【作者】 孙琳；

【导师】 高晓虹；

【作者基本信息】 大连医科大学 ， 流行病与卫生统计学， 2013， 硕士

【摘要】 目的:本文通过对大连市三所教学医院实习医师进行问卷调查，了解实习医师对抗菌药物合理使用现状的认知水平，为进一步对医学生开展合理用药专项教育提供科学依据。方法：从大连市三所教学医院选取实习医师总计580名作为调查对象，涉及14个专业，涵盖本科生、研究生两个层次。采用自填式问卷作为研究调查工具,问卷针对实习医师的特点，在查阅相关资料后自行设计形成初稿，再由流行病学专家、统计学专家和临床医生讨论修改后形成终稿。问卷内容包括抗菌药物基本知识、抗菌药物使用情况认知及获得途径三部分，共24个问题；其中抗菌药物基本知识部分包含了抗菌药物基本概念、疗效、分级管理、手术预防用药认知四方面内容，共10个问题；抗菌药物使用情况认知部分包含了抗菌药物不合理使用现状及细菌耐药性的认知、实习医师主动参与抗菌药物合理使用知识传播现状三方面内容，共10个问题；抗菌药物知识获得途径部分包括目前既有途径及期望两方面内容，共4个问题。计算全卷总正确率及对抗菌药物基本知识和抗菌药物使用两部分各题的正确率。单项选择题部分，总分共20分，按每一题答对得1分、答错得0分，计算全卷总平均分及不同性别、年龄段、学校、学习阶段、专业、工作经历、工作时间、医学背景的平均分，并进行统计学检验。其中对不同性别、学校及工作经历平均分差异的检验采用t检验，对不同年龄段、学习阶段、专业、工作时间、医学背景平均分差异的检验采用方差分析。将假设检验结果P≤0.1的因素为自变量，总平均分作为应变量，进行线性逐步回归分析。多项选择部分，统计选择各选项的人数及其构成比。采用EXCEL2007软件建立数据库，数据库结构与问卷一致。分析采用SPSS17.0软件，所有检验均采用双侧检验，检验水准为α=0.05。结果：本次共调查580名实习医师，实际发放问卷580份，回收有效问卷559份，回收率为96.38%。调查对象的总平均分为12.60，总正确率为63.0%。调查对象对抗菌药物概念的认知正确率最高（正确率85.5%）。对Ⅱ类切口手术预防应用抗菌药物情况（正确率41.3%）、Ⅰ类切口预防使用抗菌药物的认知（正确率30.1%）正确率较低，对是否必须限制抗菌药物使用的认知（正确率29.3%），正确率全卷最低。经比较发现，内科系统实习医师对抗菌药物合理使用认知的平均分（13.26分）最高，其次为外科系统实习医师（12.35分），其他专业实习医师平均分较低（11.52分），差异经统计学检验有意义，P＜0.05。无工作经历者平均分（12.76分）高于有工作经历者（11.71分），差异经统计学检验有意义，P＜0.05。多元线性回归效果检验F=7.534（P<0.01），整个方程有统计学意义。实习医师对抗菌药物合理使用的认知评分与性别、工作经历、家庭中医学背景成员数量和专业存在线性回归关系。实习医师主要通过在校学习期间（43.0%）和临床实习期间（42.7%）获得抗菌药物相关知识。在临床实习过程中，有77.7%的教师能够给予合理用药专门指导。大部分调查对象对合理使用抗菌药物知识的需求程度较高，有79.8%表示希望老师给予更多指导，抗生素相关知识的来源途径以面对面指导（57.7%）和讲座培训（28.9%）为主。结论：1、实习医师对抗菌药物合理使用的总体认知水平不够理想，虽然在临床能够主动限制使用抗菌药物，并对改善目前状况的期望较高，但在对应用原则、不合理使用抗菌药物后果的严重程度等方面的认知程度还有待于进一步提高。认知水平一定程度上受专业和有无工作经历等因素的影响。2、大多数带教老师能够给予实习医师合理用药专门指导，但他们更需要通过面对面指导和讲座培训等方式满足实习医师对合理使用抗菌药物知识的高度需求。更多还原

