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(涓€)璀�(h霉)鐞嗙▼搴忕殑姒傚康

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(浜�)璀�(h霉)鐞嗙▼搴忕殑姝ラ

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1.璀�(h霉)鐞嗚⿻浼� 瑭曚及鏄湁鐩殑銆佹湁瑷堝妰銆佺郴绲�(t菕ng)鍦版敹闆嗚硣鏂欑殑閬庣▼銆傝⿻浼扮殑鏍规湰鐩殑鏄壘鍑洪渶瑕佽В姹虹殑璀�(h霉)鐞嗗晱椤屻€傝⿻浼版槸璀�(h霉)鐞嗙▼搴忕殑绗竴姝�锛屼絾鍗昏搏绌夸簬璀�(h霉)鐞嗙▼搴忕殑鍏ㄩ亷绋�銆�

(1)鏀堕泦璩囨枡鐨勭洰鐨勶細鈶犵偤鍋氬嚭姝ｇ⒑鐨勮(h霉)鐞嗚ê鏂锋彁渚涗緷鎿�(j霉)銆傗憽鐐哄埗瑷傝(h霉)鐞嗚▓鍔冩彁渚涗緷鎿�(j霉)銆傗憿鐐鸿⿻鍍硅(h霉)鐞嗘晥鏋滄彁渚涗緷鎿�(j霉)銆傗懀鐐鸿(h霉)鐞嗙鐮旂⿳绱硣鏂欍€�

(2)璩囨枡鐨勯鍨�

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(3)璩囨枡鐨勪締婧愶細鈶犵梾浜烘槸璩囨枡鐨勪富瑕佷締婧�銆傗憽鑸囩梾浜烘湁闂�(gu膩n)鐨勪汉鍝★紝濡傝Κ灞�銆佹湅鍙嬨€佸悓浜嬬瓑銆傗憿鍏朵粬琛�(w猫i)鐢熶繚鍋ヤ汉鍝°€傗懀鐥呬汉鐩墠鎴栨棦寰€鐨勮閷勬垨鐥呮銆傗懁閱�(y墨)鐧傘€佽(h霉)鐞嗙殑鏈夐棞(gu膩n)鏂囩嵒(xi脿n)瑷橀寗銆�

(4)璩囨枡鐨勫収(n猫i)瀹癸細鈶犱竴鑸硣鏂�锛屽寘鎷梾浜虹殑濮撳悕銆佸勾榻°€佹€у垾銆佸濮荤媭娉�銆佹枃鍖栫▼搴︾瓑銆傗憽鏃㈠線鍋ュ悍鐙€娉侊紝鍖呮嫭鏃㈠線鐥呭彶銆侀亷鏁忓彶銆佷綇闄㈠彶銆佸鏃忓彶銆佹墜琛�(sh霉)鍙婂鍌峰彶绛�銆傗憿鐢熸椿鐙€娉佸拰鑷悊绋嬪害锛屽寘鎷棩甯哥敓娲昏(gu墨)寰嬪強鑷悊绋嬪害銆侀２椋熴€佸棞濂�銆佹竻娼旇(w猫i)鐢熺瓑銆傗懀蹇冪悊绀炬渻鐙€娉侊細蹇冪悊鐙€娉佸寘鎷竴鑸績鐞嗙媭鎱�(t脿i)銆佸皪鐤剧梾鑸囧仴搴风殑瑾�(r猫n)璀�銆佹噳(y墨ng)婵€姘村钩鑸囨噳(y墨ng)灏嶈兘鍔涖€佸€嬫€у偩鍚戞€�銆佹€ф牸鐗瑰緛锛屽闁嬫湕鎴栨姂閮�銆佺穵寮点€佹亹鎳肩瓑锛氱ぞ鏈冩柟闈㈠寘鎷富瑕佺ぞ鏈冮棞(gu膩n)绯诲強瀵嗗垏绋嬪害銆佺ぞ鏈冪祫绻旈棞(gu膩n)绯昏垏鏀寔绋嬪害銆佸伐浣滃(xu茅)缈�(x铆)鎯呮硜銆佺稉(j墨ng)婵�(j矛)鐙€娉佽垏閱�(y墨)鐧傛浠剁瓑銆傗懁璀�(h霉)鐞嗛珨妾�锛屽寘鎷敓鍛介珨寰�銆佽韩楂�銆侀珨閲�銆佹剰璀�銆佺灣瀛斻€佺毊鑶�銆侀粡鑶�銆佸洓鑲�銆佺嚐椁�(y菐ng)銆佷富瑕佽嚐鍣ㄩ珨妾㈢瓑銆�

