重症医学科

发布者:韩愫洁 作者科室:

WOYUANZHONGZHENGJIAQIANGYILIAOKE(Department of Critical Care Medicine)KAICHUANGYU1994NIAN4YUE3RI。JIANKEZAOQIWEIJIUBINGFANGGAIJIAN,CHUANGJIANLENINGXIADIYIJIAJIZHONGSHOUZHIGEZHONGWEIZHONGZHENGBINGRENDEZONGHEXINGJIAQIANGYILIAODANWEI。ZAIDANGSHIGUONEIXIANGGUANXUEKEJISHULILIANG、SHEBEIHERENSHISHANGCHUYUZHIHOUDEQINGKUANGXIA,ZIXINGSHEJIBINGFANGHEZIXINGZHIZUOLEXUDUOYILIAOYINGJIANSHESHI,SHEZHICHUANGWEI10~12ZHANG,SHISHIQUANFENGBISHIDEDULIGUANLIMOSHI,KAIKESHIJINYOUHUSHI8REN,YISHENG4REN。CHENGDANYIYUANNEIGEKEHEQUANQUWEIZHONGBINGRENDEQIANGJIURENWU,ZHUYAOSHOUZHIDEBINGZHONGBAOKUOGELEIXIUKE、YANZHONGCHUANGSHANG、HUOYINYANZHONGGANRAN、SHOUSHU、CHUANGSHANG、ZHONGDUDENGYINFADEQIGUANGONGNENGZHANGAIHE/HUOSHUAIJIE(RU:HUXI、XUNHUAN、SHENZANG、GANZANG、XUEYE、ZHONGSHUYUWAIZHOUSHENJINGXITONG)DESHENGMINGQIANGJIUYUQIGUANFUSU;YANZHONGNEIHUANJINGHEDIANJIEZHIWENLUANDEZHILIAO;YIJIDUIWEISHOUSHUQIGAOWEIBINGRENDEJIAQIANGJIANHUYUZHILIAODECHENGREN、ERTONGHEYINGYOUERDENGGELEIWEIZHONGBINGREN。ICUZHUANYEHUADEJIUZHI,YIJISUOYINJINDEXINJISHU、XINYEWU、XINFANGFAHEXINGUANNIANDADAGAISHANLEWEIZHONGBINGRENDEJIUZHICHENGGONGLV,TEBIEDUIDAXINGSHUHOUHUANZHE、DUOFASHANG、FUHESHANG、DUOQIGUANGONGNENGZHANGAIHUOSHUAIJIEHUANZHESIWANGLVDEJIANGDIQILEZHIGUANZHONGYAOZUOYONG,YECHUANGZAOLEXUDUOSHENGMINGJINQUDEQIJI。TONGSHI,HAIWEIWAIKELINGYUSHOUSHUSHIYINGZHENGDEKAITUOZUOZHEZHONGYAOSHENGMINGBAOZHANG。10NIANNEIICUYICHENGZHANGWEININGYIFUYUANDEZHONGDIANKESHIZHIYI。ZAIXIANGGUANYILIAO、JIAOXUEHEKEYANGONGZUOHEXUEKEFAZHANZHONGFAHUILEZHONGYAODEDIQU“YINLING”ZUOYONG。

2007NIAN11YUE12RIBANQIANZHIWAIKEDALOU。ZICI,WOYUANZHONGZHENGJIAQIANGYILIAOKEGENGSHISHIXIANLEZHIDEFEIYUE。ZHENGGEICUZIZHUSHEJI,SHEJILINIANJIEHELEZHONGZHENGYILIAOBINGFANGGUANLIGUIFANDEYAOQIU;JIEHELEZHONGGUOJIANDANMOSHIDEJIUWEIZHONGBINGFANGZAIGUOQUSHIDUONIANYUNXINGGUOCHENGZHONGSUOCUNZAIDEYILIAOHEGUANLIWENTI;JIEHELEDANGDIRENMINQUNZHONGDEFENGSUXIGUANHEJIANZHUJIEGOUTEDIANDENGYINSU;BINGJIEHEWEILAIWEIZHONGBINGXUEKEDEFAZHANQUSHI,SHIGAIBINGFANGDESHEJILIQIUDADAOYILIAOHEFUWUDEHELIHUA、KEXUEHUA、XIANDAIHUA、GUIFANHUA、ANQUANHUA、HERENXINGHUA。