【Abstract】 Objective: To investigate the current cognitive situation among interns aboutrational usage of antimicrobials by questionnaire in three teaching hospitals in Dalian,and thereby to provide scientific basis for special further education on rational usage ofantimicrobials among medical students.Methods: A total of580interns from three teaching hospitals in Dalian, of14specialties and including undergraduates and postgraduates, were selected asrespondents. Questionnaire was used and based upon the characteristics of interns. It’sfirst draft was designed after careful studying of relevant documents, and the finalversion was not formed until it was discussed and revised by epidemiologists,statisticians and clinicians discussions jointly. The questionnaire included three partswith24questions altogether: the basic knowledge of antimicrobials including basicconcepts, efficacy, hierarchical management and preventive use of antimicrobials, with10questions; the cognition about the situation of the usage of antibacterials involvingthe current situation about irrational usage of antimicrobials, the resistance of bacteria todrugs and the situation of participation in the propagation of the knowledge aboutrational usage of antimicrobials, with also10questions; the cognitive approaches,including both existing and expecting ones, by which interns got the relevant knowledgeand information, with4questions. The correct rate for total and each question wascalculated. In single-choice part, according to the scoring of1for each correct answerand0for each wrong, the average score based upon gender, age, school, learning stages,specialties, working experience, working duration and family medical background, werecalculated and statistically analyzed. Differences between the average scores based upongender, school, working experience were analyzed using the t test. One-way analysis ofvariance(ANOVA) was used for the comparison between the average scores based uponage, learning stage, specialty, working time, family medical background. Linearregression analysis was performed using the factors with hypothesis testing result of P ≤0.1as independent variables and overall average score as dependent variables. Inmultiple-choice part, the number of people choosing each option, and the constituentratio were calculated. EXCEL2007software was used to establish database whosestructure was consistent with the structure of the questionnaire. SPSS17.0software wasused to analyze the data and two-tailed test was used in all tests. A p-value less than0.05denoted the presence of a statistically significant difference.Results: A total of580interns were investigated, and580questionnaires weredistributed, and559valid questionnaires were recovered with a recovery rate of96.38%.The overall average score was12.60. The score for the cognition about the concept ofantimicrobials was the highest (mean value0.86). Comparatively lower were the scoresfor the cognition about the current situation of the preventive application ofantimicrobials in operation with class II (mean value0.41) and class Ⅰ(mean value0.30) incision, with the score for the cognition about whether the use ofantibiotics must be limited or not being the lowest (mean value0.29).By comparison, the average score on the cognition of the the rational usage ofantimicrobials among interns in internal medicine system was the highest (mean value13.26), followed by interns in surgical system (mean value12.35) and interns in otherspecialties (mean11.52) successively, with a statistically significant difference of P <0.05. There was a significant difference in the cognitive score between the subjectswith working experience and without(12.76vs11.71, P <0.05).Multiple linear regression testing demonstrated a statistically significant result(F=7.534, P<0.01). There was a linear relationship between the cognitive scores ofinterns about the rational usage of antimicrobials and gender, working experience, thenumber of family members with medical background.The interns obtained knowledge about antimicrobials mainly through schoollearning (43%) and clinical practice (42.7%). During clinical practice,77.7%of theteachers gave specific guidance on rational usage of drugs. Most of the respondentsdesired more relevant knowledge, and79.8%of them hoped to be given more guidanceby teachers. The approaches to get the relevant knowledge about antibioticswere by face-to-face instruction (57.7%) and lecturing (28.9%).Conclusion:1. Overall cognition of the interns on rational usage of antimicrobialswas not ideal. Although the interns were able to actively limit the usage ofantimicrobials in clinic, and had high expectation to improve the current situation, their cognition about application principles, the severity of the consequences secondary toirrational use of antimicrobials needed to be improved. Cognitive level was, to someextent, associated with the specialties and working experiences.2. Although interns could be given special guidance on rational use ofantimicrobials by most teachers, their desire for the relevant knowledge needs to be metmore through other pattens, such as face-to-face instructions and trainingeminars.更多还原