(5)鏀堕泦璩囨枡鐨勬柟娉�

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鈶′氦璜囷細鐩殑鏄敹闆嗙梾浜虹殑鍋ュ悍璩囨枡锛屽缓绔嬭壇濂界殑璀�(h霉)鎮ｉ棞(gu膩n)绯伙紝鍚戠梾浜烘敹闆嗘垨鍙嶉鏈夐棞(gu膩n)鑷韩鐤剧梾銆佹不鐧傚拰璀�(h霉)鐞嗙殑鏈夐棞(gu膩n)淇℃伅锛屽彇寰楀悇绋墍闇€璩囨枡锛岀嵅鍙栫梾浜虹殑淇′换锛屽悓鏅傜郸鐥呬汉鎻愪緵蹇冪悊鏀寔?锛熺厼璀冩獛類虫祰寰藉姶澶撮挦類虫祰寰藉墲鐓濶銆備氦璜囨檪瀹夋帓鍚堥仼鐨勭挵(hu谩n)澧�锛岃鏄庝氦璜囩殑鐩殑鍙婃墍闇€鐨勬檪鍟�锛屽紩灏�(d菐o)鐥呬汉鎶撲綇浜よ珖鐨勪富椤�锛屼氦璜囨檪瑕佹敞鎰忓偩鑱斤紝涓嶈鍌績锛屼笉瑕侀毃鎰忔墦鏂锋垨鎻愬嚭鏂扮殑瑭遍銆傚強鏅傚弽楗�锛岃獮鍙ヨ〃閬�(d谩)娓呮櫚銆佽獮鎰忔槑纰�銆佽獮閫熼仼鐣�(d膩ng)锛屽皪鐥呬汉鎻愬嚭鐨勫晱椤�锛屾噳(y墨ng)绲︿簣鍚堢悊鐨勮В閲嬫垨鎭扮暥(d膩ng)?sh霉)濮嗙；?y墨ng)锛屽榛�(di菐n)闋�銆佸井绗戠瓑銆備氦璜囩祼(ji茅)鏉熸檪閫�(j矛n)琛岀附绲�(ji茅)锛屽苟寰佹眰鐥呬汉鐨勬剰瑕�锛屽悜鐥呬汉鑷磋瑵銆�

鈶㈡煡闁憋細鏌ラ柋鐥呬汉鐨勯啱(y墨)鐧傜梾姝�銆佽(h霉)鐞嗙梾姝�銆佽紨鍔╂鏌ョ祼(ji茅)鏋滅瓑銆�

鈶ｉ珨妾細濡傜敓鍛介珨寰�銆佽韩楂樼瓑澶氶爡淇℃伅銆�

(6)璩囨枡鐨勬暣鐞嗗拰瑷橀寗锛氭暣鐞嗘槸灏囩梾浜虹殑鍋ュ悍璩囨枡鎸変竴瀹氱殑鏂规硶閫�(j矛n)琛屽垎椤烇紝骞舵鏌ユ湁鐒￠伜婕忕殑閬庣▼銆傛噳(y墨ng)娉ㄦ剰鏀堕泦鐨勮硣鏂欒鍙婃檪瑷橀寗锛屼富瑙€璩囨枡鐨勮閷勭洝閲忕敤鐥呬汉鐨勫師瑭�锛屽瑙€璩囨枡鐨勮閷勮閬垮厤璀�(h霉)澹殑涓昏鍒ゆ柗鍜岀祼(ji茅)璜�锛屾噳(y墨ng)浣跨敤閱�(y墨)瀛�(xu茅)琛�(sh霉)瑾炪€�

