中国全科医学 ›› 2022, Vol. 25 ›› Issue (17): 2173-2178.DOI: 10.12114/j.issn.1007-9572.2021.01.415

• 全科医生知识窗 • 上一篇    

我国肺量计检查报告单格式调查及改进建议

梁丽娟1, 蒋吴君2, 陈文雅1, 黄锐波1, 叶培韬1, 彭咏怡1, 雷薛冬1, 梁健玲1, 高怡1,*(), 郑劲平1,*()   

  1. 1.510120 广东省广州市,广州医科大学附属第一医院 国家呼吸系统疾病临床医学研究中心 国家呼吸医学中心 呼吸疾病国家重点实验室 广州呼吸健康研究院
    2.215000 江苏省苏州市吴江区儿童医院 苏州大学附属儿童医院
  • 收稿日期:2021-12-17 修回日期:2022-01-25 出版日期:2022-04-22 发布日期:2022-04-22
  • 通讯作者: 高怡, 郑劲平
  • 梁丽娟,蒋吴君,陈文雅,等.我国肺量计检查报告单格式调查及改进建议[J].中国全科医学,2022,25(17):2173-2178.[www.chinagp.net].
    作者贡献:梁丽娟、高怡、郑劲平进行文章的构思和研究的设计、实施与可行性分析;蒋吴君、陈文雅、黄锐波、叶培韬、彭咏怡、雷薛冬、梁健玲进行资料收集和整理;梁丽娟、蒋吴君进行统计学处理;梁丽娟负责撰写论文;高怡、郑劲平进行文章的修订、质量控制和审校,对文章整体负责、监督管理。
  • 基金资助:
    广东省医学科研基金(C2021073); 国家重点研发计划(2018YFC1311900,2016YFC1304603); 国家科技支撑计划(2015BAI12B10)

Investigation of the Report Format for Spirometry in China and Recommendations for Improvement

Lijuan LIANG1, Wujun JIANG2, Wenya CHEN1, Ruibo HUANG1, Peitao YE1, Yongyi PENG1, Xuedong LEI1, Jianling LIANG1, Yi GAO1,*(), Jinping ZHENG1,*()   

  1. 1.The First Affiliated Hospital of Guangzhou Medical University/National Clinical Research Center for Respiratory Disease/National Respiratory Medical Center/State Key Laboratory of Respiratory Disease/Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
    2.Suzhou Wujiang District Children's Hospital/Children's Hospital of Soochow University, Suzhou 215000, China
  • Received:2021-12-17 Revised:2022-01-25 Published:2022-04-22 Online:2022-04-22
  • Contact: Yi GAO, Jinping ZHENG
  • About author:
    LIANG L J, JIANG W J, CHEN W Y, et al. Investigation of the report format for spirometry in China and recommendations for improvement[J].Chinese General Practice, 2022, 25 (17) : 2173-2178.

