2013年8月15日-17日,2013中国医院论坛在北京国家会议中心举办。中国医院论坛是中国医院协会主办的权威性、高层次的医院管理行业盛会。其宗旨是"搭建交流合作平台、促进医院改革发展"。论坛在政府和
最近,医院联系电信部门,开通了wi-fi网络,在工作不忙的时候,可以接受咨询,更及时的提供咨询服务。
瓷器村的故事--医患矛盾的真相(2012-03-25 23:24:56)瓷器村有一家饭店,每顿饭只收1分钱的饭费。我在这家饭店工作多年,目睹了许多离奇的故事,今天要讲给你听。你一定会感兴趣的。 (一)
孩子的外科疾病 让孩子远离危险:安全防范及安全教育小儿外科专业涉及小儿的外科性疾病,一般是以年龄为界限和成人外科相区别的,当然,不同医院所定的年龄标准是不同的,比如12或14岁,因为有些先天性疾病会延续到成年期才进行诊治,而成人外科对这些疾病的治疗缺乏经验,所以有些儿童专科医院也会收治较大年龄患儿。从疾病的范围来说,小儿和成人一样,也可以出现感染、创伤、畸形、肿瘤以及血管、结石、内分泌、寄生虫等需要外科治疗的疾病,但是,小儿又不是成人的缩减版,其疾病谱和诊疗手段与成人外科有很大区别。首先是小儿外科常见疾病谱。先天性畸形是一大类。外观上有表现的患儿生后马上就能被确诊,比如多指、无肛门等疾病;也有一些是不能立即被发现的,但往往会有固定的症状和体征,而且很多不经手术处理会反复出现或者逐渐加重,比如肠闭锁的患儿呕吐不能喂养、某些先天性心脏病的患儿不能缓解的青紫、胆管闭锁的患儿持续黄疸白粪等。随着技术的发展,相当多的疾病可以在胎儿期得到诊断,最多见的是肾积水,但是,仍然有大部分畸形只能在出生后得意诊断。创伤是逐年增多的一类。社会发展,技术进步使得我们的生活越来越复杂,而孩子们所要避免的危险也就越来越多。坐在自行车后座上的孩子辐条伤常常限于皮肤皮下组织,但是也可以出现骨折,私家车的增多使得严重的复合伤也在增加,学习轮滑的骨折患儿,住高楼的坠落患儿屡见不鲜,而烧烫伤、电击伤也仍然是很多见。涉及外伤,谈一些意外伤害的防范。小儿的意外伤害原因很多,其中大部分是可以防范的,这种防范更多的体现了家长的整体素质和安全素养,并不能指责家长不关心孩子,或者不爱孩子,从感情上来说,那样的家长是非常少的。但是,很多意外伤害的产生确实有不少家长的责任。最突出的一个例子是交通违章,从孩子很小就开始,家长带着孩子乱穿马路、闯红灯、非机动车带孩子并走机动车道,这些现象现在带有很大的普遍性,一旦产生事故,仅仅是普通外伤还算是幸运,付出生病的情况也是不少。虽然说,国家的法律体系尊重生命的权利,在这样的事故处理过程中,更多的让机动车辆承担责任,但是,换一个角度来分析,作为孩子的家长,并不真正用心的注意自身的安全和孩子的安全,也就是不把自己的生命以及孩子的生命放倒一个重要的位置,才会产生这样的结果。从另外的一个角度看这个问题,也反应了家长的另外一个素质,就是对孩子的教育,潜移默化的影响。在现今社会中,违法现象很多情况下反映了对法律法规的无视或者践踏,交通法是国家的法律,家长从孩子很小就应该给孩子灌输遵守交通法规的意识,并且要从自身做起,给孩子树立遵法守德的典范,孩子才容易建立起正确的行为规范,成长为有用之才。可以想像,孩子从小就违法,长大了之后,就深切感受到违法也不过如此,基本不用付出什么成本,法律的约束力自然就变的很小,自身涉及违法行为的时候,就有可能导致严重的违法行动。也有一些导致孩子受伤害的因素来自于另外的无知状态,或者对家长应承担的责任没有正确的理解,家长总是有很多的理由来为自己解脱,举例来说,现在有很多家长喜欢用自行车、电动车、摩托车带孩子,包括幼儿以及小学生。儿童的天性是活泼的,关注自身安全的能力有限,坐在车子上难免会活动,也甚至有睡着的,导致孩子的肢体进入车辆转动的车轮等,从车辆上坠落等等,都会对孩子产生一些伤害。但是,家长总是有很多理由,比如,孩子不听话、家庭经济条件不好,买不起车等等,理由可以说是一大堆,而从实质上看,不过的推脱自己的责任罢了。涉及生活中的安全问题,还有个心理感受或者意愿取向之类的问题,举例来说,如果彩票中大奖的可能性是1%,大家可能会感觉中大奖的机会很多,很可能会去尝试,但是,如果说在某一个行动计划中产生伤害的可能性也是1%,很多人可能会认为这么少的机会,不会落到自己头上,而选择性忽略了这个危险,这也是大家平时不太注重安全的原因之一。个人和家庭的安全建立在自己对自身以及周围环境的准确判断基础上,或者说思想上要有安全这根弦。曾经见过一个这样的伤害个案:在城郊的一条比较宽阔的路上,一辆渣土车与一辆电动自行车发生了交通事故,电动自行车上是两个人,其中的男孩子已经14岁了,导致了骨盆骨折、下肢骨折、损失了两个睾丸。对于事故的详细情况可以大致的猜测一下,现在的渣土车本身违章的虽然不少,但是,电动自行车的设计能力是不适合带人的,并且没有后视镜,或者有后视镜也没有使用后视镜观察后方路面的习惯,再者,甚至可能进入机动车道等等,都是一些可能。为什么强调这些呢?无论交通事故最终怎么处理,受伤害后身体损失的是非机动车这一方,如果这一方不是很重视自身的安全,发生了这种事情之后,是否会有后悔的心态?广州曾有个很让人无语的例子,一对做废品回收的年轻夫妇,大女儿3岁了,刚上幼儿园,自己跑到了街上,被渣土车碾压死亡,孩子还有一个小弟弟。参见http://gzdaily.dayoo.com/html/2009-10/14/content_730427.htm。这种情况下说,是否家长不具有照顾自己孩子的能力?3岁的孩子对自身的安全是没有什么概念的,家长要实施全面的监护,一旦监护不到位,就很有可能受到各种类型的伤害,包括生活中可以发生的烧伤、烫伤、切割、挤压、坠落、中毒等等。深圳有个4岁的女童自己过马路,也是被泥头车碾压致死,详见http://www.gzbbs.com/thread-132509-1-1.html,这种人间惨剧,我想,家长是有一定的责任的。小儿恶性肿瘤是另家长和医生很难抉择的一类疾病。孩子的一生才刚刚起航,他们还不知道怎么选择自己的生活甚至生命,恶性肿瘤的出现就可能让他们夭折。治疗还是放弃,很难选择。不过随着科学的进步,能及早发现进行治疗,有相当多的患儿获得了痊愈。感染类疾病随着卫生条件的改善在小儿外科所处理的疾病中所占比重在减少。