2.璀�(h霉)鐞嗚ê鏂�

(1)姒傚康锛氳(h霉)鐞嗚ê鏂锋槸闂�(gu膩n)浜庡€嬩汉銆佸搴垨绀惧崁(q奴)鐝�(xi脿n)瀛樼殑鎴栨經鍦ㄧ殑鍋ュ悍鍟忛浠ュ強鐢熷懡閬庣▼鐨勫弽鎳�(y墨ng)鐨勪竴绋嚚搴婂垽鏂凤紝鏄(h霉)澹偤閬�(d谩)鍒伴爯(y霉)鏈熺祼(ji茅)鏋滈伕鎿囪(h霉)鐞嗘帾鏂界殑鍩虹(ch菙)锛岄€欎簺绲�(ji茅)鏋�(闋�(y霉)鏈熺洰妯�(bi膩o))鎳�(y墨ng)鐢辫(h霉)澹矤(f霉)璨�(z茅)鍒惰▊銆�

(2)璀�(h霉)鐞嗚ê鏂风殑绲勬垚

鈶犲悕绋憋細鏄皪璀�(h霉)鐞嗗皪璞″仴搴峰晱椤岀殑姒傛嫭鎬ф弿杩�銆傚寘鎷従(xi脿n)瀛樼殑銆佸嵄闅殑鍜屽仴搴风殑3绋(h霉)鐞嗚ê鏂�?锛孎(xi脿n)瀛樼殑鏄寚璀�(h霉)鐞嗗皪璞＄洰鍓嶅凡缍�(j墨ng)瀛樺湪鐨勫仴搴峰晱椤�锛屽“鐨啔瀹屾暣鎬у彈鎼嶏細澹撶槨鑸囧眬閮ㄧ祫绻旈暦鏈熷彈澹撴湁闂�(gu膩n)”;鍗遍毆鐨勮(h霉)鐞嗚ê鏂风殑闄宠堪褰㈠紡鐐�“鏈�……鍗遍毆”;鍋ュ悍鏄€嬩汉銆佸搴�銆佺ぞ鍗€(q奴)寰炵壒瀹氱殑鍋ュ悍姘村钩鍚戞洿楂樻按骞崇櫦(f膩)灞曠殑璀�(h霉)鐞嗚ê鏂�锛岄櫝杩板舰寮忕偤“娼涘湪鐨�……澧炲挤(qi谩ng)”“鍩�(zh铆)琛�……鏈夋晥”銆�

鈶″畾缇╋細鏄皪璀�(h霉)鐞嗚ê鏂峰悕绋辩殑涓€绋竻鏅般€佹纰虹殑鎻忚堪銆�

鈶㈣ê鏂蜂緷鎿�(j霉)锛氭槸鍋氬嚭瑭茶(h霉)鐞嗚ê鏂锋檪鐨勮嚚搴婂垽鏂锋(bi膩o)婧�(zh菙n)锛屽嵆鐩搁棞(gu膩n)鐨勭櫏鐙€銆侀珨寰佸拰鏈夐棞(gu膩n)鐥呭彶锛屼篃鍙互鏄嵄闅洜绱�銆傝(h霉)澹湪鍋氬嚭鏌愬€嬭(h霉)鐞嗚ê鏂锋檪锛岃鍙冪収瑷烘柗渚濇摎(j霉)銆傝ê鏂蜂緷鎿�(j霉)鏈�3绋紝绗竴绋ū“蹇呰渚濇摎(j霉)”锛屽嵆鍋氬嚭鏌愪竴璀�(h霉)鐞嗚ê鏂锋檪蹇呴爤鍏峰倷鐨勪緷鎿�(j霉);绗簩绋ū“涓昏渚濇摎(j霉)”锛屽嵆鍋氬嚭鏌愪竴瑷烘柗鏅傞€氬父闇€瑕佸瓨鍦ㄧ殑渚濇摎(j霉);绗笁绋ū“娆¤渚濇摎(j霉)”锛屽嵆灏嶅仛鍑烘煇涓€瑷烘柗鏈夋敮鎸佷綔鐢紝浣嗕笉涓€瀹氭瘡娆″仛鍑鸿┎瑷烘柗鏅傞兘瀛樺湪鐨勪緷鎿�(j霉)銆�

鈶ｇ浉闂�(gu膩n)鍥犵礌锛氭槸鎸囧奖闊垮€嬮珨鍋ュ悍鐙€娉佺殑鐩存帴鍥犵礌銆佷績鐧�(f膩)鍥犵礌鎴栧嵄闅洜绱�锛屽寘鎷梾鐞嗐€佺敓鐞�銆佹不鐧�銆佹儏澧�銆佸勾榻＄瓑鏂归潰銆�

(3)璀�(h霉)鐞嗚ê鏂风殑闄宠堪鏂瑰紡锛氳(h霉)鐞嗚ê鏂蜂富瑕佹湁浠ヤ笅3绋櫝杩版柟寮�銆�

鈶犱笁閮ㄥ垎闄宠堪(PSE)锛氬鐢ㄤ簬鐝�(xi脿n)瀛樼殑璀�(h霉)鐞嗚ê鏂凤紝鍗砅ES鍏紡銆�

P——鍟忛(problem)锛屽嵆璀�(h霉)鐞嗚ê鏂风殑鍚嶇ū銆�

E——鐥呭洜(etiology)锛屽嵆鐩搁棞(gu膩n)鍥犵礌锛屽鐢�“鑸�……鏈夐棞(gu膩n)”渚嗛櫝杩�銆�

S——鐧ョ媭鍜岄珨寰�(symptoms and signs)锛屼篃鍖呮嫭瀵﹂瀹�銆佸櫒姊版鏌ョ祼(ji茅)鏋�銆�

渚嬪锛屾埃楂斾氦鎻涘彈鎼嶏細鐧�(f膩)绱�銆佸懠鍚稿洶闆�銆丳aO2鐐�5.3kPa鑸囬樆濉炴€ц偤姘ｈ叓鏈夐棞(gu膩n)銆�

鈶′簩閮ㄥ垎闄宠堪(PE)锛氬鐢ㄤ簬娼涘湪鐨勮(h霉)鐞嗚ê鏂�(“鏈夊嵄闅殑”)锛屼篃鍙綔鐐虹従(xi脿n)瀛樼殑璀�(h霉)鐞嗚ê鏂风殑绨″寲褰㈠紡銆�

鍗砅E鍏紡锛屽彧鏈夎(h霉)鐞嗚ê鏂峰悕绋卞拰鐩搁棞(gu膩n)鍥犵礌锛岃€屾矑鏈夎嚚搴婅〃鐝�(xi脿n)銆備緥濡�锛屾湁鐨啔瀹屾暣鎬у彈鎼嶇殑鍗遍毆鑸囬暦鏈熻嚗搴婃湁闂�(gu膩n)銆�

鈶竴閮ㄥ垎闄宠堪(P):澶氱敤浜庡仴搴风殑璀�(h霉)鐞嗚ê鏂枫€備緥濡�锛屾瘝涔冲杺椁�(y菐ng)鏈夋晥銆�

(4)鏇稿璀�(h霉)鐞嗚ê鏂风殑娉ㄦ剰浜嬮爡锛氣憼璀�(h霉)鐞嗚ê鏂风殑闄宠堪鎳�(y墨ng)绨℃槑銆佹簴(zh菙n)纰�銆佽(gu墨)鑼�銆傗憽涓€鍊嬭(h霉)鐞嗚ê鏂峰彧閲濆皪涓€鍊嬪仴搴峰晱椤�銆傗憿閬垮厤鑸囪(h霉)鐞嗙洰妯�(bi膩o)銆佹帾鏂�銆侀啱(y墨)鐧傝ê鏂风浉娣锋穯銆傗懀浠ユ敹闆嗙殑璩囨枡浣滅偤璀�(h霉)鐞嗚ê鏂风殑渚濇摎(j霉)銆傗懁璀�(h霉)鐞嗚ê鏂烽櫝杩扮殑鍋ュ悍鍟忛蹇呴爤鏄(h霉)鐞嗘帾鏂借兘澶犺В姹虹殑銆傗懃涓嶆噳(y墨ng)鏈夋槗寮曡捣娉曞緥绯剧礇鐨勬弿杩�銆�

