无症状性血尿患儿分级诊疗模式的探讨  

Hierarchical diagnosis and treatment model of asymptomatic hematuria in children

作　　者：龚一女[1] 徐虹[1] 沈茜[1] 李正秀 谢岳林 蒋惠芬[4] 陆文 翟亦晖[1] 方晓燕[1] 

机构地区：[1]复旦大学附属儿科医院肾脏风湿科,上海201102 [2]上海市嘉定区中心医院儿科 [3]上海市嘉定区卫生和计划生育委员会医政科 [4]上海市宝山区疾病预防控制中心学校卫生科 [5]上海市宝山区中西医结合医院肾内科

出　　处：《上海医学》2016年第5期277-282,共6页Shanghai Medical Journal

基　　金：卫生行业科研专项项目(201002006);上海市学生健康促进工程重大委托项目(HJTY-2012-A07)资助

摘　　要：目的旨在通过在上海市嘉定区和宝山区构建分级诊疗模式并进行无症状性血尿患儿分级诊疗实践性研究,探索和完善"上海市学校尿液筛查网络化建设"的有效模式。方法 2013—2014年,由复旦大学附属儿科医院牵头,通过疾病筛查监测网络构建、相关临床数据信息化管理、人才队伍建设和区级医院开设专病门诊等三方面在上海市嘉定区和宝山区试点建立分级诊疗模式,并对这两个区在学校尿液筛查中发现的隐血或蛋白尿(本研究不对蛋白尿者进行分析)学生实施无症状性血尿分级诊疗。结果分级诊疗的构建:形成由上海市嘉定区和宝山区学校尿液筛查机构(一级)、上海市嘉定区中心医院和上海市宝山区中西医结合医院(二级)、复旦大学附属儿科医院(三级)构建的疾病筛查监测网络;开发并应用互联网尿液筛查数据库,对在区级医院和复旦大学附属儿科医院就诊/随访学生的临床资料进行信息化管理,并定期进行质量控制检查;协助区级医院组建儿童肾脏病诊疗队伍和开设尿液筛查专病门诊。分级诊疗的实践:共筛查上海市嘉定区和宝山区20所初中4 930名学生,发现隐血和(或)蛋白尿70例(1.42%,70/4 930);区级医院首诊69例(首诊率为98.6%,69/70);达到复旦大学附属儿科医院转诊标准2例,实际转诊1例(1/2),经评估为单纯性镜下血尿转回区级医院随访;区级医院单纯性镜下血尿随访20例(100.0%,20/20)。信息化管理:对上海市嘉定区中心医院和上海市宝山区中西医结合医院的相关临床数据进行信息化管理,综合数据登记系统和电子登记表,信息化管理达到100%。结论无症状性血尿分级诊疗的可行性强,能提高学校尿液筛查异常者的就诊率和随访率,是实现上海市学校尿液筛查网络化建设的有效模式,有望成为儿童慢性肾脏病二级预防的有力手段。区级医院儿科医师经过专科培训后可以承�Objective To establish the hierarchical diagnosis and treatment in Jiading and Baoshan districts of Shanghai and apply it in asymptomatic hematuria management in children, so as to explore an effective mode of urine screening at school in Shanghai. Methods From 2013 to 2014, led by Children＇s Hospital of Fudan University （CHFU）, the hierarchical diagnosis and treatment was established in Jiading and Baoshan Districts through building disease screening and monitoring network, information management system for clinical data, and talent teams and sub-specialty outpatient service in district hospitals. Then we implemented the model to practice asymptomatic hematuria management among students with urine occult blood and/or proteinuria found in school urine screening in these two districts. Results Disease screening and monitoring network consisted of Jiading and Baoshan district school urine screening agencies （level 1）, district hospitals （level 2） and OHFU （level 3）. A database based on the internet was developed to register clinical data of cases with asymptomatic hematuria consulted in district hospitals and CHFU, and quality control inspection was carried out regularly. Doctors in district hospitals were trained to be capable of diagnosing and managing children with kidney diseases. In this study, 4 930 students from 20 junior middle schools in Jiading and Baoshan districts were screened, and 70 students （ 1.42%, 70/4 930） with urine occult blood and/or proteinuria was found. Of them, 69 visited district hospitals （the first referral rate was 98.6%, 69/70） and 20 confirmed a diagnosis of asymptomatic hematuria. Two cases were evaluated as severe and should be transferred to CHFU, while only one case completed referral, who was diagnosed as microscopic haematuria and transferred back to the district hospital for follow-up. All the 20 cases with microscopic haematuria were followed up in district hospitals （100%, 20/20）. All the relevant clinical data in Jiading and Baoshan district ho

关 键 词：分级诊疗 儿童 无症状性血尿 学校尿液筛查 

分 类 号：R726.9[医药卫生—儿科]