但是,也容易导致家长的误解,甚至可能延误诊断与治疗,比如阑尾炎,年龄约小的孩子,表现越不典型,家长一般不会考虑自己的孩子身体不好了,会是外科性疾病,而一般是到小儿科(就是小儿内科)就诊,甚至为了方便或者经济的原因在小诊所诊治,从而延误诊断和治疗,导致并发症后遗症增多,严重的甚至危及生命。接下来谈谈小儿外科的诊疗特点,也可以说是部分就医指导儿科是个“哑科”,襁褓中的孩子就不必说了,年龄小的孩子有时很难说明自己的不适、受伤的过程、症状的变化等等,而开始上学的孩子又有可能因为各种原因而说谎。所以医生有时候会反复追问病史,反复查体和做一些相关的检查,甚至需要边观察、边对症治疗同时继续明确诊断,有的时候同一种病情反复发作几次或者就诊了多家医院才得到最终的诊断和治疗,这就需要家长注意对孩子病情的详细观察、与医生的充分交流以及对诊断需要比较长的过程的理解,从就诊策略来说,复杂的疾病需要更长的就诊时间,在门诊量很大,大夫的工作负荷有限的情况下,需要认真考虑如何就诊,可以考虑更换医院,或者避开门诊就医的就诊方式。外科是手术科室,小儿外科的进步离不开小儿麻醉的发展。由于众所周知的原因,小儿外科的手术大部分是在全麻下进行的,成人局麻下的体表肿物的切除,可能大多数孩子还是要全身麻醉后才能使得手术可以进行。麻醉安全手术才安全,麻醉能进行手术才能进行。现代麻醉是相当安全的,保证了手术的顺利开展。我们的传统医学—中医有悠久的历史,对民众产生了很多影响,对手术、麻醉等等,存在很多误解或者宣传,而大家对这些事情又缺乏理性的思维以及学习的态度,反而很容易接受“开刀伤元气”、“麻醉伤脑子”等等错误的认识,而不理性的去看:现在的中医院也开展大量的手术,全世界也没有几个因为麻醉而导致智力下降等问题的病例。很有意思的是,尽管大家对手术、麻醉有那么多的理由抗拒,反而对吸烟(包括被动吸烟)、喝酒等对身体有明显伤害的行为却普遍接受,没有多少抗拒,我个人观点,这种现象,反映了对医学的一种抵触,或者说是有偏见。小儿的生理和病理与成人有区别,使得诊治也与成人有别。比如骨折后可能出现成角和移位,但小儿容许的程度可能要大于成人,因为在发育过程中这些可容忍的畸形可能自我代偿修复;而同样是骨折,如果伤及骨骺则会出现与成人骨折完全不同的后果。再比如新生儿,因为耐受性差,当有手术探查指证时即使没能确诊也应及早治疗以免使得症状加重反而不利于手术治疗。小儿择期手术可以选择合适的年龄进行,但是年龄并不是手术的禁忌。比如常见的腹股沟斜疝一般于半岁手术而脐疝可以2岁以后处理;鞘膜积液可以2岁以后手术而隐睾应当在2岁前治疗;小儿大多数的手术是在2岁之内完成的,而在国外甚至相当一部分手术在新生儿期完成,充分考虑到小儿的发育和心理问题。至于新生儿急症应当立即处理,而肿瘤也是早发现早治疗,不能考虑年龄的大小。很多家长总喜欢用“孩子太小,不能手术”的想法来拒绝手术,不好说这种想法产生的原因是什么,但是,很多情况下,会害了孩子。
The Lancet, Volume 376, Issue 9755, Pages 1823 - 1824, 27 November 2010doi:10.1016/S0140-6736(10)62161-7Cite or Link Using DOIFacing up to the threat in ChinaOriginal TextDanghui Yu a, Tiantian Li bWe would like to offer our thanks to The Lancet for the Editorial depicting the threatened life of Chinese doctors.1 It has become an immediate topic of discussion here. To gain further insight into the attitudes of Chinese doctors, we did a survey on Ding Xiang Yuan, the most popular biomedical website in China with a registered user base of over 2 million. By Oct 2, 2010, 14 577 doctors had participated in the survey, including 5710 residents, 5132 attending physicians, 2256 associate chief physicians, and 609 chief physicians.When asked whether they were concerned about the health-system reforms in China and what their primary concerns were, 67% of doctors said that they were strongly concerned about the reforms, with 65% choosing safe medical treatments and 53% choosing cure of the patients as their primary concern.When asked about the main reasons for the increased tension between doctors and patients, 66% said that their hospitals encountered one to three medical disputes per month; 78% blamed it on a lack of government funding to hospitals and 70% accused the public media for negative reports, with 86% of doctors believing that negative reports were used to increase audience ratings. In terms of false media reports, 49% of doctors took them as deliberate, and 