中国全科医学2018，Vol.21Issue(11)：1280-1284,5.DOI:10.3969/j.issn.1007-9572.2018.00.089
基层医院慢性心力衰竭治疗现状调查
Treatment Status of Heart Failure in Grassroots Medical Institutions in China's Liaocheng
摘要
Abstract
Objective To investigate the status and associated factors of the treatment for chronic heart failure(CHF) in grassroots medical institutions of Liaocheng.Methods We conducted this survey in June 2015.Using random sampling,from 7 counties of Liaocheng,we selected totaled 7 county-level hospitals(1 was selected from each),and 14 township hospitals (2 were selected from each).We enrolled the doctors on the duty in these hospitals on the survey day and the CHF patients managed by them in the past 3 months.Using a self-developed Doctor Data Questionnaire,we collected the data about sex,age, years with the physician certification,attitude toward the guidelines for CHF,cardiovascular physicians or not,amount of study materials about CHF,degree of mastering the guidelines for CHF,status of hospital hardware facilities,attitude of the hospital toward standardized treatment for CHF.We collected the data of the CHF patients by reviewing their medical records,including the demographic data,clinical data(symptoms,signs,auxiliary examination results and use of anti-CHF drugs at the time of discharge).Results Totaled 64 doctors were enrolled,26 of them from county-level hospitals,and other 38 from township hospitals.Both groups had no significant differences in gender,age,years with physician qualification and attitude toward heart failure guideline(P>0.05),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.关键词
心力衰竭/基层医院/指南/治疗Key words
Heart failure/Primary hospital/Guidebooks/Therapy分类
医药卫生引用本文复制引用
孙桂锋,刘宇,李艳,薛玉增..基层医院慢性心力衰竭治疗现状调查[J].中国全科医学,2018,21(11):1280-1284,5.基金项目
2015年度山东省医药卫生科技发展计划项目(2015WS0013) （2015WS0013）
