렬선체적、뇨류솔화직장지진결과균불상동.제IPSS평분외,기타진단방법적사용솔재량류의원의사중균불상동,차지구차이대,기중화북지구종합의원적직장지진솔고우사구의원,이초성여뇨류솔검사솔저우사구；화동지구여화북완전상반；화남지구직장지진화뇨류솔검사응용솔겁저,이초성검사교고,차사구고우종합의원.약물치료시BPH환자적수요치료방법(97.53％),량류의원의생연합용약적비례차이유통계학의의단균접근75％.사구의원중,중도증상화체정환자등대관찰적비례저우중도증상환자,단수술치료비례미현저증가；이재종합의원중,중도증상화체정환자수술치료적비례고우중도증상환자,단등대관찰적비례각무강저. 결론 량류의원의사진단방법적응용불동,차존재지구차이；치료책략여증상혹체정적엄중정도상관,량류의원의사적용약책략접근.
Objective To comparing the diagnostic and therapeutic strategies for patients with benign prostatic hyperplasia(BPH) between doctors in general hospitals and community hospitals,and to provide scientific clues for the standardization in medical practice.Methods General and community hospitals in urban China were selected via the stratified sampling.127,325 outpatients in these hospitals from December 2011 to December 2012 were randomly recruited.Results The average age of patients was(67.82±8.62) years.There were significant differences in I-PSS,prostate volume,urinary flow rate(UFR) and result of digital rectal examination(DRE) between patients in general and community hospitals.The rates of diagnostic applications were different between doctors in the two kinds of hospitals except I-PSS.Compared with community hospitals,DRE was more frequently applied while ultrasonic inspection and UFR test were less used in general hospitals in North China.A totally opposite situation was observed in East China as compared with the north.The application rates of DRE and UFR test were lower and ultrasonic inspection rate was higher in community hospitals than in general hospitals in South China.Pharmacotherapy was the most common treatment for BPH patients in both types of hospitals(97.53 ％).The rates of drug combinations were statistically different but both were close to 75％ in the two types of hospitals.In community hospitals,the percentage of patients receiving watchful waiting with severe symptoms and signs were lower than that of patients receiving watchful waiting with moderate symptoms and signs,but the percentage of patients receiving operation was not significantly increased.On the contrary,the percentage of patients receiving operation with severe symptoms and signs was higher than that of patients receiving operation with moderate symptoms and signs in general hospitals,but the percentage of patients receiving watchful waiting was not decreased.Conclusions Applications of diagnostic methods are significantly different between doctors in general hospitals and community hospitals and vary among regions.Therapeutic strategies are correlated with the severity of obstructive symptoms or signs.The medication strategy is similar between the two types of doctors.