37% thought that the media needed qualified scientific gatekeepers for their medical news.Finally, 91% of doctors strongly agreed that China's health-system reforms could not be successful without reforming the social and economic status of doctors.We declare that we have no conflicts of interest.References1 The Lancet. Chinese doctors are under threat. Lancet 2010; 376: 657. Full Text | PDF(70KB) | CrossRef | PubMeda Academic Journal of Second Military Medical University, Shanghai 200433, Chinab Ding Xiang Yuan Biomedical Forum, Hangzhou, Zhejiang, China
The Lancet, Volume 376, Issue 9742, Page 657, 28 August 2010 System change, the theme of the World Cancer Congress in Shenzhen, China, Aug 18—21, was a central message in the opening address by the Chinese Minister of Health, Chen Zhu, as he described current health-care system reforms in China. At the Congress many international health policy makers and physicians led discussions on frameworks and actions for system change, but there was little participation from local Chinese doctors. To understand why there were so few Chinese delegates in the plenary sessions on system change compared with sessions on patients' care, one must first understand that for many Chinese doctors personal safety is of greater concern. Chinese doctors are often victims of terrible violence. In June this year, a doctor and a nurse were fatally stabbed in Shandong Province by the son of a patient who died of liver cancer 13 years ago, and a paediatrician in Fujian Province was injured after leaping out of a fifth-floor window to escape the angry relatives of a newborn baby who had died under his care. Thus, it is not surprising to see that in July police officers were invited to be the vice-presidents of 27 hospitals in Shenyang. With hospitals turned into battlegrounds, being a doctor has become a dangerous job in China. The problem may be largely one of perception. Many Chinese patients believe that doctors and hospitals conspire to increase charges by providing unnecessary examinations, investigations, and treatments. Additionally, some doctors accept red envelopes (a monetary gift in exchange for favourable service) against the rules. Many patients blame the deterioration of their health directly on doctors, claiming that doctors lack devotion and skills. The intellectual ideals of ancient China were “either to be a good prime minister or to be an excellent doctor”, while in modern China doctors and nurses used to be worshipped as “angels in white”. How has the perception of Chinese doctors become so eroded? The Chinese media certainly have an important role in provoking tension between doctors and patients. There