外科医生对脊髓损伤后自主神经反射异常的认识
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摘要
目的了解外科医生关于脊髓损伤后自主神经反射异常的知识水平。方法 2018年9月1至30日,问卷测试7个科室的71名外科医生关于脊髓损伤后自主神经反射异常的知识水平。结果总体合格率35%,产生原因、临床表现、诊断标准、处理措施知识点的总体得分率<60%。不同科室之间在产生原因、临床表现、处理措施知识上存在显著性差异(F> 2.270, P <0.05)。接触脊髓损伤患者机会不同的医生之间在处理措施知识上存在显著性差异(F=4.043, P <0.05)。不同自主神经反射异常知识自评结果的医生之间在临床表现和处理措施知识上存在显著性差异(F=5.519, P <0.01)。不同教育背景、技术职称或工作年限的医生之间在自主神经反射异常各知识点上无显著性差异(F <2.107, P> 0.05)。结论部分外科医生关于脊髓损伤后自主神经反射异常的知识水平不高,需要加强学习和培训。
Objective To investigate the levels of knowledge on autonomic dysreflexia(AD) following spinal cord injury(SCI)from surgeons.Methods September 1st to 30th, 71 surgeons from seven departments were tested with the knowledge about AD with a questionnaire.Results Only 35% of them gave the correct answer above 60% of the items. The items that got respondence less than 60% involved in those about causes, clinical signs and symptoms, diagnosis, and treatment for AD. The respondence about knowledge of causes, clinical signs and symptoms, and treatment for AD was different among departments(F > 2.270, P < 0.05). The respondence about knowledge of treatment for AD was different among the surgeons who had managed different numbers of SCI patients(F = 4.043, P < 0.05). The knowledge of clinical signs and symptoms, and treatment was different among the surgeons with their self-reported knowledge level of AD(F = 5.519, P < 0.01). There was no difference in knowledge for AD among the surgeons with different educational background, technological position and length of career(F < 2.107, P > 0.05).Conclusion The knowledge about AD needs to improve in the surgeons.
Objective To investigate the levels of knowledge on autonomic dysreflexia(AD) following spinal cord injury(SCI)from surgeons.Methods September 1st to 30th, 71 surgeons from seven departments were tested with the knowledge about AD with a questionnaire.Results Only 35% of them gave the correct answer above 60% of the items. The items that got respondence less than 60% involved in those about causes, clinical signs and symptoms, diagnosis, and treatment for AD. The respondence about knowledge of causes, clinical signs and symptoms, and treatment for AD was different among departments(F > 2.270, P < 0.05). The respondence about knowledge of treatment for AD was different among the surgeons who had managed different numbers of SCI patients(F = 4.043, P < 0.05). The knowledge of clinical signs and symptoms, and treatment was different among the surgeons with their self-reported knowledge level of AD(F = 5.519, P < 0.01). There was no difference in knowledge for AD among the surgeons with different educational background, technological position and length of career(F < 2.107, P > 0.05).Conclusion The knowledge about AD needs to improve in the surgeons.
引文
[1]Cowan H.Autonomic dysreflexia in spinal cord injury[J].Nurs Times,2015,111(44):22-24.
[2]Lee E,Joo M.Prevalence of autonomic dysreflexia in patients with spinal cord injury above T6[J].Biomed Res Int,2017,2017:2027594.
[3]郑樱,周红俊,刘根林,等.脊髓损伤并发症的预防和治疗[J].中国康复理论与实践,2008,14(7):617-619.
[4]熊巍,苏跃,张军卫,等.脊髓损伤后植物神经反射异常的临床特点及防治措施[J].中国康复理论与实践,2018,24(10)1172-1177.
[5]Furlan J.Autonomic dysreflexia:a clinical emergency[J].JTrauma Acute Care Surg,2013,75(3):496-500.
[6]Sharif H,Hou S.Autonomic dysreflexia:a cardiovascular disor‐der following spinal cord injury[J].Neural Regen Res,201712(9):1390-1400.
[7]Wan D,Krassioukov A.Life-threatening outcomes associated with autonomic dysreflexia:a clinical review[J].J Spinal Cord Med,2014,37(1):2-10.
