防疫形势下胃肠道症状患者全科管理

General management of patients with gastrointestinal symptoms under the situation of epidemic prevention

2019-12月底湖北省武汉市及全国其他地区陆续出现新型冠状病毒肺炎(corona virus disease 2019,COVID-19)病例以来,全国医务工作者积极进入抗疫状态。全科医生作为居民的健康守门人,三级医院全科医学作为特殊的学科,在这场突发公共卫生事件面前也面临着严峻的考验,如何落实全科理念,做好防疫工作是当前工作的重点。胃肠道症状为新型冠状病毒肺炎病例最常见非典型症状,评估胃肠道状况,对患者综合病情评估必不可少。疫情之下,在互联网背景下,应创新既往的全科医学服务模式,警惕疫情期间胃肠道症状患者,关注胃肠道症状发生和(或)加重之前是否有流行病学史,是否合并呼吸道症状和(或)发热,并确定胃肠道症状是以上消化道为主还是下消化道为主。针对可能存在的疫情,应注意切断传染源,评估胃肠道症状与疫情的关系,对胃肠道症状患者进行饮食指导,并通过运动指导提高免疫力。全科医生还要为胃肠道症状患者提供健康咨询及随访服务,使患者治疗达到可及性、可持续性和可获得性,体现"全程、全人"的全科思维,做好新型冠状病毒防控工作。

Since the end of December 2019,there have been corona virus disease 2019(COVID-19)cases in Wuhan City of Hubei Province and other regions of the country,medical workers across the country have actively entered the anti epidemic state.As the health gatekeeper of residents,general practitioners in tertiary hospitals,as a special subject,are also facing a severe test in the face of this public health emergency.How to implement the concept of general practice and do a good job in epidemic prevention are the focus of the current work.Gastrointestinal symptoms are the most common atypical symptoms in COVID-19 patients.It is necessary to evaluate the status of gastrointestinal tract.Under the situation of epidemic,under the background of internet,we should innovate the previous general medical service mode,be alert to the patients with gastrointestinal symptoms during the epidemic,pay attention to whether there is an epidemiological history before the occurrence and(or)aggravation of gastrointestinal symptoms,whether there are respiratory symptoms and(or)fever,and determine whether the gastrointestinal symptoms are dominated by the upper or lower digestive tract.In view of the possible epidemic situation,we should pay attention to cut off the source of infection,evaluate the relationship between gastrointestinal symptoms and the epidemic situation,give diet guidance to patients with gastrointestinal symptoms,and improve immunity through exercise guidance.General practitioners should also provide health consultation and follow-up services for patients with gastrointestinal symptoms,so as to make the treatment of patients accessible,sustainable and accessible,reflect the general thinking of"whole process,whole person",and do a good job in the prevention and control of COVID-19.