(5)閱�(y墨)璀�(h霉)鍚堜綔鍟忛——娼涘湪骞剁櫦(f膩)鐧ワ細鍚堜綔鎬у晱椤屾槸鎸囩敱璀�(h霉)澹拰閱�(y墨)鐢熷叡鍚屽悎浣滄墠鑳借В姹虹殑鍟忛(娼涘湪骞剁櫦(f膩)鐧�)锛屽鎸囨槑鍥犺嚐鍣ㄧ梾鐞嗙敓鐞嗘敼璁婃墍鑷寸殑骞剁櫦(f膩)鐧ワ紝鏄渶瑕佽(h霉)鐞嗕汉鍝￠€�(j矛n)琛岀洠(ji膩n)娓苟鑸囧叾浠栭啱(y墨)鍕�(w霉)浜哄摗鍏卞悓铏曠悊浠ユ笡灏戠櫦(f膩)鐢熺殑鍟忛銆傚苟闈炴墍鏈夌殑骞剁櫦(f膩)鐧ラ兘鏄悎浣滄€у晱椤�锛岃兘澶犻€氶亷璀�(h霉)鐞嗘帾鏂藉共闋�(y霉)鍜岃檿鐞嗙殑灞簬璀�(h霉)鐞嗚ê鏂�锛屼笉鑳介爯(y霉)闃叉垨鐛�(d煤)绔嬭檿鐞嗙殑鍓囧爆浜庡悎浣滄€у晱椤�銆傚悎浣滄€у晱椤屾湁鍏跺浐瀹氱殑闄宠堪鏂瑰紡锛屽嵆“娼涘湪骞剁櫦(f膩)鐧ワ細××××”銆傛經鍦ㄥ苟鐧�(f膩)鐧ュ彲绨″鐐篜C锛屽“娼涘湪骞剁櫦(f膩)鐧ワ細蹇冨緥澶卞父”鎴�“PC:蹇冨緥澶卞父”銆�

(6)璀�(h霉)鐞嗚ê鏂疯垏閱�(y墨)鐧傝ê鏂风殑鍗€(q奴)鍒�

鈶犺嚚搴婄爺绌剁殑灏嶈薄涓嶅悓锛氳(h霉)鐞嗚ê鏂锋槸灏嶅€嬩汉銆佸搴垨绀惧崁(q奴)鐝�(xi脿n)瀛樼殑鎴栨經鍦ㄧ殑鍋ュ悍鍟忛浠ュ強鐢熷懡閬庣▼鐨勫弽鎳�(y墨ng)鐨勫垽鏂�;閱�(y墨)鐧傝ê鏂锋槸灏嶅€嬮珨鐥呯悊鐢熺悊鏀硅畩鐨勫垽鏂枫€�

鈶℃弿杩扮殑鍏�(n猫i)瀹逛笉鍚岋細璀�(h霉)鐞嗚ê鏂锋槸鍊嬮珨灏嶅仴搴峰晱椤岀殑鍙嶆噳(y墨ng)锛岄毃鐥呬汉鐨勫弽鎳�(y墨ng)璁婂寲鑰岃畩鍖�;閱�(y墨)鐧傝ê鏂峰湪鐥呯▼涓繚鎸佷笉璁娿€�

鈶㈡焙绛栬€呬笉鍚岋細璀�(h霉)鐞嗚ê鏂风殑姹虹瓥鑰呮槸璀�(h霉)澹�锛岄啱(y墨)鐧傝ê鏂风殑姹虹瓥鑰呮槸閱�(y墨)鐢�銆�

鈶ｈ伔璨�(z茅)鑼冨湇涓嶅悓锛氳(h霉)鐞嗚ê鏂峰爆浜庤(h霉)鐞嗚伔璨�(z茅)鑼冨湇锛岄啱(y墨)鐧傝ê鏂峰爆浜庨啱(y墨)鐧傝伔璨�(z茅)鑼冨湇銆�

3.璀�(h霉)鐞嗚▓鍔� 璀�(h霉)鐞嗚▓鍔冩槸閲濆皪璀�(h霉)鐞嗚ê鏂峰埗瑷傜殑鍏烽珨璀�(h霉)鐞嗘帾鏂介亷绋�锛屾槸璀�(h霉)鐞嗚鍕曠殑鎸囧崡銆�

(1)瑾�(r猫n)瀹氬劒(y艒u)鍏堟搴�

鈶犳帓搴忓師鍓囷細a.鍏堣В姹虹洿鎺ュ嵄鍙婄敓鍛界殑鍟忛銆俠.鍏堣В姹轰綆灞ゆ闇€瑕�锛屽啀瑙ｆ焙楂樺堡娆￠渶瑕�銆俢.鍦ㄤ笉閬曞弽鍘熷墖鐨勫墠鎻愪笅锛氬厛瑙ｆ焙鐥呬汉瑾�(r猫n)鐐烘渶閲嶈鐨勫晱椤�銆俤.鍏堣В姹虹従(xi脿n)瀛樼殑鍟忛锛屼絾涓嶅拷瑕栨經鍦ㄧ殑銆佹湁鍗遍毆鎬х殑鍟忛銆�

鈶℃帓鍒楅爢搴忥細a.棣栧劒(y艒u)鍟忛锛岀洿鎺ュ▉鑴呯敓鍛界殑鍟忛銆俠.涓劒(y艒u)鍟忛锛屼笉鐩存帴濞佽剠鐢熷懡锛屼絾鑳介€犳垚韬珨鎴栫簿绁炰笂鎼嶅鐨勫晱椤�銆俢.娆″劒(y艒u)鍟忛锛屽湪鐧�(f膩)灞曞拰鐢熸椿璁婂寲涓墍鐢�(ch菐n)鐢熺殑鍟忛锛屽彲绋嶅悗瑙ｆ焙銆�

(2)瑷�(sh猫)瀹氶爯(y霉)鏈熺洰妯�(bi膩o)锛氭寚鐥呬汉鎺ュ彈璀�(h霉)鐞嗗悗锛屾湡鏈涢仈(d谩)鍒扮殑鍋ュ悍鐙€鎱�(t脿i)鎴栬鐐虹殑鏀硅畩锛屽嵆鏈€鐞嗘兂鐨勮(h霉)鐞嗘晥鏋�銆�

鈶犲垎椤烇細a.杩戞湡鐩(bi膩o)锛屼竴鑸寚7澶╀互鍏�(n猫i)鍙仈(d谩)鍒扮殑鐩(bi膩o)銆俠.閬�(yu菐n)鏈熺洰妯�(bi膩o)锛屾寚闇€瑕佽純闀锋檪闁撴墠鑳藉鐝�(xi脿n)鐨勭洰妯�(bi膩o)銆�

鈶￠櫝杩帮細璀�(h霉)鐞嗙洰妯�(bi膩o)鐨勯櫝杩板寘鎷富瑾炪€佽瑐瑾�銆佽鐐烘(bi膩o)婧�(zh菙n)銆佹浠剁媭瑾炲拰瑭曞児鏅傞枔銆備富瑾炴槸璀�(h霉)鐞嗗皪璞℃檪鍙互鐪佺暐銆�

鈶㈤櫝杩扮洰妯�(bi膩o)鐨勬敞鎰忎簨闋咃細a.蹇呴爤鍒囧鍙锛屽爆浜庤(h霉)鐞嗗伐浣滆寖鐤�;b.涓昏獮鏄梾浜烘垨鐥呬汉韬珨鐨勪竴閮ㄥ垎;c.蹇呴爤鍏烽珨銆佸彲娓噺锛屾湁鍏烽珨鏃ユ湡;d.鎳�(y墨ng)鍏锋湁鏄庣⒑閲濆皪鎬�锛屼竴鍊嬬洰妯�(bi膩o)閲濆皪涓€鍊嬭(h霉)鐞嗚ê鏂�;e.鎳�(y墨ng)鑸囬啱(y墨)鐧傚伐浣滅浉鍗�(xi茅)瑾�(di脿o)銆�

(3)瑷�(sh猫)瀹氳(h霉)鐞嗚▓鍔�(璀�(h霉)鐞嗘帾鏂�)

鈶犲収(n猫i)瀹癸細鍖呮嫭鍗�(xi茅)鍔╃梾浜哄畬鎴愮敓娲昏(h霉)鐞�銆佹不鐧傛€х殑鎺柦銆佸嵄闅晱椤岀殑闋�(y霉)闃�銆佺梾鎯呭強蹇冪悊娲诲嫊鐨勮瀵�銆佸仴搴锋暀鑲茶垏鍜ㄨ銆佹彁渚涘績鐞嗘敮鎸�銆佸埗瑷傚嚭闄㈣▓鍔冦€�

鈶￠鍨嬶細a.鐛�(d煤)绔嬫€ц(h霉)鐞嗘帾鏂�锛屽湪璀�(h霉)澹伔璨�(z茅)鑼冨湇鍏�(n猫i)锛岃(h霉)澹彲鐛�(d煤)绔嬪垽鏂枫€佹焙瀹氱殑鎺柦;b.渚濊炒鎬ц(h霉)鐞嗘帾鏂�锛岄渶瑕侀啱(y墨)鍥戞墠鑳藉煼(zh铆)琛岀殑鎺柦;c.鍗�(xi茅)浣滄€ц(h霉)鐞嗘帾鏂�锛岄渶瑕侀啱(y墨)璀�(h霉)鍚堜綔瀹屾垚鐨勬帾鏂�銆�

鈶㈡敞鎰忎簨闋咃細a.鎳�(y墨ng)鑸囬啱(y墨)鐧傚伐浣滅浉鍗�(xi茅)瑾�(di脿o)锛歜.鎳�(y墨ng)鏈夌瀛�(xu茅)鐨勭悊璜栦緷鎿�(j霉);c.瑕佸垏瀵﹀彲琛�锛屾棦瑕佽€冩叜鐥呬汉鐨勫闅涙儏娉佸拰缍�(j墨ng)婵�(j矛)瀵﹀姏锛屼篃瑕佽€冩叜鍒拌(h霉)鐞嗕汉鍝＄殑妲�(g貌u)鎴愭儏娉�銆侀啱(y墨)闄㈣ō(sh猫)鏂�銆佽ō(sh猫)鍌欑瓑锛岄珨鐝�(xi脿n)鍊嬫€у寲;d.璀�(h霉)鐞嗘帾鏂芥噳(y墨ng)鏄庣⒑銆佸叿楂�銆佸叏闈�;e.鎳�(y墨ng)淇濊瓑鐥呬汉鐨勫畨鍏�;f.鎺柦鏄嚌灏嶇洰妯�(bi膩o)鍒惰▊鐨勩€�

鈶ｈ(h霉)鐞嗚▓鍔冿細灏囪(h霉)鐞嗚ê鏂�銆佽(h霉)鐞嗙洰妯�(bi膩o)銆佽(h霉)鐞嗘帾鏂界瓑鎸変竴瀹氭牸寮忔浉瀵垚鏂�锛屾(g貌u)鎴愯(h霉)鐞嗚▓鍔�銆�

4.瀵︽柦 瀵︽柦鏄皣璀�(h霉)鐞嗚▓鍔冧粯璜歌鍕�锛屽鐝�(xi脿n)璀�(h霉)鐞嗙洰妯�(bi膩o)鐨勯亷绋�銆傚鏂界殑鍏�(n猫i)瀹癸細灏囪(h霉)鐞嗚▓鍔冨収(n猫i)鐨勮(h霉)鐞嗘帾鏂介€�(j矛n)琛屽垎閰嶅拰瀵︽柦銆傚鏂芥椹燂細瀵︽柦璀�(h霉)鐞嗚▓鍔冪殑閬庣▼鍙垎3姝�锛屽嵆婧�(zh菙n)鍌�銆佸鏂�銆佽閷�銆傚鏂芥柟娉曟湁锛氳(h霉)澹畬鎴愩€佽垏鍏朵粬閱�(y墨)鍕�(w霉)浜哄摗鍚堜綔瀹屾垚浠ュ強鎸囧皫(d菐o)鐥呬汉鍙婂灞叡鍚屽弮鑸囧畬鎴�銆�

5.瑭曞児 瑭曞児鏄寚璀�(h霉)鐞嗙祼(ji茅)鏋滆垏闋�(y霉)瀹氱殑璀�(h霉)鐞嗙洰妯�(bi膩o)閫愪竴灏嶇収锛屽皪璀�(h霉)澹煼(zh铆)琛岃(h霉)鐞嗙▼搴忕殑鏁堟灉銆佽唱(zh矛)閲忓仛鍑鸿⿻瀹氱殑閬庣▼銆傝⿻鍍归洊鐒舵槸璀�(h霉)鐞嗙▼搴忕殑鏈€鍚庝竴姝�锛屼絾瑭曞児瀵﹂殯璨┛浜庤(h霉)鐞嗙▼搴忕殑鍏ㄩ亷绋�銆傗憼瑭曞児鏂瑰紡锛氳(h霉)澹嚜鎴戣⿻鍍�锛岃(h霉)鐞嗘煡鎴�锛岃(h霉)澹暦鑸囪(h霉)鐞嗘暀甯殑妾㈡煡瑭曞畾銆傗憽瑭曞児鍏�(n猫i)瀹癸細璀�(h霉)鐞嗛亷绋�銆佽(h霉)鐞嗘晥鏋滃拰鐩(bi膩o)瀵︾従(xi脿n)绋嬪害銆傚叾涓渶閲嶈鐨勬槸璀�(h霉)鐞嗘晥鏋滅殑瑭曞児銆傝(h霉)鐞嗙洰妯�(bi膩o)瀵︾従(xi脿n)鐨勭▼搴﹀垎鐐猴細鐩(bi膩o)瀹屽叏瀵︾従(xi脿n)——绲傛瑷堝妰;鐩(bi膩o)閮ㄥ垎瀵︾従(xi脿n)——绻肩簩(x霉)鏈夋晥鐨勬帾鏂斤細鐩(bi膩o)鏈鐝�(xi脿n)——鍦ㄦ柊璩囨枡鐨勫熀绀�(ch菙)涓婇噸瑷傝▓鍔�銆傗憿瑭曞児姝ラ锛氭敹闆嗚硣鏂�锛屽垽鏂锋晥鏋滐紝鍒嗘瀽鍘熷洜锛屼慨瑷傝▓鍔冦€�

