全科医生偏头痛诊疗状况调查分析

doi:10.3969/j.issn.1006-7795.2023.03.019

摘要/Abstract

摘要： 目的了解全科医生对偏头痛的认知情况与诊治现状，为进一步提高全科医生诊治偏头痛的能力提供参考。方法根据偏头痛诊治中的相关问题设计《全科医生偏头痛诊疗状况调查》问卷，收集受访者的人口学特征以及对当前偏头痛临床诊治方法的掌握情况。自2021 年6月1 日至2021 年9 月30日，采取横断面调查的方法，采用便利抽样，抽取500名全科医生作为研究对象，合计发送问卷500份，回收有效问卷450份（90%），对450份问卷结果进行汇总分析。结果调查显示，450名受访者平均年龄为（36.6±7.2）岁，其中男性全科医生208名（46.22%）。75.81%的受访者为本科学历，受访者以中级职称为主，其中高级职称32.31%、中级职称39.72%、初级职称28.97%。在临床实践中，诊治过头痛患者的全科医生占85.58%，学习过《国际头痛分类》（第三版）（The International Classification of Headache Disorders, 3rd edition, ICHD-3）者占比仅为20.66%，三级医院全科医生对ICHD-3的掌握情况显著优于一、二级医院（P<0.000 1）。能够正确回答偏头痛发作持续时间及诊断标准的受访者占比仅为30%左右。56.74%的受访者考虑过偏头痛的预防用药，但在用药指征及用药选择上的知识仍较为欠缺。结论当前全科医生对偏头痛诊疗的认知仍存在一定差距。今后应进一步加强全科医生偏头痛相关知识培训，提高全科医生对偏头痛的认知及诊疗能力，进而降低偏头痛的疾病负担。

关键词: 偏头痛, 诊疗状况, 调查问卷, 人口学资料

Abstract: Objective To evaluate the cognition and diagnosis of migraine of general practitioners, so as to provide reference for further improving the general practitioner’s ability to diagnose and treat migraine. Methods The questionnaire entitled “General Practitioners Migraine Diagnosis and Treatment Status Survey” was designed according to the relevant problems in the diagnosis and treatment of migraine. The demographic characteristics of the respondents and their mastery of the current clinical diagnosis and treatment of migraine were collected. From June 1 to September 30, 2021, 500 general practitioners were selected by the method of cross-sectional survey. A total of 500 questionnaires were sent and 450 (90%) valid questionnaires were collected. The results of 450 questionnaires were summarized and analyzed. Results The survey showed that the average age of 450 respondents was （36.6±7.2） years old, including 208 (46.22%) male general practitioners. 75.81% of the respondents had a bachelor's degree, and 39.72% of them owned intermediate professional titles (32.31% with senior professional titles and the remaining 28.97% with junior professional titles). In clinical practice, 85.58% of general practitioners had treated headache patients. Only 20.66% had studied the International Classification of Headache Disorders, 3rd edition (ICHD-3), and the knowledge of ICHD-3 among respondents from tertiary hospitals was significantly better than that those from primary and secondary hospitals (P<0.000 1). Only about 30% of the subjects correctly answered the duration and diagnostic criteria of migraine attacks. 56.74% of the respondents had considered the use of drugs for migraine prevention, but the knowledge of medication indications and drug choices still were needed. Conclusions There is still a gap in the current knowledge of migraine diagnosis and treatment among general practitioners. In the future, we should further strengthen the general practitioner in professional knowledge training to improve the general practitioner's ability of cognition and diagnosis and treatment on migraine, so as to reduce the disease burden of migraine.

Key words: migraine, diagnosis and treatment, questionnaire, demographic data

中图分类号:

R741

赵惠卿, 张亚清. 全科医生偏头痛诊疗状况调查分析[J]. 首都医科大学学报, 2023, 44(3): 482-486.

