综合医院住院病人整体诊疗中的问题及对策

Countermeasures and Whole Diagnosis-treat Problems in the Inpatients With Surgical Diseases.

【目的】 分析综合医院外科住院患儿综合治疗中存在的问题并探讨应对措施。 【方法】 以外科性疾病住院的 12岁以下儿童 3 0 2例为研究对象 ,采取随机抽查病历、查阅医嘱的方法对 2 8项诊治内容进行综合评价分析。 【结果】 抗生素使用不合理比较明显 ,无充分依据的预防性使用抗生素占 5 8% ,剂量过大或过小占 3 1% ,用法不合理占 2 2 % ,疗程及其它错误占 8% ;使用解热镇痛药、镇静安眠药及抗过敏药存在剂量问题分别占 48%、18%及3 6% ;存在使用儿童禁用或慎用的耳毒性药物和喹诺酮类药物现象 ;对 89%的患儿没有认真计算热卡、液量、液体质量、输液速度 ,几乎对 10 0 %的患儿未注意心理护理和处理。 【结论】 综合医院专科以外的系统综合诊疗问题比较普遍和突出 ,病人作为一个整体的系统诊疗被忽视。建立“以病人为中心”的多学科整体诊疗模式是解决目前综合医院普遍存在的“全”与“专”矛盾的理想方式。

The improper treatments were comprehensively analyzed on 302 inpatients with surgical diseases,which involved in departments of otolarynogolgy,stomatology,surgery in three polyclinics,so as to explore relevant countermeasure. The 302 hospitalized children were retrospectively analyzed on the 28 items of the diagnosis treatment measures. The various mistakes of antibiotic application were commonly found among theseinpatients. The administering rate of preventive antibiotics without adequate reason was up to 58%.The problems of overdose and underdose,therapeutic method and treatment course accounted for 31%,30% respectively.Dose mistakes of febrifuges,quietives soporifics and antihistamines accounted for 48%,18% and 36% respectively.The forbidden or restrictive drugs,such as audition toxic and norfloxacin,for children were used in the part patients.There was no serious reckoning on energy,liquid requirements,qualities,velocities of transfusion in 89% patients.Nearly 100% patients were neglected in psychological cares. [Conclusions] It was found that the striking problems existed in the diagnosis treat methods of the inpatients and that the systematic treatment of inpatient regarded as a whole was ignored.It could be an ideal method of the settling contradiction of 'General' and 'Special' in polyclinic to set up a medical mode,which connecting patient regarded as a whole rather than a disease,of multi subject diagnosis and treatment on the patient.