[A survey on the practice of bronchoscopy in county-level hospitals of China].

Objective: To investigate the bronchoscopy resource allocation and technology application in county-level hospitals in China. Methods: A cross-sectional survey was conducted. In 2021, 12 provinces were sampled from all provinces in China according to the regional Gross Domestic Product (GDP) and the number of counties, in which a total of 291 county-level hospitals were randomly enrolled. Two county-level hospitals which carried out bronchoscopy technology in each province were randomly sampled to investigate the status of bronchoscopy resources, technical application, decontamination and anesthesia by using questionnaires. Independent sample t test or two related sample nonparametric test were used for comparison between groups. Spearman correlation analysis was used to explore the correlation. Bilateral P<0.05 was considered statistically significant. Results: According to the sampling results, it was estimated that in the county-level hospitals, the proportion of those performing bronchoscopy was 11.4% (9.9%, 13.8%), which was significantly correlated with the population in the province (r=0.64, P=0.025) and the regional GDP (r=0.65, P=0.025).The 24 county-level hospitals interviewed were equipped with (1.6±1.0) bronchoscopes on average, and the number of hospitals with electronic bronchoscopes and fiberoptic bronchoscopes was 22 (91.7%) and 6 (25.0%), respectively. Six (25.0%) hospitals performed bronchoscopy every working day. Twelve (50.0%) hospitals had relatively permanent physicians and nurses. All operating doctors had received special training. There was a significant increase in the number of bronchoscopy cases per hospital in 2020 compared to 2019 [140(70, 335) vs. 100(29, 254), P=0.001]. All hospitals used standard cleaning and sterilization workbenches, cleaning agents and disinfectants. Surface anesthesia was available in 24 hospitals, and bronchoscopy techniques under sedation and analgesia were performed in 10 (41.7%) hospitals. Atropine was still used to prevent airway secretions in 2 (8.3%) hospitals,although not recommended by guidelines. Conclusions: There was a large gap between the current status of bronchoscopy technology in county-level hospitals and the standards of the National Health Commission, together with regional disparities. Bronchoscopist training in the standardization and the decontamination work met the requirements. In some hospitals, the use of complementary medicines was not standardized or the sedatives were not given routinely according to the guidelines. We should promote the popularization and standardization of bronchoscopy technology, and strengthen the allocation of related resources in China's county hospitals.目的： 了解我国县级医院支气管镜资源配置及技术应用现状。 方法： 一项横断面调查。2021年3—8月，根据地区生产总值、县域数量分层抽样，从中国各省中抽样12个省级行政区，共抽查291家县级医院，调查支气管镜技术在县级医院的开展情况。在每个省级行政区常规开展支气管镜技术的县级医院中用计算机随机抽样2家，调查这24家医院的支气管镜资源配备、技术应用、洗消及麻醉等现状。组间比较采用独立样本t检验或两相关样本非参数检验。采用Spearman相关分析探索相关性。双侧P<0.05为差异有统计学意义。 结果： 根据抽样结果估算，每个省级行政区常规开展支气管镜技术的县级医院数量占县级医院总数的比例是11.4%（9.9%，13.8%），与省级行政区内人口数（r=0.64，P=0.025）、地区生产总值（r=0.65，P=0.025）显著相关。接受问卷调查的24家县级医院每家配备（1.6±1.0）条支气管镜，配备电子支气管镜、纤维支气管镜的医院数量分别为22家（91.7%）、6家（25.0%）。6家（25.0%）医院每个工作日进行支气管镜操作，12家（50.2%）医院有相对固定的医生及护士。全部操作医生接受过专项培训。2020年每家医院支气管镜检查例数较2019年显著增加［140（70，335）比100（29，254），P=0.001］。全部医院采用符合标准的洗消槽、清洗剂和消毒液。24家医院采用表面麻醉，10家（41.7%）医院开展表面麻醉联合镇静镇痛。2家（8.3%）医院仍在使用阿托品减少气道分泌物。 结论： 支气管镜技术在县级医院普及情况距离国家卫生计生委员会有关标准的差距大，存在区域间的不平衡。支气管镜操作医师均接受规范培训、洗消工作符合要求，但部分医院辅助用药不规范、未按指南常规给予镇静剂。应加强县级医院支气管镜技术开展及相关资源的配置，规范操作流程。.