YI、SHEJIHELIYUGUIFANHUA

QUANBINGFANGANZHUANGYOUKONGQICENGLIUJINGHUAXITONG,CENGLIUBINGFANGFENWEIA、BHECQUSANGEDABINGQU,ZONGJICHUANGWEISHU26ZHANG。QIZHONG,AQUHEBQU(JUNWEI100000JIKONGQIZHILIANGBIAOZHUN)CHUANGWEIFENBIEYOU8ZHANGHE13ZHANGCHUANG,BAOHANLE2ZHANGFUYABINGFANG,BIANYUGAOGANRANWEIXIANBINGRENDESHOUZHIYUGELI;2ZHANGVIPBINGFANG,BIANYUTESHUBINGRENHEXUYAOJIATINGZHAOGUGUANLIBINGRENDEXUYAO,BINGSHEYOUJIASHUTONGDAO;ZHONGZHUANGUANHUAIBINGFANGGENGSHIFUHEDANGDIXISU,BIANYUSIWANG、LINZHONG、JINGSHENZHANGAI、TESHUWENDINGLINSHIZHUANKEDAICHUANGBINGRENQUNTIDEXUYAO。ERCQU(10000JIBIAOZHUN)SHE5ZHANGCHUANGWEI,KEYONGYUQIGUANYIZHI、XUEYEJINGHUAHEMIANYILIJIDIDEZHONGZHENGHUANZHESHOUZHI。BINGCHUANGMEIGEDANYUANDECHUANGWEISHUSHEJIKEKONGZHIZAI5~8ZHANG,BIANYUZHONGZHENGBINGRENDEFENZUHEYOUXIAODEYILIAOGUANLI。

ANZHAOGUOJIADUICENGLIUBINGFANGDEYAOQIU,LIUCHENGFEICHANGQINGXIYUHELI。GUIFANHUASHEJICHUGONGZUORENYUANTONGDAO、BINGYUANTONGDAO、WULIUTONGDAOHEWUWUTONGDAO。NEIBUSHEYOUDUOGONGNENGTONGDAO,BIANYUGONGZUORENYUAN、WUZILIUDONGHEJIASHUTANSHI。TONGSHI,FUZHUGONGNENGFENQUMINGQUE,BAOKUO,BINGQU、YISHENGBANGONGQU、JIAOXUEYUSHENGHUOQUHEWUWUQUDENG。FUZHUYONGFANGWANSHAN,BAOKUOZHILIAOSHI、YIQISHI、JINGMAIYINGYANGPEIZHISHI、XIAODUJIAN、WUWUJIAN、QINGXIJIAN、BEIFUJIAN、XUEYEJINGHUAZHUNBEIJIAN、ERJIYILIAOKUFANGHEZILIAOKUFANG、QIANTANSHI、SHIYANSHI、XINXISHIHEJIASHUDENGDAIXIUXIQUDENG,WEIWEIZHONGBINGRENDEJIUZHITIGONGLEHELIDE、BIANYUSHIYONGDE、GUIFANGUANLIDEFUZHUGONGNENGKONGJIAN。SHIBINGFANGZAIKONGJIANYUHUANJINGJIANSHEYUSHEJIFANGMIANDADAOLEGUONEI,NAIZHIGUOJIYILIUSHUIPING。

