急诊腹痛分诊流程及诊断思路-华丽

,,,[5],,,,,,:,,,,,3~4d,,,,,,,,,,,,,,,,,,,,,,,,[][1].[M].:,1994:132[2],,,.[M].5.:,2009:241-245[3],,.[M].:,2009:88-95[4],,.[M].:,2009:131-146;172-178[5].[M].:,1996:721-726[]2010-02-20华丽,叶剑鸿,罗梁贤,刘慧恒(厦门大学附属中山医院,福建厦门361004)[]目的探讨急诊非创伤性腹痛分诊模式及诊断思路方法护士询问并记录重要相关病史;进入腹痛绿色通道;经过急诊腹痛诊疗流程筛查出可能的高危腹痛并进入下一步骤相应的医疗干预;中低危腹痛患者由绿色通道转至普通急诊进一步诊治或门诊就诊;提出分类诊断思路结果快速筛查出高危腹痛患者并给予紧急处理措施,缩短了腹痛患者在急诊停留时间,改善了急诊拥堵情况,降低了低危腹痛患者的住院率,提高了诊断准确性结论该分诊模式改变了以往依靠预检护士个人经验指导并决定急诊腹痛患者获得医疗服务紧急程度的现状,减少了高危腹痛的漏诊和低危腹痛的过度医疗,合理地应用了急诊有限资源[]急诊腹痛;分诊;流程;诊断[]R459.7[]B[]1008-8849(2010)28-3618-03,10%[1],,,,,[2],,,2008[3],,11[4],14:;,;;2,:;;;21,3618ModernJournalofIntegratedTraditionalChineseandWesternMedicine2010Oc,t19(28),,;,,,,,,,,,,,,,,,,,5min,,()()(),;,;,22,,;,23,,,,X,,,,,CT,,,,,,,[5]3,6[1]31:++32:++33:+++34:+()+35:+36:++441,,,,,,,[6],,42,,,,,43,,,(),,,;,44,,;,45,3619ModernJournalofIntegratedTraditionalChineseandWesternMedicine2010Oc,t19(28),40%[7],,,,,,,,,,,,,,,[][1].[M].:,2008:229-237[2]KaminRA,NowickiTA,CourtneyDS,eta.lPearlsandpitfallsintheemergencydepartmentevaluationofabdominalpain[J].EmergMedClinNorthAm,2003,21(1):61-72[3].[M].:,2007[4]LyonC,ClarkDC.Diagnosisofacuteabdominalpaininolderpa-tients[J].AmFamPhysician,2006,74(9):1537-1544[5].[J].,2008,11(22):2100-2101[6].[J].,2009,8(3):145-146[7]PowersRD,GuertlerAT.AbdominalpainintheED:stabilityandchangeover20years[J].AmJEmergMed,1995,13(3):301-303[]2010-05-04CT陈怀春,陈欣杰,梁春平,潘科,狄海庭,张坚(江苏省溧阳市中医院,江苏溧阳213300)[]目的探讨CT三维重建在波及关节面的复杂骨折诊治中的应用价值方法选择波及关节面的复杂骨折患者17例:髋臼骨折3例,胫骨平台骨折5例,Pilon骨折3例,跟骨骨折4例,肱骨骨折2例,术前均行X线摄片及CT三维重建,均接受手术治疗结果CT三维重建在波及关节面的复杂骨折诊治中能清晰显示骨折线走行,骨折块的大小分布和关节面损伤位置及程度结论CT三维重建在波及关节面的复杂骨折诊治中具有重要的指导意义,应将CT三维重建作为术前常规检查,以指导术前全面评估和准确分型,选择适宜手术入路和最佳的固定方法[]CT三维重建;波节关节面的复杂骨折;诊断;治疗[]R683[]B[]1008-8849(2010)28-3620-02,,,X,,2008120091217CT,,11112,5;26~78,36.2:3,5,Pilon3,4,2XCT,:8,5,2,212CT,SOMA-TOMSpiritCT,:130kV,50~200mA,1~2mm,1~1.5mm,1~1.5,512512:(MPR)(SSD)(VRT),,,,2CT,32,1(Kocher-Langenbeck),;5,4,,TL,1,;3Pilon,,,;4,,;2,,3~18,9.23,:1,3X,,,,,CT,,3620ModernJournalofIntegratedTraditionalChineseandWesternMedicine2010Oc,t19(28)