不同阶段神经内科住院总医师会诊病例分析  

Comparative analysis of consultation cases in in-patient administration during different period for chief in residen

作　　者：张远锦[1] 李坚[1] 樊东升[1] 

机构地区：[1]北京大学第三医院神经内科,100191

出　　处：《北京医学》2016年第5期436-438,共3页Beijing Medical Journal

摘　　要：目的分析北京大学第三医院神经内科不同阶段的会诊病例组成,总结住院总医师院内会诊的变化规律。方法北京大学第三医院神经内科执行24 h住院总医师值班制度,值班期间参与医院本部和北京大学第六医院的常规和急症会诊。采用对照研究方法,比较2006年6月1日至2006年11月30日和2009年9月1日至2010年8月31日两个阶段的会诊病例构成。结果第一阶段新会诊患者共512例,其中急会诊244例(47.7%),常规会诊268例(52.3%);内科系统患者286例(55.9%),外科系统226例(44.1%)。第二阶段新会诊患者共820例,其中急会诊304例(37.1%),常规会诊516例(62.9%);内科系统患者424例(51.7%),外科系统396例(48.3%)。第一阶段会诊7.11例/24 h,第二阶段5.69例/24 h。频数位于前三的疾病分别为系统性疾病神经系统表现(第一阶段230例,44.9%;第二阶段279例,34.0%;P<0.05),脑梗死(第一阶段88例,17.2%;第二阶段181例,22.1%;P=0.03)及医源性因素导致的神经系统损害(第一阶段44例,8.6%;第二阶段85例,10.4%;P=0.29)。第二阶段与第一阶段比较,系统性疾病神经系统表现的构成比减少、脑梗死构成比增加,差异均有统计学意义。结论第二阶段会诊数量减少考虑与上级医师会诊增多有关。系统性疾病的神经系统表现比例减少、脑梗死比例增多,考虑与他科医师对神经系统并发症的认识程度提高和住院患者脑血管病危险因素增加有关。Objective To investigate the changes of neurological disease constituent ratio in different consultation periods by chief in resident. Methods Department of Neurology in Peking University Third Hospital performed 24-hours- chief- resident on duty system in alternative days. Emergency and routine consultations came from Peking University Third Hospital and The Sixth Hospital during rotating duty time. The first author had been chief resident from June 1, 2006 to November 30, 2006 （the first stage） and from September 1, 2009 to August 3 l, 2010 （the second stage）. The con- sultation cases were analyzed. Statistics was applied by SPSS 17.0 software package. Comparation was conducted by chi- square test. P 〈 0.05 is defined as statistical significance. Results Our data showed the top three frequent diseases in two stages were systemic diseases nervous complication, cerebral infarction and nervous system damage caused by iatrogenic factors. Conclusion The chief resident in the first stage consulted patients 7.11 cases/24 hours, 5.69 cases/24 hours in second stage. Since including case in alternative day there should be selection bias. The proportion of cerebral infarction increased with statistical significance while no statistically significant difference between the proportions of iatrogenic fac- tors in two stages. The increasing awareness of stroke by physicians, proportion of in-patient population with cerebral in- farction risk factor accouts for the changes.

关 键 词：住院总医师 对比分析 

分 类 号：R741[医药卫生—神经病学与精神病学]