ER、SHESHIXIANDAIHUA

ZHENGGEKESHISHEBEITOUZIYUE1500YUWANYUAN。SUOPEIBEIDEYILIAOSHEBEI90%YISHANGWEIJINKOUYILIAOSHEBEI,BAOKUOYONGYOUMEICHUANGYITAIDEDUOGONGNENGQUANZIDONGYOUCHUANGHUXIJI,WUCHUANGHUXIJI;JIANYOUCHUANGHEWUCHUANGDENGGONGNENGDUOCANSHUJIANCEJIANHUYI;GEZHONGGAOJIANDUANDECHUANGPANGJIANCHAHEZHILIAOSHEBEI,RU:CHUANGPANGXUEYEJINGHUAZHILIAOYI(CRRT)、XINDIANYUCHUZHANYI、DONGMAIXUEQIFENXIYI、XIANWEIZHIQIGUANJING、BINGTAN、ZHUSHEYUJINGMAISHUYEBENG、PAITANJI、QIDAOSHIHUAZHILIAOYI、CHUANGPANGxGUANGJI、XIAZHIJINGMAIXUESHUANYUFANGZHILIAOBENGDENGDENG。CIWAI,WEISHIXIANCHUANGPANGKUAISUJIANYANERTIGONG、XUEQIFENXI、DIANJIEZHIHEXUERUSUANCEDING、JIXINGXINJIGENGSAISHIYANJIXUENING、TANGHUAXUEHONGDANBAICEDING,YIJIKUAISUWAIZHOUXUETUPIANDENGDENG,WEIWEIZHONGBINGRENDEKUAISUJIUZHITIGONGKEXUECANSHU。ZHENGGESHESHIPEIBEIWEIYUGUOJILINGXIANSHUIPING。

YIYUANDEXIANDAIHUAWEIBINGFANGGUANLISHISHIXIANDAIHUATIGONGDEZUIDADEPINGTAI,BAOKUOWULIUCHUANSHUXITONG,DIANZIBINGLIGUANLIXITONG,BINGFANGZHONGYANGZHANSHIGUANLIDENG。

SAN、FUWURENXINGHUA

BENBINGFANGRENXINGHUASHEJIYUGUANLIHANGAILEBINGYUANDEGUANLIYUFUWU、JIASHUDECHUANGKOUFUWU、GONGZUORENYUANGONGZUOYUSHENGHUOHUANJING,YIJIJIAOXUEKEYANGUANLIDENGFANGMIAN。CHONGFENTIXIANQUANFANGWEIDERENXINGHUAGUANLIYUFUWU。

1.BINGYUANYILIAOFUWUDERENXINGHUA:MEIGEBINGYUANDAIYOUBANGEDUANDEZHILIAODANYUAN,MEIGEDANYUANJUNPEIYOUDUIJIANG(JIASHU-BINGREN,DANJIANBINGFANG-ZHONGYANGZHAN),DUIQINGXINGBINGRENJIYUCHUANGPANGDIANSHI,BINGFANGSHEYOUBEIJINGYINLE,KEBANGZHUZUOXINLIDIAOJIEHEHUANJIEKONGJUDENG。

2.JIASHUCHUANGKOUFUWURENXINGHUA:①SHELITANSHITONGDAO,JIEJUEJIASHUTANSHIHECENGLIUBINGFANGGUANLIZHIJIANDEMAODUNWENTI,BINGZAITANSHITONGDAOSHEDUIJIANGXITONG,MANZUJIASHUHEBINGYUANDEJIAOLIU,BINGQIEXIANYUMEIZHOUYICI20FENZHONGDECHUANGPANGTANSHI,DUIZHANGQIZHILIUICUDEWEIZHONGBINGRENTIXIANRENXINGHUADEFUWU,TANSUOCHUXIANDAIWEIZHONGBINGFANGGUANLIDEFANGFA。QIANTANSHIBIANYUYIHURENYUANJISHIDUIJIASHUJIAODAIBINGQING、QIANZI、TANHUAHECHUANDIHULIHECANYINYONGPINDENG。②BINGFANGSHEJIYOUSHIPINGXITONG,LIANTONGQIANTANSHIHESHIJIAOSHI,HOUZHEBIANYUJIASHUZHONGDUOHUOMEITISHIJIANSHICAOZUOSHIYONG。③JIASHUDENGHOUQUNEISHEYOUDIANSHISHIPIN,SHIXIANHUJIAO、BINGQINGBOBAOYIJISHENGHUOFUWUDENGGONGNENG,CHONGFENTIXIANLEXIANDAIICUDERENXINGHUAZHILIAOYUQUANFANGWEIDEFUWULINIAN。