摘要: 背景 肺量计检查是最常见且应用最广泛的肺功能检查手段,其质量控制(以下简称质控)是肺功能检查推广应用的基石,报告单格式的质控是肺量计检查质控的关键一环,但我国肺量计检查报告单格式总体参差不齐,不利于肺量计检查的推广应用。 目的 探讨我国肺量计检查报告单格式的现状。 方法 收集2016年4月至2018年12月部分医院的肺量计检查报告单,分为受试者基本信息、检查指标、结果图形、结果评价4部分,每部分均以关键指标和/或重要指标进行评价。(1)受试者基本信息关键指标包括性别、身高、体质指数、年龄、预计值来源等;(2)检查指标关键指标包括用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、1秒率(FEV1/FVC或FEV1/VCmax),重要指标包括最大呼气中期流量(FEF25%~75%、用力呼出50%及75%肺活量时的瞬时呼气流量(FEF50%、FEF75%)、吸气峰值流量(PIF)、用力呼气时间(FET)等;(3)结果图形关键指标包括流量-容积曲线(F-V曲线)、容积-时间曲线(V-T曲线);(4)结果评价关键指标包括受试者配合程度、检查质控评级、医师意见。比较不同地区及等级医院间报告单格式达标差异。 结果 共纳入1 562家医院各1份肺量计检查报告单,其中仅0.4%含所有关键指标。(1)受试者基本信息:27.7%的肺量计检查报告单无关键指标缺失,28.2%的肺量计检查报告单含预计值来源,不同地区及不同等级医院间肺量计检查报告单受试者基本信息关键指标比较,差异均有统计学意义(P<0.05);(2)检查指标:91.9%的肺量计检查报告单无关键指标缺失,超90.0%的肺量计检查报告单列出FEF25%~75%、FEF50%和FEF75%,仅36.4%、46.0%的报告单报告了PIF、FET;(3)结果图形:73.4%的肺量计检查报告单无关键指标缺失,26.6%的肺量计检查报告单无V-T曲线;(4)结果评价:1.6%的肺量计检查报告单无关键指标缺失,14.9%的肺量计检查报告单报告了质控评级,不同等级医院间肺量计检查报告单结果评价比较,差异有统计学意义(P<0.05)。 结论 我国部分医院肺量计检查报告单格式与规范要求差距较大,预计值来源、吸气相和质控指标及质控评级等部分的缺失严重影响了肺功能检查对临床的指导价值,建议在肺功能检查规范化相关培训中增添针对报告单格式的规范化培训,并加强肺功能相关医务工作者对报告单各项指标的理解及应用。

关键词: 肺量计测定法, 呼吸试验, 检查报告单, 格式, 规范

Abstract:

Background

Spirometry is the most common and extensively used pulmonary function test method, whose quality control is the cornerstone for its promotion and application. The report format is a key factor associated with the quality control of spirometry, but it is generally various in China, which is not conducive to the popularization and application of spirometry.

Objective

To assess the current status of report formats for spirometry in Chinese mainland.

Methods

The reports of spirometry were collected from some hospitals in China between April 2016 and December 2018, which are composed of four parts, including the general demographic information, test indicators, graphs, and results evaluation. The key and/or essential information for each part is as follows: (1) the general demographicinformation part: sex, height, BMI, age and the reference source; (2) test indicators part: forced vital capacity (FVC) , forced expiratory volume in 1 second (FEV1) , the ratio of FEV1/FVC or FEV1/VCmax, maximal mid-expiratory flow〔FEF25%-75%, forced expiratory flow at 50% (FEF50%) , forced expiratory flow at 75% (FEF75%) 〕, peak inspiratory flow (PIF) and forced expiratory time (FET) ; (3) graphs part: flow-volume curve (F-V curve) and volume-time curve (V-T curve) ; (4) results evaluation part: subjects cooperation, test quality control level, and physician interpretation. The differences in the report format of spirometry were compared by region and hospital level in this study.

Results

In total, 1 562 spirometry reports from 1 562 hospitals (one from each hospital) across China were enrolled, but only 0.4% provided all key indicators. (1) For the general demographic information part, only 27.7% reports provided complete key indicators, which differed significantly by regions and the level of hospitals (P<0.05) . Moreover, the part showed the reference source only accounted for 28.2%. (2) Furthermore, in the test indicators part, 91.9% of the total reports provided all key indicators. More than 90.0% reports listed FEF25%-75%, FEF50% and/or FEF75%, while the PIF and FET was reported in 36.4%, 46.0%, respectively. (3) In terms of the graphs part, 73.4% reports provided key indicators, but 26.6% did not report the important information like V-T curve. (4) Finally, in the results evaluation part, the report without lacking key indicators were only accounted for 1.6%, and there were great differences between hospitals of different levels (P<0.05) . What's more, only 14.9% clearly showed the quality control of spirometry.

Conclusion

There were great differences of the report formats for spirometry analyzed and the 2019 Standard for pulmonary function examination report. Lack of the key information such as the reference resource, inspiratory phase indicators, the indicators about quality control and quality control of test would seriously affect the clinical value of spirometry. Therefore, it is suggested to add the program of report format standards during the standardized trainings of pulmonary function testing, and strengthen the understanding and application of various indicators of spirometry among pulmonary function practitioners.

Key words: Spirometry, Breath tests, Spirometry report, Format, Standardization