中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2014年
8期
601-605
,共5页
沈敏学%胡明%史静琤%祖雄兵%孙振球%杨芳
瀋敏學%鬍明%史靜琤%祖雄兵%孫振毬%楊芳
침민학%호명%사정쟁%조웅병%손진구%양방
前列腺增生%泌尿外科医师%老年科医师%诊断策略%用药策略
前列腺增生%泌尿外科醫師%老年科醫師%診斷策略%用藥策略
전렬선증생%비뇨외과의사%노년과의사%진단책략%용약책략
Prostatic hyperplasia%Urologist%Geriatrician%Diagnosis strategy%Medication strategy
目的 比较泌尿外科与老年科医师对良性前列腺增生(BPH)患者诊断与用药策略的差异,推动我国BPH临床诊疗实践的规范化.方法 对我国各地城市综合医院的泌尿外科和老年科进行分层抽样,整群抽取了2010年12月至2011年12月特定日期在门诊就诊的BPH患者共145 315人进行调查,由接诊医师填写问卷.对患者一般特征、两科医师诊断和治疗BPH的方法进行对比.结果 共收集有效问卷142 511份,其中泌尿外科119 426份,老年科23 085份.患者年龄(68.34±8.61)岁,症状评分(17.93±4.73)分.诊断依据使用率由高到低依次为症状评分(99.2％)、超声检查(86.0％)、直肠指检(66.0％)和尿流率检查(55.2％),其中泌尿外科的超声检查率低于老年科,其余项检查率均高于老年科,直肠指检率是后者的2.2倍,以上差异均有统计学意义(p＜0.01).对于中、重度BPH患者,泌尿外科医师以联合用药为主(中度72.1％,重度79.9％),其应用率为老年科的2倍(p＜0.01);老年科医师以单独用药为主(中度59.7％,重度56.1％).泌尿外科对α受体阻滞剂、植物制剂和中药的应用率高于老年科(P＜0.01).结论 泌尿外科医师对BPH的初步诊断策略比老年科医师更为全面.对于中、重度BPH患者,老年科医师倾向于单独应用5α还原酶抑制剂,泌尿外科医师倾向于联合应用5α还原酶抑制剂+α受体阻滞剂.
目的 比較泌尿外科與老年科醫師對良性前列腺增生(BPH)患者診斷與用藥策略的差異,推動我國BPH臨床診療實踐的規範化.方法 對我國各地城市綜閤醫院的泌尿外科和老年科進行分層抽樣,整群抽取瞭2010年12月至2011年12月特定日期在門診就診的BPH患者共145 315人進行調查,由接診醫師填寫問捲.對患者一般特徵、兩科醫師診斷和治療BPH的方法進行對比.結果 共收集有效問捲142 511份,其中泌尿外科119 426份,老年科23 085份.患者年齡(68.34±8.61)歲,癥狀評分(17.93±4.73)分.診斷依據使用率由高到低依次為癥狀評分(99.2％)、超聲檢查(86.0％)、直腸指檢(66.0％)和尿流率檢查(55.2％),其中泌尿外科的超聲檢查率低于老年科,其餘項檢查率均高于老年科,直腸指檢率是後者的2.2倍,以上差異均有統計學意義(p＜0.01).對于中、重度BPH患者,泌尿外科醫師以聯閤用藥為主(中度72.1％,重度79.9％),其應用率為老年科的2倍(p＜0.01);老年科醫師以單獨用藥為主(中度59.7％,重度56.1％).泌尿外科對α受體阻滯劑、植物製劑和中藥的應用率高于老年科(P＜0.01).結論 泌尿外科醫師對BPH的初步診斷策略比老年科醫師更為全麵.對于中、重度BPH患者,老年科醫師傾嚮于單獨應用5α還原酶抑製劑,泌尿外科醫師傾嚮于聯閤應用5α還原酶抑製劑+α受體阻滯劑.
목적 비교비뇨외과여노년과의사대량성전렬선증생(BPH)환자진단여용약책략적차이,추동아국BPH림상진료실천적규범화.방법 대아국각지성시종합의원적비뇨외과화노년과진행분층추양,정군추취료2010년12월지2011년12월특정일기재문진취진적BPH환자공145 315인진행조사,유접진의사전사문권.대환자일반특정、량과의사진단화치료BPH적방법진행대비.결과 공수집유효문권142 511빈,기중비뇨외과119 426빈,노년과23 085빈.환자년령(68.34±8.61)세,증상평분(17.93±4.73)분.진단의거사용솔유고도저의차위증상평분(99.2％)、초성검사(86.0％)、직장지검(66.0％)화뇨류솔검사(55.2％),기중비뇨외과적초성검사솔저우노년과,기여항검사솔균고우노년과,직장지검솔시후자적2.2배,이상차이균유통계학의의(p＜0.01).대우중、중도BPH환자,비뇨외과의사이연합용약위주(중도72.1％,중도79.9％),기응용솔위노년과적2배(p＜0.01);노년과의사이단독용약위주(중도59.7％,중도56.1％).비뇨외과대α수체조체제、식물제제화중약적응용솔고우노년과(P＜0.01).결론 비뇨외과의사대BPH적초보진단책략비노년과의사경위전면.대우중、중도BPH환자,노년과의사경향우단독응용5α환원매억제제,비뇨외과의사경향우연합응용5α환원매억제제+α수체조체제.
Objective To promote the standardization of medical practice in China by comparing the discrepancies of diagnosis and medication strategies for benign prostatic hyperplasia (BPH) between urologists and geriatricians.Methods Departments of urology and geriatrics in general hospitals in China were selected through stratified sampling and 145 315 patients who went for the outpatient service in certain days during December 2011 to December 2012 were recruited by cluster.Questionnaires were completed by corresponding doctors and data of patient clinical characteristics as well as diagnostic and therapeutic pattern were collected.Results A total of 142 511 valid questionnaires were collected with 119 426 from urology and 23 085 from geriatrics.The average age of BPH patients was (68.34±8.61) years and the average IPSS was 17.93±4.73.The rates of diagnostic method were IPSS (99.2％),ultrasonic inspection (86.0％),digital rectal examination (DRE) (66.0％) and urine flow rate test (55.2％).The rate of ultrasonic application was lower while the rates of other methods were higher among urologists (P＜0.01) ; the rate of DRE among urologists was 2.2 times to that among geriatricians.For patients with moderate or severe symptoms,most urologists (72.1％ in moderate patients and 79.9％ in severe patients) applied drug-combination strategy and the rate was 2 times to that among geriatricians (P＜0.01).In contrast,most geriatricians (59.7％ in moderate patients and 56.1％ in severe patients) applied single drug to BPH patients.Urologists utilized α-receptor blockers,plant preparations and traditional Chinese medicine more frequently than geriatricians (P＜0.01).Conclusions Urologists performed more integrated diagnosis strategy compared with geriatricians.The urologists tended to use 5α-reductase inhibitor combined with α-receptor blocker to treat BPH patients with moderate or severe symptoms,while geriatricians preferred 5α-reductase inhibitor alone.
