某教學醫院臨床醫師對肺造影偵測肺栓塞癥的認知及態度調查研究

A Survey of the Knowledge and Attitude on Pulmonary Embolism Detection with Lung Scanning among Clinical Physicians in a Teaching Hospital

程紹智(Shiou-Chi Cherng) ； 楊世平(Shih-Ping Yang) ； 余明德(Ming-Der Yu) ； 陳群互(Chun-Hu Chen) ； 樊裕明(Yu-Ming Fan) ； 楊久騰(Giou-Teng Yang)

《核子醫學雜誌》 15卷3期 (2002/09) Pp. 119-127

https://doi.org/10.6332/ANMS.1503.002

摘要

背景：本研究藉著問卷調查，瞭解某教學醫院相關科醫師對核醫肺造影偵測肺栓塞病的認知與態度，以達到核醫部改進肺造影偵測肺栓塞症的目的。
方法：針對20位主治、16位住院及24位第二年之實習醫師發出60份問卷。問卷內容共30題，包括6題簡答－對肺栓塞症的基本認識，12題是非－對核醫肺臟通氣及灌注造影的概念及12題勾選－對核醫部肺造影偵測肺栓塞症的看法。我們囑咐受訪者只依直覺，不刻意翻閱相關資料作答。
結果：有效回收問卷53份，回收率均88%(53/60)。大部份的受訪醫師認為一個長期臨床、有呼吸困難症狀、呼吸加速、胸部Ｘ光有肺浸潤現象、心電圖出現S1Q3T3、實驗室檢查呈現動脈血氧分壓下降及D-dimers濃度上升的病患最有可能罹患肺栓塞症；對核醫肺造影檢查的適應症、條件限制及禁忌等的認各情形相對較差；有13位受訪者對核醫部肺造影偵測肺栓塞症覺得不滿意，主要原因在於結果報告有太多的中或低度可能性肺栓塞症。
結論：受訪醫師對國內肺栓塞症患者的臨床特徵普遍認為與國外相同，因此可能忽略掉一些非典型徵候的病患；核醫部須主動、適時地提供各科醫師有關肺造影偵測肺栓塞症的資訊，以加深其對肺造影的認識；繕打肺造影偵測肺栓塞症報告時，儘量給予較明確的答案，乃推動肺造影檢查的最有效途徑。

關鍵字

肺造影 ； 肺栓塞癥 ； 認知 ； 態度

並列摘要

Background: We surveyed through a questionnaire, the knowledge and attitude on pulmonary embolism (PE) detection with lung scanning among clinical physicians in a teaching hospital. The main purpose of this study was to improve the service models of lung scan in detection PE of the Department of Nuclear Medicine.
Methods: A questionnaire was distributed to 60 clinical physicians (24 intern, 16 resident and 20 attending). The questionnaire consisted of 30-question including 6 essays for the basic knowledge of PE, 12 true or false for the concepts of lung ventilation and perfusion scintigraphy and 12 choices for the attitude on PE detection with lung scanning. We asked the physicians that they had no references, but completed the questionnaire directly.
Results: Fifty-three physicians participated in this study. The response rate was about 88% (53/60). Most of the respondents thought that a patient with being bedridden, dyspnea,tachypnea, lung infiltration on chest radiography, S1Q3T3 pattern on electrocardiogram, hypoxemia and rising D-dimers concentration in laboratory tests was the most possible a victim of PE. In general, the respondents were not aware of the indications, restrictions, and contraindications of lung scan well; thirteen of them had no feeling of satisfaction in PE detection with lung scanning and the major cause was lots of reports with intermediate or low probability of PE on lung scan.
Conclusions: The clinical physicians of our hospital might miss some patients who had PE with atypically clinical symptoms and signs because they commonly thought the patients with PE in Taiwan were not different from other series. In order to make a positive impression of lung scan in detection PE on them, the staffs of Nuclear Medicine have to supply some information to them automatically. The reporters of Nuclear Medicine had better give the appliers a more definite answer when describing the results of lung scan and this is the best way to ask the clinical physicians to apply lung scan.

並列關鍵字

lung scan ； pulmonary embolism ； knowledge ； attitude