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[10]Fantin R,Brunner C,Putz G.Potential for lowering the risk of autonomic dysreflexia by means of transversus abdominis plane block in a paraplegic patient for cesarean delivery[J].In J Obstet Anesth,2018,36:134-135.
[11]Le?o P,Figueiredo P.Autonomic hyperreflexia after spina cord injury managed successfully with intravenous lidocaine:a case report[J].Patient Saf Surg,2016,10(1):10.
[12]Aronson S.Perioperative hypertensive emergencies[J].Curr Hypertens Rep,2014,16(7):448.
[13]Jackson C,Acland R.Knowledge of autonomic dysreflexia in the emergency department[J].Emerg Med J,2011,28(10)866-869.
[14]Str?i?N,Marki?D.The knowledge about autonomic dysre‐flexia among nursing and physiotherapy students[J].J Spina Cord Med,2018.doi:10.1080/10790268.2018.1439432.[Epub ahead of print]
[15]Eldahan K C,Rabchevsky A G.Autonomic dysreflexia after spinal cord injury:systemic pathophysiology and methods of management[J].Auton Neurosci,2018,209:59-70.
[16]Solinsky R,Kirshblum S C,Burns S P.Exploring detailed characteristics of autonomic dysreflexia[J].J Spinal Cord Med,2018,41(5):549-555.
[17]Salim M S,Mazlan M,Hasnan N.Intracerebral haemorrhage following uncontrolled autonomic dysreflexia post suprapubic catheter placement surgery[J].Spinal Cord Ser Cases,2017,3:17043.
[18]Krassioukov A,Tomasone J R,Pak M,et al."The ABCs of AD":a prospective evaluation of the efficacy of an educational intervention to increase knowledge of autonomic dysreflexia management among emergency health care professionals[J].JSpinal Cord Med,2016,39(2):190-196.
[19]张军.近因效应的认知影响及教学应用[J].化学教学,2017(9):24-27.
[20]Yoshizawa T,Kadekawa K,Tyagi P,et al.Mechanisms induc‐ing autonomic dysreflexia during urinary bladder distention in rats with spinal cord injury[J].Spinal Cord,2014,53:190.
[21]Lee J S,Fang S Y,Roan J N,et al.Spinal cord injury enhanc‐es arterial expression and reactivity ofα1-adrenergic receptors-mechanistic investigation into autonomic dysreflexia[J].Spine J,2016,16(1):65-71.
[22]Kadekawa K,Yoshizawa T,Wada N,et al.Effects of lipo‐some-based local suppression of nerve growth factor in the bladder on autonomic dysreflexia during urinary bladder disten‐tion in rats with spinal cord injury[J].Exp Neurol,2017,291:44-50.
[23]Cloutier F,Kalincik T,Lauschke J,et al.Olfactory ensheath‐ing cells but not fibroblasts reduce the duration of autonomic dysreflexia in spinal cord injured rats[J].Auton Neurosci,2016,201:17-23.
[24]Liu N,Zhou M,Biering-Sorensen F,et al.Iatrogenic urologi‐cal triggers of autonomic dysreflexia:a systematic review[J].Spinal Cord,2015,53(7):500-509.
[25]Martin Ginis K A,Tomasone J R,Welsford M,et al.Online training improves paramedics'knowledge of autonomic dysre‐flexia management guidelines[J].Spinal Cord,2017,55(2):216-222.
[2]Lee E,Joo M.Prevalence of autonomic dysreflexia in patients with spinal cord injury above T6[J].Biomed Res Int,2017,2017:2027594.
[3]郑樱,周红俊,刘根林,等.脊髓损伤并发症的预防和治疗[J].中国康复理论与实践,2008,14(7):617-619.
[4]熊巍,苏跃,张军卫,等.脊髓损伤后植物神经反射异常的临床特点及防治措施[J].中国康复理论与实践,2018,24(10)1172-1177.
[5]Furlan J.Autonomic dysreflexia:a clinical emergency[J].JTrauma Acute Care Surg,2013,75(3):496-500.
