中国全科医师对水肿型未分化疾病认知和临床实践现况调查

张云红; 任菁菁; 赵艳萍; 胡月; 龙珑; 张雪莲

doi:10.16766/j.cnki.issn.1674-4152.004269

中国全科医师对水肿型未分化疾病认知和临床实践现况调查

doi: 10.16766/j.cnki.issn.1674-4152.004269

1.
大理白族自治州人民医院全科医学科，云南大理 671000
2.
浙江大学医学院附属第一医院全科医学科，浙江杭州 310003

基金项目:

国家自然科学基金项目 72274169

云南省卫生健康委2024年度中青年骨干医师研修项目 2024-5

详细信息

通讯作者:
任菁菁，E-mail：3204092@zju.edu.cn

中图分类号: R499
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出版历程
- 收稿日期: 2025-05-22
- 网络出版日期: 2026-01-07

Analysis of the cognition and clinical practice about edema-related medically unspecified disease of general practitioners in China

1.
Department of General Practice, Dali Bai Autonomous Prefecture People' s Hospital, Dali, Yunnan 671000, China

摘要

摘要: 目的调查全科医师对水肿型未分化疾病认知和临床实践情况，为提升其规范诊治水平提供参考依据。方法选取2025年1月10—24日自愿参加的419名全科医师作为调查对象。通过问卷星进行线上问卷调查。结果 21.0%(88/419)的全科医师开设未分化疾病/水肿门诊，62.8%(263/419)经常遇到水肿患者(≥1例/周)，96.4%(404/419)认为水肿需要积极干预，28.2%(118/419)参加过水肿培训，95.9%(402/419)认为需要水肿指南或共识，96.7%(405/419)认为需要开展水肿培训。年龄大、职称高、学历高、三级医院的全科医师所遇到水肿病例更多(χ²=8.663、20.537、31.440、49.080，P=0.013、＜0.001、＜0.001、＜0.001)，职称高、年龄大者更关注和提供心理支持(χ²=8.937、10.033，P=0.011、0.007)，职称高者更经常随访和评估(χ²=11.894，P=0.003)，而全科医师对水肿指南或共识以及培训需求差异无统计学意义(P＞0.05)。结论国内水肿门诊开诊率低，全科医师对水肿的认知和临床实践有差异，水肿培训不足，但需求高，今后可通过开展水肿门诊和加强培训提升其诊治能力。
- 全科医师 /
- 水肿 /
- 未分化疾病 /
- 认知 /
- 临床实践
Abstract: Objective To investigate general practitioners ' (GPs) cognition and clinical practice regarding edema-related medically unspecified disease (MUD), providing reference for improving standardized diagnosis and treatment. Methods A total of 419 general practitioners who voluntarily participated from January 10th to 24th, 2025 were selected as the survey subjects. An online questionnaire survey was conducted through Wenjuanxing. Results Only 21.0% (88/419) of GPs had established edema clinics, 62.8% (263/419) frequently encountered edema patients, 96.4% (404/419) emphasized the necessity of active intervention for edema, 28.2% (118/419) had attended edema-related academic conferences, 95.9% (402/419) demanded standardized guidelines, and 96.7% (405/419) advocated for training. GPs with older age, higher title, higher education, or working in tertiary hospitals managed more edema cases (χ²=8.663, 20.537, 31.440, 49.080; P=0.013, < 0.001, < 0.001, < 0.001). GPs with higher title, older age, or longer experience provided more psychological support (χ²=8.937, 10.033, P=0.011, 0.007). Higher title correlated with more frequent follow-ups and assessments (χ²=11.894, P=0.003). No significant differences in guideline awareness or training needs were observed (P>0.05). Conclusion Low edema clinic establishment rates and disparities in edema cognition among GPs. Despite high training demands, current training is insufficient. Future strategies should prioritize edema clinic development and targeted training programs to enhance GPs ' diagnostic and therapeutic capabilities.
- General practitioners /
- Edema /
- Medically unspecified disease /
- Cognition /
- Clinical practice

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表 1 419名全科医师的基本资料

Table 1. Demographic characteristics of the 419 general practitioners

项目	分类	人数(%)
性别	女性	250(59.7)
	男性	169(40.3)
职称	高级职称	114(27.2)
	中级职称	130(31.0)
	初级职称	175(41.8)
年龄	≤30岁	162(38.7)
	31~50	205(48.9)
	＞50岁	52(12.4)
学历	本科及以下	321(76.6)
	硕士及以上	98(23.4)
医院类别	一级医院	235(56.1)
	二级医院	34(8.1)
	三级医院	150(35.8)

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表 2 对不同年龄和性别水肿可能病因的选择[人(%)]

Table 2. Possible causes of edema categorized by age and sex [case(%)]

