关于慢性危重症及其管理的几点思考

Considerations regarding chronic critical illness and its management

慢性危重症(CCI)很难在定义上具体界定。笔者认为CCI不应限定患者的专科来源,而应关注疾病的预防和诊治特点。建议将所有具备疾病危重性、表现多样性、治疗困难性、病程长期性、病情反复性5个特点的疾病状态统称为泛慢性危重症(ECCI),可能更具临床实际意义。CCI患者适合由包括有重症和全科工作经验的医师和护理人员、呼吸治疗师、物理治疗师、营养治疗师以及心理治疗师、专业治疗师和社会工作者等复合型实用技术人才形成多学科团队共同实施对患者的管理,其中呼吸治疗师稀缺,亟需加强培养。建设CCI管理中心可以对患者实施跨专业的全面技术支持和从医院到居家的全程闭环管理,提高患者救治品质并降低社会负担。CCI管理中心宜包括呼吸机撤机中心、CCI病房、CCI综合门诊、长期照护病房、日间照护单元、CCI居家指导中心等部门。CCI管理中心应该进行属地管理和分级管理。CCI救治网络建设和医保及收费政策的支持是重要保障。

Chronic critical illness(CCI)is difficult to define,which the author thinks should not limit the source of patients,but should pay attention to the features of disease prevention and treatment. It is suggested that all the disease states with the following five characteristics,namely,the severity of disease,the diversity of manifestations,the difficulty of treatment,the long-term course of disease and the recurrence of disease,should be collectively referred to as extended chronic critical illness(ECCI),which may have more clinical practical significance. Patients with CCI can be managed by a multidisciplinary team,consisting of doctors and nurses with experience in critical care and general practice,respiratory therapists,physiotherapists,nutritional therapists,psychotherapists,occupational therapists and social workers,and among them,respiratory therapists are scarce and it is necessary to strengthen talent cultivation. CCI medical management center can provide comprehensive technical support to CCI patients and close-loop management from hospital to home to improve the quality of treatment and reduce the social burden. CCI medical management center should include ventilator evacuation center,CCI ward,CCI general out-patient clinic,long-term care ward,day care unit,CCI home guidance center,etc. CCI medical management center should be managed locally and hierarchically. The construction of CCI network and the support of medical insurance and charging policy are important guarantees.