中国实用外科杂志

中国实用外科杂志

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中国胃肠外科医师围手术期贫血管理理念现状分析

张    鹏1，毛    淦1，童    昕1，沈    乾1，孙    雄1，闫    超2，李子禹2，陶凯雄1，季加孚2   

  1. 1 华中科技大学同济医学院附属协和医院胃肠外科，湖北武汉 430022；2北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心 恶性肿瘤发病机制及转化研究教育部重点实验室，北京 100142
  • 出版日期:2022-08-01

  • Online:2022-08-01

摘要： 目的    分析中国胃肠外科医师围手术期贫血管理理念现状。方法    2021 年12月至2022年1月对中国胃肠肿瘤外科联盟医师进行问卷调查，问卷内容包括受调查医师基本信息、贫血管理理念及贫血诊疗现状等。结果    收集有效问卷235份，受调查医师来自于全国27个省（自治区、直辖市）。194名（82.6%）受调查医师认为贫血会影响胃肠道肿瘤病人的长期预后。针对病人术后短期预后，76名（32.4%）受调查医师认为轻、中、重度贫血均有影响；158名（67.2%）受调查医师认为中重度贫血有影响，轻度贫血无影响。36名（15.3%）受调查医师表示其管理的术前轻度贫血病人中行贫血治疗比例>50%，38名（16.2%）受调查医师表示其管理的术后轻度贫血病人中行贫血治疗比例>50%；175名（74.5%）的受调查医师表示其管理的术前中重度贫血病人中行贫血治疗比例>50%，165名（70.2%）受调查医师表示其管理的术后中重度贫血病人中行贫血治疗比例>50%。对于术前中重度贫血病人，222名（94.5%）受调查医师采取的主要治疗措施为输血；对于术后中重度贫血的胃肠道肿瘤病人，212名（90.2%）受调查医师采取的主要治疗措施为输血。在围手术期胃肠道肿瘤病人的贫血治疗药物使用上，63名（26.8%）受调查医师表示常规或经常使用静脉铁剂，受调查医师表示影响其选择静脉铁剂的因素主要为不良反应（63.4%，149/235）、静脉铁剂疗效（62.6%，147/235）及价格（55.3%，130/235）。30名（12.8%）受调查医师表示常规或经常使用促红细胞生成素，受调查医师表示影响其选择促红细胞生成素的因素依次为对此类药物疗效不了解（45.1%，106/235）、增加血栓形成风险（36.6%，86/235）、潜在影响病人长期预后风险（35.7%，84/235）。 结论    中国胃肠外科医师已具备一定的围手术期贫血管理理念，但仍存在轻度贫血病人治疗重视程度不足、中重度贫血病人治疗手段单一及对铁剂治疗认识及应用不足等问题，围手术期贫血的规范化治疗仍有待提高。

关键词: 贫血, 胃肠外科, 医师, 管理理念, 问卷调查

Abstract: Analysis of the current situation of perioperative anemia management among gastrointestinal surgeons in China        ZHANG Peng*, MAO Gan, TONG Xin, et al.*Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Corresponding authors:LI Zi-yu, E-mail: ziyu_li@hsc.pku.edu.cn;TAO Kai-xiong, E-mail：kaixiongtao@hust.edu.cn;JI Jia-fu, E-mail: jijiafu@hsc.pku.edu.cn
Abstract    Objective    To investigate the current situation of perioperative anemia management among gastrointestinal surgeons in China.  Methods    From December 2021 to January 2022, a questionnaire survey was conducted among surgeons from the China Gastrointestinal Cancer Surgery Union. The contents of the questionnaire included the basic information of the surveyed surgeons, the management of anemia, and the current situation of the treatment for anemia.  Results    A total of 235 valid questionnaires were collected. The surgeons surveyed were from 27 provinces. 194 (82.6%) surgeons indicated that anemia would affect the long-term prognosis of cancer patients. 76 (32.4%) surveyed physicians indicated that mild, moderate, and severe anemia would affect patients short-term postoperative recovery; 158 (67.2%) physicians surveyed indicated that mild anemia had no effect, while moderate and severe anemia affected patients' short-term recovery after surgery. 36 (15.3%) surveyed physicians indicated that more than 50% of the preoperative mild anemia patients they managed received anemia treatment, and 38 (16.2%) surveyed physicians indicated that more than 50% of the postoperative mild anemia patients they managed had received anemia treatment; 175 (74.5%) surveyed physicians indicated that more than 50% of preoperative moderate-to-severe anemia patients under their management had been treated for anemia, and 165 (70.2%) surveyed physicians said more than 50% of the postoperative patients with moderate to severe anemia received treatment for anemia. For preoperative moderate and severe anemia patients, 222 (94.5%) the surveyed physicians mainly used blood transfusion; for postoperative moderate and severe anemia patients with gastrointestinal tumors, 212 (90.2%) the surveyed physicians took the main treatment method: blood transfusion. Regarding the use of drugs for anemia treatment in patients with gastrointestinal tumors in the perioperative period, 63 (26.8%) surveyed physicians indicated that intravenous iron was routinely or frequently used, and the main factor affecting their choice of intravenous iron was adverse reactions (63.4%, 149/235), the efficacy of intravenous iron (62.6%, 147/235) and price (55.3%, 130/235). 30 (12.8%) surveyed physicians indicated that erythropoietin was used routinely or frequently, and the factors that influenced their choice of erythropoietin were unfamiliar with the efficacy of such drugs (45.1%, 106/235), increased risk of thrombosis (36.6%, 86/235), and potentially affected long-term prognosis of patients (35.7%, 84/235).  Conclusion    Chinese gastrointestinal surgeons have a certain concept of perioperative anemia management, but there are still problems such as insufficient attention to the treatment of patients with mild anemia, single treatment methods for patients with moderate to severe anemia, and insufficient understanding and application of iron therapy. Standardized treatment of anemia still needs to be improved.

Key words: anemia, gastrointestinal surgery; , physician, disease management, questionnaire survey