Zhao Huiqing, Zhang Yaqing. Investigation and analysis of migraine diagnosis and treatment in general practitioners[J]. Journal of Capital Medical University, 2023, 44(3): 482-486.

参考文献

［1］于生元. 全科医生在偏头痛诊疗中需要注意的几个问题［J］. 中华全科医师杂志, 2007, 6(2): 69－71.
［2］Steiner T J, Stovner L J, Jensen R, et al. Migraine remains second among the worlds causes of disability, and first among young women: findings from GBD2019［J］. J Headache Pain, 2020, 21(1): 137.
［3］GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990－2019: a systematic analysis for the Global Burden of Disease Study 2019［J］. Lancet, 2020, 396(10258): 1204－1222.
［4］Ashina M, Katsarava Z, Do T P, et al. Migraine: epidemiology and systems of care［J］. Lancet, 2021, 397(10283): 1485－1495.
［5］GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990－2016: a systematic analysis for the Global Burden of Disease Study 2016［J］. Lancet Neurol, 2018, 17(11): 954－976.
［6］陆佳洁, 赵红如. 偏头痛疾病负担研究进展［J］. 中国现代神经疾病杂志, 2022, 22(2): 69－72.
［7］Aljunaid M A, Jamal H H, Mubarak A A, et al. Levels and determinants of knowledge about chronic migraine diagnosis and management among primary health-care physicians in ministry of health, Jeddah 2019［J］. J Family Med Prim Care, 2020, 9(5): 2324－2331.
［8］Choudry H, Ata F, Naveed Alam M N, et al. Migraine in physicians and final year medical students: a cross-sectional insight into prevalence, self-awareness, and knowledge from Pakistan［J］. World J Methodol, 2022, 12(5): 414－427.
［9］Steiner T J, Birbeck G L, Jensen R H, et al. Headache disorders are third cause of disability worldwide［J］. J Headache Pain, 2015, 16(1): 58.
［10］Kernick D, Stapley S, Hamilton W. GPs classification of headache: is primary headache underdiagnosed?［J］. Br J Gen Pract, 2008, 58(547): 102－104.
［11］Dabilgou A A, Dravé A, Kyelem J M A, et al. Knowledge, attitudes, and management of general practitioners of the hospital districts of Ouagadougou about migraine (Burkina Faso)［J］. Pain Res Manag, 2021, 2021: 9327363.
［12］Guerrero A L, Negro A, Ryvlin P, et al. Need of guidance in disabling and chronic migraine identification in the primary care setting, results from the European MyLife anamnesis survey［J］. BMC Fam Pract, 2021, 22(1): 54.
［13］Kristoffersen E S, Faiz K W, Hansen J M, et al. The management and clinical knowledge of headache disorders among general practitioners in Norway: a questionnaire survey［J］. J Headache Pain, 2021, 22(1): 136.
［14］中华医学会疼痛学分会面痛学组.中国偏头痛防治指南［J］.中国疼痛医学杂志，2016，22（10）：721-727.
［15］Burch R C, Buse D C, Lipton R B. Migraine: epidemiology, burden, and comorbidity［J］. Neurol Clin, 2019, 37(4): 631－649.
［16］Lipton R B, Stewart W F, Diamond S, et al. Prevalence and burden of migraine in the United States: data from the American Migraine Study Ⅱ［J］. Headache, 2001, 41(7): 646－657.
［17］Yao C Y, Wang Y, Wang L J, et al. Burden of headache disorders in China, 1990－2017: findings from the Global Burden of Disease Study 2017［J］. J Headache Pain, 2019, 20(1): 102.
［18］Yu S Y, Liu R Z, Gang Z, et al. The prevalence and burden of primary headaches in China: a population-based door-to-door survey［J］. Headache, 2012, 52(4): 582－591.
［19］Gooch C L, Pracht E, Borenstein A R. The burden of neurological disease in the United States: a summary report and call to action［J］. Ann Neurol, 2017, 81(4): 479－484.
［20］Frese T, Druckrey H, Sandholzer H. Headache in general practice: frequency, management, and results of encounter［J］. Int Sch Res Notices, 2014, 2014: 169428.
［21］Thiele A, Strau S, Angermaier A, et al. Treatment realities of headache disorders in rural Germany by the example of the region of western Pomerania［J］. Brain Sci, 2021, 11(7): 839.