[6]Sharif H,Hou S.Autonomic dysreflexia:a cardiovascular disor‐der following spinal cord injury[J].Neural Regen Res,201712(9):1390-1400.
[7]Wan D,Krassioukov A.Life-threatening outcomes associated with autonomic dysreflexia:a clinical review[J].J Spinal Cord Med,2014,37(1):2-10.
[8]Baron E L,Frost E A M,Bonilla G.Unusual presentation of re‐fractory autonomic dysreflexia during general anesthesia[J].JNeurosurg Anesthesiol,2017,29(3):361-362.
[9]Israel J S,Carlson A R,Bonneau L A,et al.Reconstructive sur‐gery and patients with spinal cord injury:perioperative consid‐erations for the plastic surgeon[J].J Plast Surg Hand Surg2016,50(1):44-49.
[10]Fantin R,Brunner C,Putz G.Potential for lowering the risk of autonomic dysreflexia by means of transversus abdominis plane block in a paraplegic patient for cesarean delivery[J].In J Obstet Anesth,2018,36:134-135.
[11]Le?o P,Figueiredo P.Autonomic hyperreflexia after spina cord injury managed successfully with intravenous lidocaine:a case report[J].Patient Saf Surg,2016,10(1):10.
[12]Aronson S.Perioperative hypertensive emergencies[J].Curr Hypertens Rep,2014,16(7):448.
[13]Jackson C,Acland R.Knowledge of autonomic dysreflexia in the emergency department[J].Emerg Med J,2011,28(10)866-869.
[14]Str?i?N,Marki?D.The knowledge about autonomic dysre‐flexia among nursing and physiotherapy students[J].J Spina Cord Med,2018.doi:10.1080/10790268.2018.1439432.[Epub ahead of print]
[15]Eldahan K C,Rabchevsky A G.Autonomic dysreflexia after spinal cord injury:systemic pathophysiology and methods of management[J].Auton Neurosci,2018,209:59-70.
[16]Solinsky R,Kirshblum S C,Burns S P.Exploring detailed characteristics of autonomic dysreflexia[J].J Spinal Cord Med,2018,41(5):549-555.
[17]Salim M S,Mazlan M,Hasnan N.Intracerebral haemorrhage following uncontrolled autonomic dysreflexia post suprapubic catheter placement surgery[J].Spinal Cord Ser Cases,2017,3:17043.
[18]Krassioukov A,Tomasone J R,Pak M,et al."The ABCs of AD":a prospective evaluation of the efficacy of an educational intervention to increase knowledge of autonomic dysreflexia management among emergency health care professionals[J].JSpinal Cord Med,2016,39(2):190-196.
[19]张军.近因效应的认知影响及教学应用[J].化学教学,2017(9):24-27.
[20]Yoshizawa T,Kadekawa K,Tyagi P,et al.Mechanisms induc‐ing autonomic dysreflexia during urinary bladder distention in rats with spinal cord injury[J].Spinal Cord,2014,53:190.
[21]Lee J S,Fang S Y,Roan J N,et al.Spinal cord injury enhanc‐es arterial expression and reactivity ofα1-adrenergic receptors-mechanistic investigation into autonomic dysreflexia[J].Spine J,2016,16(1):65-71.
[22]Kadekawa K,Yoshizawa T,Wada N,et al.Effects of lipo‐some-based local suppression of nerve growth factor in the bladder on autonomic dysreflexia during urinary bladder disten‐tion in rats with spinal cord injury[J].Exp Neurol,2017,291:44-50.
[23]Cloutier F,Kalincik T,Lauschke J,et al.Olfactory ensheath‐ing cells but not fibroblasts reduce the duration of autonomic dysreflexia in spinal cord injured rats[J].Auton Neurosci,2016,201:17-23.
[24]Liu N,Zhou M,Biering-Sorensen F,et al.Iatrogenic urologi‐cal triggers of autonomic dysreflexia:a systematic review[J].Spinal Cord,2015,53(7):500-509.
[25]Martin Ginis K A,Tomasone J R,Welsford M,et al.Online training improves paramedics'knowledge of autonomic dysre‐flexia management guidelines[J].Spinal Cord,2017,55(2):216-222.