3.GONGZUORENYUANGUANLIRENXINGHUA:JIANGGONGZUORENYUANDEBANGONGQUHESHENGHUOQUFENBIESHELI,SHIDEYISHENGBANGONGANJINGHELI,BIANYUYISHENGGONGZUO、XUEXI、KEYAN、XIAOXINGBINGLITAOLUNHEZHIBAN,BINGBIANYUKUAISUJINRUDAODABINGQUSHISHIQIANGJIU;ERSHENGHUOQUDESHELIBAOKUOLEJIAOXUE、PEIXUN、YIHURENYUANGENGYI、XIYU、KUAISUCANYIN(CANTING)、HUSHIZHIBANXIUXISHI、ZHURENXINGZHENGJIEDAI,YIJIXINXIHEZILIAOGUANLIDENG。YIFANGMIANBINGQUHESHENGHUOQUYUBINGQUDEGONGNENGFENKAIYOUYIYUGANRANFANGHU,JIANSHAOGANRAO,QUEBAOHULIRENYUANCHONGZUDEXIUXIDUIZHANGQITILIDEBAOCHIFEICHANGYOUYI,JIANSHAODUIYEBANDEDANYOU。ZAIWEIZHONGZHENGBINGFANGZHANGQICHAOFUHEGONGZUODE、GAOBILISHULIANGDEYIHURENYUANTIGONGRENXINGHUAFUWUDETONGSHI,YEWEIKESHIWENHUADAILAILEKONGJIANYUHUOLI。

SI、YILIAOANQUANHUA

BENBINGFANGZAIYILIAOANQUANFANGFANHEGUANLI,TEBIEZAIFANGZHIJIAOCHAGANRANDESHEJIZHONGZUOWEIZHONGDIAN,QITUCHUDIANYOU:

1.CENGLIUBINGFANGDECHANGNIANWENDUYUSHIDUDUIWEIZHONGBINGRENDEJIFAYIYUANNEIGANRAN,YOUQISHIQIDAOGANRAN、QIDAOGUANLIDAILAI。

2.MEIGEZHILIAODANYUANCAIYONGXUANGUAKETUILADEBANGEDUAN,BUJINJIEJUEYIHURENYUANBUZUYOUBIANYUANQUANKANHUNANTI,YOUDUIXIANGLINBINGRENQIANGJIUZHILIAODE、XINLIGANYUQIDAOLESHIJUE、TINGJUEDEGANYUHEFANGHU。TONGSHIZAIFANGZHIJIAOCHAGANRANDEWUPIN。

3.MEIDANYUANDEXISHOUTAOZHUANG,BAOKUOXISHOUCHI、YICIXINGCASHOUZHIHE、ZHUANYONGXIAODUJIYAXISHOUYE、KUAISUXIAODUYEPINGTAIHEGUIFANXISHOUBIAOZHUNTUDENG,JUNWEIGUIFAN、JIANDUHEBIAOZHUNHUADEYIHURENYUANXISHOUCAOZUOHEGUANNIANTIGONGLEYINGJIANBAOZHANG,WEIYUANNEIGANRANDEKONGZHIDIANDINGLELIANGHAODEWUZHIHEHUANJINGJICHU。

4.ZHONGYANGJIANHUZHANLIANJIEGECHUANGPANGXINXI,SUISHIDIAOYONGHEJIANCHAHUIKUIBINGRENXINXI。SHIPINGZHONGYANGZHANWEIBINGREN、JIASHUQUDEANQUANTIGONGYINGXIANGJIYIHECHAZHAO。JUNWEIANQUANYILIAOGUANLITIGONGSHUJUHEYINGXIANGBAOZHANG。

