强化推广肺栓塞诊疗技术对肺栓塞诊断和预后的影响

目的：在广西地区强化推广肺栓塞诊疗技术及其效果评价。方法2008年底举办静脉血栓栓塞症诊疗技术专题学习班对广西地区13家医院呼吸内科医护人员、放射科和超声科医生进行肺栓塞流行病学、临床表现、诊断技术以及治疗规范进行集中培训，之后对各参与单位进行肺栓塞诊疗技术指导。比较培训之后2009～2011年与2005～2007年肺栓塞病例占呼吸内科同期住院病例比例、诊疗技术和住院期间病死率。结果与2005～2007年比较，2009～2011年肺栓塞病例占同期呼吸内科住院病例比例显著增高1.03％（604／58530） vs 0.71％（273／38581）]（ P＜0.001），确诊病例占肺栓塞病例也显著提高73.01％（441／604） vs 64.84％（177／273）]，P＝0.014。 CT肺动脉造影是2005～2007年及2009～2011年确诊肺栓塞主要技术（分别为95.69％和92.95％）。2009～2011年住院期间死于肺栓塞比例较2005～2007年显著下降8.61％（52／604） vs 16.12％（44／273）]，P＝0.017。结论强化推广静脉血栓栓塞症诊疗技术有利于提高肺栓塞诊疗水平和改善患者预后。

Impact of training program on the diagnosis and prognosis of pulmonary embolism

Objective To explore the impact of a training program for venous thromboembolism on the diag-nosis and prognosis of pulmonary embolism （ PE） in Guangxi .Methods Thirteen hospitals in Guangxi were included and the groups consisting of doctors and nurses of respiratory department , radiologists and sonologists from the hospi-tals were trained intensively in a class in late 2008 .The training program included venous thromboembolism epidemi-ology, clinical manifestation, diagnosis and management .After that, the trainers guided the trainees through inter-net, telephone or at present .The training effect were evaluated by comparison of PE cases , diagnostic techniques and hospital mortality between 2005~2007 and 2009~2011 .Results Comparing with 2005~2007 , PE incidence in re-spiratory hospitalizations raised significantly from 2009 to 20111.03%（604/58 530） vs 0.71%（273/38 581）, P〈0.001 ] and proportion of definite PE cases to all PE also increased significantly 73.01%（ 441/604 ） vs 64.84%（177/273）, P=0.014].CT pulmonary angiography was the key diagnostic technique in both two periods （95.69%among 2005~2007 and 92.95%among 2009~2011 ） .The hospital mortality in 2005~2007 and 2009~2011 were 16.12%（ 44/273 ） and 8.61%（ 52/604 ） , respectively （ P =0.017 ） .Conclusion Training program of venous thromboembolism improves the level of diagnosis and prognosis of PE .