基层医院实施《诊疗与防控手足口病指南》的困境

Dilemma for Practice of " Guideline of Diagnosis,Treatment,Prevention and Control of Hand-foot-mouth Disease" in the Primary Hospitals

探讨实施卫生部所颁发的手足口病诊疗与防控指南存在的难点。通过实践,依据指南,笔者将近几年工作中所遇到处理各种肠道病毒感染病例存在的问题加以分析,列出实施指南存在诸多临床及非临床的影响因素,包括:(1)上报、隔离引起的矛盾;(2)诊断、治疗、转诊引起的矛盾;(3)处理肠道病毒71型(EV71)感染、疱疹性咽峡炎等与手足口病的矛盾。较多的矛盾令基层医院依照目前的指南难以良好地开展工作,期待更完善的指南以及各地医疗主管部门制定切合实际的、可行的、各种具体的防控预案。

To explore difficulties in the practice of guideline of diagnosis,treatment,prevention and control of hand-foot-mouth disease issued by Chinese Ministry of Health.Problems encountered in recent years during handling of intestinalvirus infection cases were summarized and analyzed.Both clinical and nonclinical factors affect the practice of guideline,including （1） conflict because of case report and isolation; （2） contradiction caused by diagnosis,treatment and referral; （3） discrepancy during treatment of EV71 infection,Herpangina and hand-foot-mouth disease.It is difficult for basic hospital to well practice according to current guideline because of so many contradictions encountered.An improved guideline and more practical,feasible and detailed pre arranged planning by local health institution are expected.