5.LIUCHENGQINGXIYUHELI,FUYAGELIBINGFANGMANZUTESHUGANRANBINGRENDEGUANLIXUQIU。

WU、GUANLIKEXUEHUA

1. JIANLISHIYINGWEIZHONGBINGRENDEDULIGUANLIXITONG,JIEHEGUONEIWAIDEGUANLILINIAN,YINDIZHIYIDESHELISHIYINGWEIZHONGBINGRENGUANLIYUHULIXITONGHEGANGWEI,TANSUOCHUJIYILIAO、HULI、JIAOXUEHEKEYANGUANLIDEYILIUKESHI。

2.JINRUXINBINGFANGQIANHOU,KESHIGENJUWEILAIFAZHANFANGXIANGHEXINDEGUANLIXUQIU,QUANKERENYUANCANYUBINGZHIDINGDEQUANXINDEGEXIANGGUIZHANGZHIDU。BINGYANGEZHIDUGUANLIHEZHIDUDEZHIXING,GUIFANKESHIYILIAO,FENGONGMINGQUE,ZERENMINGQUEDAOREN,YINERSHIDEJINGUANBINGFANGKUODA,YILIAOGONGZUORENWUZHONG,DANGONGZUOSHIZHONGBAOCHIJINRANYOUXUZHUANGTAI。

LIU、XUEKEJIANSHEHERENCAIDUIWUGAOBIAOZHUNHUA

JINGLILE15NIANDEXUEKEJIANSHE,WOYUANICUYONGYOUYIZHISUZHIYOULIANG、JISHUJINGZHAN、SHILIQIANGJING、JINGYANFENGFU、XIANGHUPEIHEMOQIDEYIHUTUANDUI,YESHIQUANYUANZUIDADELINCHUANGKESHI。JIANKEYILAIZHONGSHIXUEKEJIANSHEYURENCAITIDUIJIANSHE。QUANKEXIANYOUYIHURENYUANGONGYOU50REN(YILIAOZU13REN,HULIZU50REN),QIZHONGZHURENYISHI3REN,FUZHURENYISHI4REN,ZHUZHIYISHI3REN,ZHUYUANYISHI3REN。HULIZUZHONGYOUFUZHURENHUSHI1REN、ZHUGUANHULISHI11REN、HUSHI15REN、HUSHI18REN,JIANKANGZHULIYUAN5REN。KEZHURENTONGSHIRENZHONGHUAYIXUEHUIZHONGZHENGYIXUEFENHUICHANGWUWEIYUAN;ZHONGHUAYIXUEHUIBINGLISHENGLIFENHUIWEIZHONGBINGZUCHANGWUWEIYUAN;ZHONGGUOYISHIXUEHUIZHONGZHENGYISHIFENHUICHANGWUWEIYUAN;NINGXIAZHONGZHENGYIXUEHUIZHURENWEIYUAN,YIJININGXIAYIXUEYUANZHONGZHENGYIXUEJIAOYANSHIZHUREN。KESHIJIANSHESHIZHONGBAOCHILIANGHAODETUANJIEXIEZUOHEJINGSHENMIANMAO,JIJICHUANGJIANYILIUDEJINGSHENWENMINGHEGAOSIXIANGSUZHIKESHI,YIKEXUEFAZHANGUANDELINIAN,TISHENGYILIUDEYILIAOZHILIANG,SHIJIANKEXUEFAZHANGUAN,DAZAOYILIUHERENXINGHUAFUWU,YIKEXUESHIJIANFAZHANGUANWEIZHIDAO,YONGYUKAITUOCHUANGXIN,TUANJIEXIEZUO,HEXIEFAZHAN。

