诊疗规范能否规避腹部钝性伤救治中的风险

Whether diagnostic and treatment norms can avoid risks in the treatment of blunt abdominal injuries

临床实践中,医师如果不遵循规范选择某项诊疗技术,则可能存在局限性,容易造成诊治方案的偏差和不一致性,甚至危及医疗安全。本文阐述诊疗规范的概念,分别介绍了国家政府、行业组织、教材专著和医疗机构等层面各类规范的特点和存在问题。以钝性脾损伤为例,指出遵循规范规避腹部钝性伤诊疗风险的初次评估方法,区分血流动力学稳定和不稳定患者的不同救治流程。提出了对现有规范分门别类,减少重复性,增加权威性;积极宣讲、示范规范,评价其实施效果;并注意区分诊疗规范与精益求精的医疗行为等。

In clinical practice,if physicians do not follow the norms to select the treatment technology, the resulting limitations may cause bias and inconsistency of diagnosis and treatment, and even endangering the safety of health care. This paper describes the concept of norms for diagnosis and treatment, introduces the characteristics and problems of norms from the level of national governments, trade organizations, teaching monographs and medical in- stitution. The author takes blunt splenic injuries as an example, describes the initial assessment method to follow the norms to avoid the risk of blunt abdominal trauma treatment, and distinguishes different treatment processes for he- modynamically stable and unstable patients. Finally, the author advises to classify the existing norms, reduce the du- plication ,increase the authority, actively promote the application of norms and apply demonstration and evaluate its effectiveness. Also, the author advises to pay attention to distinguishing differences between diagnostic and treatment norms and improvement of medical practices.