神经内科住院总医师会诊工作分析

摘要

Objective To describe consultation practice patterns of the neurology chief residents in different hospitals and to compare the differences of different neurology chief residents' meetings. Methods Summarizing medical records of a chief resident in neurology department in General Hospital of the Second Artillery from December 1st, 2008 to October 31st, 2009. Results A total of 797 new inpatients (423 males, 374 females, mean age of 67.4) were consulted during a 11-month period of neurology residency,including emergency consultation for 263 cases (33％)and routine consultation for 534 cases(67％ ). The chief resident consulted an average of 16 new patients per week. The most common diagnosis for an emergency consultation and routine consultation was acute cerebrovascular disease (113 case and 143 case, 42.9％ of emergency consultation and 26.8％ of routine consultation). Disturbances of consciousness(26 cases,9.9％ of emergency consultation )that is in emergency consultation second place, characterized by acute onset of cognitive and / or behavioral disorders secondary to respiration failure, renal failure or multiple organ failure. The results are different from Peking Union College Hospital. For routine consultation, the second cause was concerned about preoperative evaluations of the chronic neurologic disorders in routine consultation, including in apoplexy sequelae and lacunar infarction. Conclusion It is different to consultation practice patterns of the neurology chief resident in various hospitals. The patient encounter profile suggests that chief residents should be prepared for the consultation practice. Accumulation of related data from other residencies and hospitals is necessary and can help residency directors assess and guide the residency program in practice patterns.%目的:分析神经内科住院总医师会诊病例的构成特点,比较不同医院神经内科住院总医师会诊差异.方法:统计第二炮兵总医院神经内科1名住院总医师在2008年12月1日-2009年10月31日会诊病例.结果:共新会诊患者797例,女性374例,男性423例,年龄4～101岁,平均年龄67.4岁.平均每周新会诊病例16例.急会诊263例(33%),常规会诊534例(67%),急会诊和常规会诊以急性脑血管病最多(113例和143例),分别占急会诊和常规会诊的42.9%和26.8%.意识障碍(26例)列急会诊第二位,占急会诊的9.9%.病因包括呼吸衰竭、肾功能衰竭、肝功能衰竭、多器官衰竭及心肺腹苏后至脑代谢异常、脑功能障碍;与北京协和医院的统计数据不同.对于神经系统疾病进行术前评估及预防位居常规会诊第二位,包括卒中后遗症、陈旧性脑梗塞、腔隙性脑梗塞.结论:不同医院的神经内科会诊构成具有一定差别,住院总医师应该了解会诊患者的疾病特点,在会诊工作中学习和积累经验.