论文部分内容阅读
目的:了解新型冠状病毒肺炎（新冠肺炎）的临床治疗情况及医护人员对国家诊疗方案的依从性。方法:2020年2月28日对全国参与新冠肺炎救治的医护人员进行网络问卷调查。问卷内容包括药物治疗、呼吸支持治疗、镇静镇痛治疗、连续性肾脏替代治疗（CRRT）及体外膜肺氧合（ECMO）支持等。结果:来自全国9个省市1 103名医护人员参与了问卷调查，其中699名医护人员（医生504名、护士195名）参与了新冠肺炎的救治工作，最终432名医生和170名护士提交了有效问卷。医生和护士的问卷调查结果基本一致，考虑到在新冠肺炎诊治中医生占主导地位，护士主要为执行者且参与调查人员较少，故主要对医生的问卷结果进行分析。参与调查的医生主要来自湖北（29.2%），其次为河南（24.5%）、贵州（22.7%）、广西（14.6%）等；55.4%的医生来自三甲医院，且高级职称占多数（56.4%）；有232名医生（53.7%）参与了轻型和普通型新冠肺炎的救治工作，200名医生（46.3%）参与了重型和危重型患者的救治工作。调查结果显示，95%以上的医生表示会为新冠肺炎患者进行抗病毒治疗，无论病情轻重，且抗病毒药物的选择主要为α-干扰素（69.5%）、洛匹那韦/利托那韦（克力芝，65.0%）、阿比多尔（60.0%）、利巴韦林（55.7%）等，与国家诊疗方案的推荐基本一致。95.5%的医生会常规给予重型和危重型患者抗菌药物治疗；94.0%的医生选择给予重型和危重型患者小剂量糖皮质激素治疗；约2/3的医生报告会给予有创通气的危重患者进行肺复张或俯卧位通气治疗；79.0%的医生更倾向于对有创通气患者应用深镇静；约1/3的医生认为应尽早行CRRT治疗，近1/3的医生认为应在危重患者中更积极地应用ECMO治疗。结论:参与新冠肺炎救治的医护人员对国家诊疗方案比较熟悉并愿意遵循，但新冠肺炎是一种新发的疾病，人们对其认知有限，相关治疗仍存在较多争议，需进一步做实做细诊疗方案的培训，并期待更多的循证证据指导临床。“,”Objective:To investigate the clinical treatment and assess the knowledge and use of the coronavirus disease 2019 (COVID-19) treatment plan issued by the nation.Methods:A nationwide questionnaire survey on line was administered to medical staffs involved in COVID-19 treatment on February 28th, 2020. The questionnaire included drug treatment, respiratory support therapy, sedation and analgesia, continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO), etc.Results:There were 1 103 respondents, of whom 699 (504 doctors and 195 nurses) participated in the treatment of COVID-19. Finally, 432 doctors and 170 nurses from 9 provinces submitted valid questionnaires. The results of the questionnaire surveys of doctors and nurses were basically the same. Considering that doctors dominated in the diagnosis and treatment of COVID-19, the results of the questionnaires of doctors were mainly analyzed. The doctors participating in the survey were mainly from Hubei (29.2%), followed by Henan (24.5%), Guizhou (22.7%), and Guangxi (14.6%), etc. 55.4% of the doctors came from tertiary three hospitals, and most of them have senior titles (56.4%). 232 doctors (53.7%) participated in the treatment of mild COVID-19, and 200 doctors (46.3%) participated in the treatment of severe and critically ill patients. More than 95% of the doctors expressed that they would carry out antiviral treatment for patients with COVID-19 regardless of disease severity. The main antiviral drugs included α-interferon (69.5%), lopinavir/ritonavir (65.0%), abidol (60.0%), and ribavirin (55.7%). The choice of antiviral drugs was highly consistent with the national treatment programs of COVID-19. At the same time, 95.5% of doctors would routinely prescribe antibiotics to severe and critically ill patients. 94.0% of doctors agreed to prescribe low-dose glucocorticoid therapy to severe and critically ill patients. About 2/3 of doctors would perform lung recruitment or prone position treatment for critical patients with invasive ventilation. 79.0% of doctors preferred to use deep sedation for patients with invasive ventilation. About 1/3 of doctors believed that CRRT should be initiated early, and nearly 1/3 of doctors suggested that ECMO should be used more aggressively in critically ill patients.Conclusions:Medical staffs are familiar with the national treatment plan of COVID-19 and willing to follow it. However, as a new disease, we have limited knowledge about COVID-19 and there are still many controversies. Further practical training is needed to make clinicians more aware of the disease, and more evidence-based evidence is needed to guide clinical treatment.