CAJ | 학술논문

目的调查县级医院医生对心房颤动(房颤)患者使用华法林抗凝预防卒中的认知情况.方法 2013年6-11月,对江苏、河南、浙江、江西四省9家县级医院的心内科或内科292名医生进行问卷调查.调查问卷内容主要包括:医生对房颤的诊断方法,血栓和出血的危险评分,华法林抗凝治疗相关知识的掌握情况以及抗凝治疗的顾虑.结果最终208份问卷进入统计学分析.83.2％的医生(173例)来自一级和二级医院.医生自我报告对风湿瓣膜性房颤、非风湿瓣膜性房颤和人工瓣膜置换术后房颤患者的华法林抗凝治疗比例分别为30.0％(10.0％～60.0％)、20.0％(10.0％～50.0％)及80.0％ (40.0％～ 100.0％).影响医生使用华法林抗凝治疗的主要原因是担心出血不良反应74.0％(154例),其次为需要定期监测凝血占65.4％(136例),患者高龄93例(44.7％).51.0％(106例)的医生认为心电图是诊断房颤的主要手段.62.5％(130例)的医生认为华法林抗凝目标值INR在2～3.知道CHADS2评分、CHA2DS2-VASc评分、HAS-BLED评分的分别占51.0％(106例)、41.3％(86例)、34.6％(72例),但仅有15.4％(32例)、6.3％(13例)、5.3％(11例)的医生正确回答了各评分的全部危险因素.68.3％(142例)的医生知道华法林拮抗剂为维生素K.结论县级医院医生对房颤抗凝治疗的关注和对危险分层评分的了解不足,影响其使用抗凝治疗的最大障碍是担心出血和定期INR监测的不便.县级医院医生对于房颤患者的抗凝治疗知识需要进一步提高.
목적 조사현급의원의생대심방전동(방전)환자사용화법림항응예방졸중적인지정황.방법 2013년6-11월,대강소、하남、절강、강서사성9가현급의원적심내과혹내과292명의생진행문권조사.조사문권내용주요포괄:의생대방전적진단방법,혈전화출혈적위험평분,화법림항응치료상관지식적장악정황이급항응치료적고필.결과 최종208빈문권진입통계학분석.83.2％적의생(173례)래자일급화이급의원.의생자아보고대풍습판막성방전、비풍습판막성방전화인공판막치환술후방전환자적화법림항응치료비례분별위30.0％(10.0％～60.0％)、20.0％(10.0％～50.0％)급80.0％ (40.0％～ 100.0％).영향의생사용화법림항응치료적주요원인시담심출혈불량반응74.0％(154례),기차위수요정기감측응혈점65.4％(136례),환자고령93례(44.7％).51.0％(106례)적의생인위심전도시진단방전적주요수단.62.5％(130례)적의생인위화법림항응목표치INR재2～3.지도CHADS2평분、CHA2DS2-VASc평분、HAS-BLED평분적분별점51.0％(106례)、41.3％(86례)、34.6％(72례),단부유15.4％(32례)、6.3％(13례)、5.3％(11례)적의생정학회답료각평분적전부위험인소.68.3％(142례)적의생지도화법림길항제위유생소K.결론 현급의원의생대방전항응치료적관주화대위험분층평분적료해불족,영향기사용항응치료적최대장애시담심출혈화정기INR감측적불편.현급의원의생대우방전환자적항응치료지식수요진일보제고.
Objective To investigate the perception of anticoagulant treatment for atrial fibrillation (AF) in physicians from county-level hospitals.Methods Two hundred and ninety two physicians from 9 hospitals of Jiangsu,Henan,Zhejiang,Jiangxi provinces were enrolled in this cross-sectional survey from June to November 2013.A standard questionnaire was used in the survey,which consisted of questions on knowledge,awareness and concerns of physicians regarding the diagnosis of atrial fibrillation and administration of warfarin.Results Total 292 questionnaires were returned and 208 of them were finally analyzed.According to the reports of the physicians,the percentage of anticoagulant treatment was 30.0％ (10.0％-60.0％) in patients with rheumatic valvular AF,20.0％ (10.0％-50.0％) in patients with non-valvular AF and 80.0％ (40.0％-100.0％) in those with mechanical heart valve replacement.The most common concerns of prescribing warfarin were worries about the bleeding related to warfarin (74.0％,154),the necessary of monitoring INR (65.4％,136) and advanced age (44.7％,93).A half of physicians (51.0％,106) thought that ECG was the main means for diagnosis of AF and only 28.3％ (59) used both ECG and Holter as diagnosis procedure.Among the physicians who reported to use INR for monitoring warfarin administration,62.5％ (130) reported a target ranging 2-3 and one third reported a target INR ＜ 2.The proportion of the physicians who were aware of CHADS2 score and CHA2DS2-VASc score was 51.0％ (106) and 41.3％ (86),but only 15.4％ (32) and 6.3％ (13) of them knew the correct answer of the risk factors,respectively.Although 34.6％ (72) physicians were aware of HAS-BLED score,only 5.3％ (11) selected the 9 parameters correctly.68.3％ (142) physicians reported that vitamin K is the antidote for warfarin.Conclusion This study reveals the concerns and deficits in perception of anticoagulant treatment for AF patients in physicians of county-level hospitals,suggesting that education programs are needed to increase the prevalence of warfarin use in patients with AF.