急性呼吸循环障碍的改良七步法分析及治疗流程  

Analysis and treatment workflow of modified seven-step approach for acute respiratory and circulatory disorders

作　　者：周然[1] 尹万红[1] 杨吕 王小亭 晁彦公 何伟[4] Zhou Ran;Yin Wanhong;Yang Lyu;Wang Xiaoting;Chao Yangong;He Wei(Department of Critical Care Medicine,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Critical Care Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Critical Care Medicine,the First Affiliated Hospital of Tsinghua University,Beijing 100016,China;Department of Critical Care Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100041,China)

机构地区：[1]四川大学华西医院重症医学科,成都610041 [2]中国医学科学院,北京协和医学院,北京协和医院重症医学科,北京100730 [3]清华大学第一附属医院重症医学科,北京100016 [4]首都医科大学附属北京同仁医院重症医学科,北京100041

出　　处：《中华内科杂志》2023年第12期1423-1429,共7页Chinese Journal of Internal Medicine

摘　　要：急性呼吸循环障碍是最常见的重症综合征,其实质是以心肺为核心的器官/系统受损,是疾病和损伤进入重症阶段的基本表现。其发生发展包含以下几个环节:个体的特殊性、原发疾病打击、机体反应失调及全身性紊乱。因此,急性呼吸循环障碍的诊治是临床难题。根据既往提出的基于重症超声的病理生理导向的急性呼吸循环事件管理流程(PIEPEAR),结合近年的临床实践经验,总结了改良的七步法分析及治疗流程,有助于引导临床医生对急性呼吸循环障碍时的合理思考及规范治疗。该流程包括:基于临床问题的辨析、目的性临床信息追加获取、基于重症超声的床旁核心病情评估、病理生理紊乱及机体反应表型分析、病因诊断、分层一体化治疗、两层三面的治疗效果反馈。通过"庖丁解牛"式的思维引导和可视化监测,强化临床问题辨析及围绕病理生理紊乱、机体反应及原发病因三位一体的诊疗分析思路,以更准确地厘清病情关键节点,使治疗更具针对性和简单,达到"升维认知、降维治疗"的目的。Acute respiratory and circulatory disorders are the most common critical syndromes,the essence of which is damage to the organs/systems of the heart and lungs.These comprise the essential manifestation of disease and injury progression to the severe stage.Its development involves the following components:individual specificity,primary disease strike,dysregulation of the host′s response,and systemic disorders.Admission for acute respiratory and circulatory disorders is a clinical challenge.Based on a previously proposed flow,a critical care ultrasound-based stepwise approach(PIEPEAR)as a standard procedure to manage patients with acute cardiorespiratory compromise and practical experience in recent years,a modified seven-step analysis and treatment process has been developed to help guide clinicians with rational thinking and standardized treatment when faced with acute respiratory and circulatory disorders.The process consists of seven steps:problem-based clinical analysis,intentional information acquisition,evaluation of core disorder based on critical care ultrasound,pathophysiology and host response phenotype identification,etiology diagnosis,act treatment through pathophysiology-host response and etiology,and re-check.The modified seven-step approach is guided by a“modular analysis”style of thinking and visual monitoring.This approach can strengthen the identification of clinical problems and facilitate a three-in-one analysis.It focuses on pathophysiological disorders,body reactions,and primary causes to more accurately understand the condition′s key points,and make treatment more straight forward,to finally achieve the aim of“comprehensive cognition and refined treatment”.

关 键 词：急性呼吸循环障碍 改良七步法 可视化 流程 

分 类 号：R459.7[医药卫生—急诊医学]