全科医学临床诊疗思维研究——腹痛  

Clinical Diagnostic and Therapeutic Perspectives in Primary Care Practice:a Case Study of Abdominal Pain

作　　者：柴栖晨[1] 王静 CHAI Xichen;WANG Jing(Department of General Practice,Zhejiang Hospital,Hangzhou 310013,China;Teaching-Research Office of General Practice,Department of Clinical Medicine,Hangzhou Medical College,Hangzhou 310053,China)

机构地区：[1]浙江医院全科医学科,浙江省杭州市310013 [2]杭州医学院临床医学院全科医学教研室,浙江省杭州市310013

出　　处：《中国全科医学》2021年第17期2241-2244,共4页Chinese General Practice

基　　金：杭州医学院教学改革和研究重大招标项目(XJJG201802)。

摘　　要：本文介绍全科医生接诊腹痛患者时,采用约翰·莫塔教授的临床安全策略——临床5问思维法,识别腹痛:(1)导致腹痛的常见疾病有哪些?(2)不能忽视哪些重要疾病?(3)腹痛有什么容易被遗漏的疾病?(4)是否患有潜在的常被掩盖的疾病?(5)患者是不是还有什么话没有说?通过详细的问诊、全面细致的体格检查和研读检验检查结果,诊断为中枢介导的腹痛综合征。本案例启示:(1)面对腹痛患者,首先应排除危及生命的器质性病变。(2)采用全科医学整体性临床思维不易发生漏诊、误诊,能揭示胃肠功能性疾病患者隐藏的可能原因。通过排除患者顾虑、调整治疗、开展以家庭为单位的服务,最终取得满意疗效。This article introduces the encountering of a patient with abdominal pain by a general practitioner general using John Murtagh’s safe diagnostic strategy,which consists of five questions:(1)What are the common causes of abdominal pain ?(2)What severe disorders must not be overlooked ?(3)What conditions that may be associated with abdominal pain are often missed ?(4)Could the patient have a concealing illness ?(5)Is the patient attempting to say something ? After detailed consultation,comprehensive physical examination and laboratory test,the patient was diagnosed with centrally mediated abdominal pain syndrome.The revelation of this case is:(1)Abnormal pain associated with a life-threatening organic lesion should be differentiated from simple abdominal pain first.(2)Using comprehensive clinical perspectives in primary care practice may reduce the possibilities of missed diagnosis and misdiagnosis,and find the hidden causes of gastrointestinal functional diseases.Through eliminating the unnecessary concerns of patients,adjusting treatment,and delivering home-based health care,satisfactory results may be achieved.

关 键 词：腹痛 中枢介导的腹痛综合征 全科医生 临床5问思维法 RICE问诊 

分 类 号：R572[医药卫生—消化系统]