XUEKEFAZHANDETONGSHIZHUZHONGKEYANRENCAIDEPEIYANGHEFAZHAN。XIANYOUSHUOSHIDAOSHI2REN。YIPEIYANGBOSHI2REN,SHUOSHI6REN。MEINIANJIESHOUSHUOSHIYANJIUSHENG5-6REN。CHENGDANZIZHIQUJIKEYANKETI4XIANG,HUOZIZHIQUJIKEYANCHENGGUO2XIANG,BINGYOUSHUXIANGBEIJING、HUOGUOJIHUODUOZHONGXINXIEZUOYANJIUXIANGMU,BUDUANTIGAOKEYANYUXUESHUSHUIPING。

NINGYIFUYUANZONGHEXINGICUYICHENGWEIXIBEIDIQUZHONGYAODEWEIZHONGBINGRENCAIPEIYANGHEJIAOXUEJIDI。WEIQUANQUWEIZHONGBINGYILIAODANWEIDEJIANSHE、WEIWEIZHONGBINGYILIAORENCAIDUIWUDEPEIYANG,WEININGYIFUYUAN,NAIZHIQUANQUWEIZHONGBINGJIJIUYIXUEDEFAZHANFAHUIZHEYUELAIYUEZHONGYAODEZUOYONG。CHENGLIHOU,XIANHOUJIESHOUZIZHIQUNEIHEWAIFU(NEIMENGGUXIBU、GANSU、QINGHAIDENG)DEJINXIUYIHURENYUAN150YURENCI;MEINIANJIESHOUBENYUANLUNZHUANHUOGEKEJINXIUYISHI50YURENCI。2000NIANSHOUCIWEININGXIAYIXUEYUANBENKEBANKAISHELE“WEIZHONGBINGJIJIUYIXUE”KECHENG,YUJIZHENKEYIQIBIANXIELE“WEIZHONGBINGYIXUE”DEJIAOCAI,TIANBULENINGXIAYIXUEYUANDEJIAOXUEKONGBAI。QICHENGDANWEIZHONGBINGYUJIJIUYIXUEJIAOXUEKECHENG,KECHENGBANFANWEIHANGAILEBENKESHENG、MAZUIZHUANKESHENG、HULIBENKEYUZHUANKE、JIXUYIXUEJIAOYUTUOCHANBANYUYEYUBAN,YIJIQUANQUHUOXIBUDIQUDEWEIZHONGBINGYUJIJIUXUEXIBANKECHENG,CHENGWEIXIANDAIYIXUEJIAOYUBUKEQUESHAODEZHONGYAOZUCHENGBUFEN。CIWAI,2005NIANLINGDAOCHENGLILENINGXIAYIXUEZHONGZHENGYIXUEFENHUI。KESHIMEINIANWEIQUANQUHEXIBUDIQUCHENGBANXIANGGUANLEIXINGZHONGZHENGYIXUEXUESHUHUIYIHUOPEIXUNHUIYI,ZAIDIQUXUEKEFAZHANZHONGQIZHELONGTOUZUOYONG。KESHICENGDUOCIZHUBANSHENGNEI、QUANGUOXUESHUHUIYIHEPEIXUNBAN,CANYUQUANGUOWEIZHONGBINGJIXUYIXUEJIAOYUGONGZUO。ZAIKEYANYUXUESHUYUXUEKEJIAOLIUZHONGBUDUANKUOZHANXUESHUSHIYE,BAOCHIYUTIGAOZISHENDEXUESHUDIWEI,ZHUAZHUJIYU,JIJIMIANDUITIAOZHAN,ZAIJINBUZHONGXUNQIUGENGDADEFAZHANKONGJIAN。

MUQIAN,ICUCHENGWEIYIYUANWEIZHONGBINGRENZHILIAODEZHONGYAOBAOZHANGKESHIHEZHONGDIANXUEKE,QIKEGUANDEGUIMO、GAOCHAOZHUANYEJISHUSHUIPINGHEHEXIANJINDEGUANLISHUIPINGJIYIJISHENYUGUONEILINGXIANSHUIPING,YIZHIHUODEZHONGDUOZHUANJIA、XUEZHEHELINGDAODEHAOPING。