[1]	杜天舒, 宫晓丽, 艾孜儿·艾尼瓦尔, 张震, 刘玚, 王晓民, 张婷. CD200R1缺失促进脂多糖诱导的小胶质细胞内吞[J]. 首都医科大学学报, 2022, 43(1): 82-90.
[2]	王梦月, 赵鑫, 曹枭, 王可, 贾军. 帕金森病小鼠模型自主活动状态下的运动启动分析[J]. 首都医科大学学报, 2021, 42(4): 553-558.
[3]	刘翕然, 徐雁, 王维治, 王丽华, 张美妮, 李春阳, 董会卿, 李国忠, 刘洪波, 付锦, 金涛, 管阳太, 檀国军, 郭力, 张星虎. 中国多发性硬化临床特点及诊断难点分析[J]. 首都医科大学学报, 2021, 42(3): 360-366.
[4]	侯雨桐, 杨淑娜, 李悦, 李譞婷, 胡文立. 脑白质高信号与上下肢运动功能障碍的相关性研究[J]. 首都医科大学学报, 2021, 42(3): 385-390.
[5]	袁惠莉, 宫晓丽, 范征, 梁志刚, 王晓民. 远志皂苷对脂多糖诱导的帕金森病模型大鼠的作用及机制研究[J]. 首都医科大学学报, 2020, 41(6): 914-922.
[6]	李妍. 守护“记忆之魂”的中国痴呆临床研究引领者——贾建平教授[J]. 首都医科大学学报, 2020, 41(5): 822-827.
[7]	宫晓丽, 刘梦茹, 王乐, 刘玚, 张婷, 孙英, 王晓民. α-突触核蛋白在小胶质细胞炎性反应和吞噬功能中的作用研究[J]. 首都医科大学学报, 2018, 39(5): 693-698.
[8]	刘梦茹, 宫晓丽, 王乐, 刘玚, 张婷, 王晓民. 脂多糖对肠道α-突触核蛋白表达的影响[J]. 首都医科大学学报, 2018, 39(4): 557-562.
[9]	郝渊渊, 孙婉玲. M蛋白与周围神经病变[J]. 首都医科大学学报, 2018, 39(3): 344-348.
[10]	马隽, 王朝辉, 谷雪松, 满凤媛. ApoEε4基因结合sMRI对不同亚型轻度认知功能障碍的研究[J]. 首都医科大学学报, 2017, 38(1): 59-62.
[11]	王雪, 申甲梅, 高歌, 段春礼, 鲁玲玲, 杨慧. PINK1减轻α-突触核蛋白引起的线粒体损伤[J]. 首都医科大学学报, 2016, 37(1): 70-75.
[12]	张如意, 张丽, 李林. 线粒体功能障碍、α-突触核蛋白与帕金森病[J]. 首都医科大学学报, 2015, 36(6): 861-864.
[13]	鲁玲玲, 施予晴, 魏雨菲, 贾焕珍, 乔芳伟, 杨慧. 帕金森病相关基因α-突触核蛋白和PINK1对Nurr1的调节作用[J]. 首都医科大学学报, 2015, 36(6): 895-901.
[14]	李晖, 齐志刚, 李坤成. 针灸治疗阿尔茨海默病机制研究进展[J]. 首都医科大学学报, 2015, 36(5): 809-813.
[15]	王志群, 李坤成. 阿尔茨海默病的静息态功能磁共振、弥散张量成像及脑灌注研究进展[J]. 首都医科大学学报, 2015, 36(4): 640-644.