重症患者救治的临床思维特征

Clinical thinking in the treatment of critically ill patients

重症患者救治过程中的临床思维在遵从一般临床思维方式的同时,有其自身的特征。首先根据对病情的综合评估,针对目前状态下的主要问题采取积极有效的干预措施,阻断疾病发展,为原发病治疗争取时间,为机体修复创造条件。包括首先处理危及患者生命的问题,以最快的速度、最有效的措施维持患者生命体征平稳;分清主次,重点解决突出问题;在治疗过程中,边治疗边观察患者对治疗的反应性,尽量做到"精准";在诊疗过程中,主要问题在病情的不同阶段会发生转变,及时抓住病情转折点;动态观察病情演变,修正诊断;合理使用临床"指南"和"专家共识",在规范的基础上强调个体差异,"精确医疗"的理念是个体化医疗的体现;同时也要正确对待临床工作的不确定性。

Clinical thinking in the treatment of critically ill patients has its own characteristics on a basis of the general method. At first, based on a comprehensive assessment of the disease, the positive and effective interventions are taken for the major problems currently.The disease＇s progression is blocked as fast as we can, to save time for the treatment of primary disease and create the conditions for the body recovery.The life-threatening problems are treated with the highest speed and the most effective measures to maintain the stable vital signs of patients. The prominent problems are resolved preferentially. To pursue ＂precise＂, the patients＇ response must be observed timely in the course of treatment.Because the main issues can change at different stages, the inflection point of the disease should be grasped in time during the treatment. The evolution of disease is observed and the diagnosis can be amended dynamically.The ＂ Guide＂ and ＂expert consensus＂ are carried rationally and the emphasis of the individual differences should be based on standardization. The concept of ＂ precision medicine ＂ is the embodiment of individualized treatment. Meanwhile the uncertainty of clinical work must be treated in a right way.