项目	老年男性	老年女性	中青年男性	中青年女性	χ²值	P值
心源性、肝源性、肾源性疾病	407(97.1)	347(82.8)	258(61.6)	220(52.5)	70.019	＜0.001
内分泌系统疾病	304(72.6)	384(91.6)	260(62.1)	345(82.3)	26.403	＜0.001
心理社会因素	124(29.6)	166(39.6)	151(36.0)	200(47.7)	18.800	＜0.001
营养不良	266(63.5)	243(58.0)	128(30.5)	165(39.4)	62.908	＜0.001
特发性水肿	217(51.8)	247(58.9)	200(47.7)	246(58.7)	6.985	0.072
药物性水肿	278(66.3)	229(54.7)	157(37.5)	147(35.1)	56.980	＜0.001
功能性水肿	366(87.4)	356(85.0)	254(60.6)	295(70.4)	26.350	＜0.001
血管疾病(如静脉曲张、静脉血栓等)	327(78.0)	272(64.9)	181(43.2)	161(38.4)	77.470	＜0.001
肿瘤	274(65.4)	235(56.1)	123(29.4)	109(26.0)	108.182	＜0.001
局部性水肿(如局部炎症、淋巴管炎、丹毒、过敏等)	273(65.2)	238(56.8)	235(56.1)	212(50.6)	7.937	0.047
遗传性血管性水肿	140(33.4)	129(30.8)	152(36.3)	134(32.0)	2.124	0.547
其他	19(4.5)	14(3.3)	13(3.1)	17(4.1)	1.444	0.695
χ²值	526.954	485.508	324.943	440.023
P值	＜0.001	＜0.001	＜0.001	＜0.001

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表 3 对不同年龄水肿患者辅助检查的选择[人(%)]

Table 3. Diagnostic test preferences for edema management across age cohorts[case(%)]

项目	老年	中青年	χ²值	P值
脑钠肽	327(78.0)	153(36.5)	63.075	＜0.001
肝肾功能、尿常规、血常规等	407(97.1)	388(92.6)	0.454	0.500
甲状腺功能	326(77.8)	354(84.5)	1.153	0.283
D-二聚体	286(68.3)	173(41.3)	27.819	＜0.001
补体C4等	109(26.0)	130(31.0)	1.845	0.174
下肢血管彩超	361(86.2)	247(58.9)	21.375	＜0.001
心脏彩超	346(82.6)	205(48.9)	36.082	＜0.001
泌尿系彩超	235(56.1)	213(50.8)	1.080	0.299
肿瘤标志物	216(51.6)	127(30.3)	23.093	＜0.001
垂体及性腺激素	131(31.3)	193(46.1)	11.864	＜0.001
抗核抗体谱	109(26.0)	139(33.2)	3.629	0.057
胸部X线或CT	169(40.3)	131(31.3)	4.813	0.028
心理量表测试	73(17.4)	100(23.9)	4.214	0.040
其他	10(2.4)	9(2.1)	0.053	0.819
χ²值	710.188	686.317
P值	＜0.001	＜0.001

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表 4 不同特征全科医师对水肿型MUD临床实践比较[人(%)]

Table 4. Comparison of cognition and clinical practices regarding edema-related medically unspecified conditions among general practitioners with different characteristics[case(%)]

项目	经常遇到水肿(≥1次/周)	经常随访和评估	需要住院治疗	关注和提供心理支持
职称
高级职称	87(76.3)	73(64.0)	36(31.6)	87(76.3)
中级职称	87(66.9)	55(42.3)	55(42.3)	79(60.8)
初级职称	89(50.9)	97(55.4)	109(62.3)	106(60.6)
χ²值	20.537	11.894	28.313	8.937
P值	＜0.001	0.003	＜0.001	0.011
年龄
≤30岁	88(54.3)	91(56.2)	102(63.0)	95(58.6)
31~50岁	142(69.3)	100(48.8)	84(41.0)	134(65.4)
＞50岁	33(63.5)	34(65.4)	14(26.9)	43(82.7)
χ²值	8.663	5.249	27.840	10.033
P值	0.013	0.072	＜0.001	0.007
学历
本科及以下	178(55.5)	174(54.2)	166(51.7)	206(64.2)
硕士及以上	85(86.7)	51(52.0)	34(34.7)	66(67.3)
χ²值	31.440	0.142	8.717	0.332
P值	＜0.001	0.707	0.003	0.565
医院级别
一级医院	116(49.4)	128(54.5)	115(48.9)	154(65.5)
二级医院	20(58.8)	19(55.9)	18(52.9)	19(55.9)
三级医院	127(84.7)	78(52.0)	67(44.7)	99(66.0)
χ²值	49.080	0.295	1.071	1.335
P值	＜0.001	0.863	0.585	0.513

项目	参加水肿培训	需要建立水肿门诊	需要水肿指南或共识	需要开展水肿培训
职称
高级职称	46(40.4)	106(93)	110(96.5)	111(97.4)
中级职称	37(28.5)	112(86.2)	125(96.2)	124(95.4)
初级职称	35(20.0)	157(89.7)	167(95.4)	170(97.1)
χ²值	14.140	3.028	0.222
P值	＜0.001	0.220	0.895	0.655^a
年龄
≤30岁	37(22.8)	144(88.9)	156(96.3)	159(98.1)
31~50岁	62(30.2)	181(88.3)	195(95.1)	194(94.6)
＞50岁	19(36.5)	50(96.2)	51(98.1)	52(100.0)
χ²值	4.511	2.832	1.015
P值	0.105	0.243	0.602	0.084^a
学历
本科及以下	87(27.1)	287(89.4)	307(95.6)	311(96.9)
硕士及以上	31(31.6)	88(89.8)	95(96.9)	94(95.9)
χ²值	0.761	0.012
P值	0.383	0.913	0.772^a	0.748^a
医院级别
一级医院	66(28.1)	209(88.9)	228(97.0)	227(96.6)
二级医院	8(23.5)	32(94.1)	32(94.1)	32(94.1)
三级医院	44(29.3)	134(89.3)	142(94.7)	146(97.3)
χ²值	0.463	0.855	1.621	0.894
P值	0.793	0.652	0.445	0.640
注：^a为采用Fisher精确检验。

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