(涓�)璀�(h霉)鐞嗙梾妗堢殑鏇稿

璀�(h霉)鐞嗙梾妗堝寘鎷互涓�5鍊嬫柟闈㈢殑鍏�(n猫i)瀹�銆�

1.鐥呬汉鍏ラ櫌璀�(h霉)鐞嗚⿻浼板柈 鐢ㄤ簬灏嶆柊鐥呬汉閫�(j矛n)琛屽垵姝ョ殑璀�(h霉)鐞嗚⿻浼�锛屾壘鍑虹梾浜虹殑鍋ュ悍鍟忛锛屾彁鍑鸿(h霉)鐞嗚ê鏂�銆�

2.璀�(h霉)鐞嗚▓鍔冨柈 鍗冲皪鐥呬汉瀵﹁璀�(h霉)鐞嗙殑鍏烽珨鏂规銆�

3.璀�(h霉)鐞嗚閷勫柈 瑷橀寗鐥呬汉鍋ュ悍鐙€娉佸拰璀�(h霉)鐞嗘帾鏂藉鏂芥儏娉�锛岄噰鐢≒IO瑷橀寗鏂瑰紡銆侾(problem)锛氱梾浜虹殑鍋ュ悍鍟忛;I(intervention)锛氶嚌灏嶅仴搴峰晱椤岄噰鍙栫殑璀�(h霉)鐞嗘帾鏂�;O(outcome)锛氳(h霉)鐞嗘晥鏋�銆�

4.浣忛櫌鐥呬汉璀�(h霉)鐞嗚⿻浼板柈 璀�(h霉)澹皪鍒嗙鐨勭梾浜鸿鐥呮儏姣忕彮銆佹瘡澶╂垨鏁�(sh霉)澶╅€�(j矛n)琛岃⿻浼般€傚収(n猫i)瀹瑰彲瑕栫梾鎯呰€屽畾銆�

5.鐥呬汉鍑洪櫌璀�(h霉)鐞嗚⿻浼板柈 鍖呮嫭鍋ュ悍鏁欒偛瑷堝妰鍜岃(h霉)鐞嗗皬绲�(ji茅)銆�

(1)鍋ュ悍鏁欒偛锛氣憼閲濆皪鎵€鎮ｇ柧鐥呭埗瀹氬仴搴锋暀鑲茶▓鍔�銆傗憽鑸囩梾浜轰竴璧疯◣璜栨湁瀹虫垨鏈夋剰鐨勭敓娲荤繏(x铆)鎱ｃ€傗憿鎸囧皫(d菐o)鐥呬汉涓诲嫊鍙冭垏灏嬫壘鐝�(xi脿n)瀛樻垨娼涘湪鐨勫仴搴峰晱椤�銆傗懀鍑洪櫌鎸囧皫(d菐o)锛屽寘鎷敓娲荤繏(x铆)鎱�锛岄２椋熴€佹湇钘�锛屽姛鑳介崨鐓�锛屽畾鏈熷京(f霉)鏌ャ€�

(2)璀�(h霉)鐞嗗皬绲�(ji茅)锛氱洰妯�(bi膩o)鏄惁閬�(d谩)鍒�锛岃(h霉)鐞嗗晱椤屾槸鍚﹁В姹�锛岃(h霉)鐞嗘帾鏂芥槸鍚﹁惤瀵︼紝璀�(h霉)鐞嗘晥鏋滄槸鍚︽豢鎰�銆�

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