全科医学临床诊疗思维研究——排尿困难  

Clinical Diagnostic and Therapeutic Perspectives in Primary Gare Practice:a Case Study of Dysuria

作　　者：周雅 王静 ZHOU Ya;WANG Jing(Teaching-Research Office of General Practice,Department of Clinical Medicine,Hangzhou Medical College,Hangzhou 310053,China)

机构地区：[1]杭州医学院临床医学院全科医学教研室,浙江省杭州市310053

出　　处：《中国全科医学》2021年第11期1436-1440,共5页Chinese General Practice

基　　金：杭州医学院教学改革和研究重大招标项目(项目编号XJJG201802)。

摘　　要：本文讲述一例排尿困难病人的诊治过程,全科医生采用约翰·莫塔教授的临床安全策略——临床5问思维法:(1)哪些常见疾病会引起排尿困难?(2)哪些重要疾病不能忽视?(3)有哪些容易被遗漏的病因?(4)是否有潜在的常被掩盖的疾病?(5)家属是不是有什么话还没有说?结合病史、查体和辅助检查综合分析,确诊良性前列腺增生症。本案例的启示:(1)在老龄化社区中,全科医生不仅要掌握排尿困难患者的处理流程,还要重视高危人群的筛查;(2)老年男性出现排尿困难的症状,首先考虑良性前列腺增生症,同时也要警惕前列腺癌的可能;(3)在诊疗过程中,不但要关注患者的症状,更要关注患者,体现以人为中心的全科医学理念。This paper describes the diagnosis and treatment process of a patient with dysuria.Professor John Murtagh's safe diagnostic strategy was used for the diagnosis,which is composed of five clinical questions:(1)What most common diseases can cause dysuria?(2)What serious disorders must not be ignored?(3)What conditions are often omitted?(4)Could the patient have an underlying illness?(5)Is the patient's family member attempting to say something?Based on the comprehensive analysis of medical history,physical examination and auxiliary examination,the diagnosis of benign prostatic hyperplasia was confirmed.The important significance of the diagnosis of this case is as follows:(1)General practitioners should master the management process for dysuria patients and attach importance to the screening of residents at high risk of dysuria from an elderly community.(2)Dysuria in elderly men indicates benign prostatic hyperplasia probably,but it also may be an alarm signal of prostatic cancer.(3)Upholding patient-centered general practice views,attention should be paid to both physical and mental conditions of the patient during the consultation.

关 键 词：排尿困难 前列腺增生 尿潴留 全科医生 临床5问思维法 RICE问诊 

分 类 号：R691.2[医药卫生—泌尿科学]