is disproportionate coverage in newspapers, television, and on the internet of how health professionals have cheated patients. Just a few weeks ago the Southern Metropolis Daily (the most popular newspaper in Guangdong) falsely accused a midwife, who had treated haemorrhoids for a patient after childbirth, of stitching the patient's anus closed on purpose. In November, 2009, one of China's most authoritative media outlets, CCTV (China Central Television), reported that the renowned Peking University First Hospital was carrying out illegal medical practices by allowing medical students to do surgical procedures, and as a result a patient had died. Even though the hospital and the Ministry of Health made it clear that involving medical students in clinical procedures including surgery under the supervision of licensed doctors is legal, trust in doctors and hospitals was seriously damaged. It is hard to tell whether the misreport resulted from a lack of medical knowledge on the parts of the Southern Metropolis Daily and CCTV, or whether it was motivated by a desire for a sensational story. However, the public misunderstanding of the medical profession will surely hurt both doctors and patients in the end. Most hospitals in China, especially the large ones such as Peking Union Medical College Hospital and Huashan Hospital of Fudan University, are run by the government. Public hospitals in China enjoyed full government funding before 1985. After economic reforms, the hospitals now receive very limited financial support from the government, with the result that hospitals must generate income to cover costs. As the main source of hospitals' income is from diagnostics and treatment, there is a financial incentive to over-investigate and over-treat. To minimise inappropriate conflicts of interest, the Chinese Government passed laws to prevent doctors receiving financial kickbacks from drug companies. Because the standard salary of a doctor is modest, even by Chinese standards, many doctors struggle to balance professional ethics and making ends meet in an economically booming China. Such pressures, coupled with a sense of feeling seriously undervalued by the government and society as a whole, drive many doctors out of medicine into other jobs. China's health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in shaping health policy, by giving voice to their own experiences and constructive ideas about the health system.
近来,我们收治了4例因为用药导致的肾、输尿管结石的儿童,均采用保守治疗治愈。这几例都有因为其他疾病(感冒、腹泻等)用药物治疗的病史,在治疗过程中出现腹痛、血尿等,部分病例存在血尿素氮、肌酐升高等肾功能损害证据。多数双侧肾脏、输尿管同时出现结石。
近日收治一乳糜淋巴管囊肿病例,比较少见。
近日收治一脊髓栓系综合症病人,自幼骶尾部有一凹陷,未引起重视,随孩子年龄增长,左足增长速度比右足慢,两只脚的大小差距越来越大,7岁时才来就诊。经过磁共振检查,确定为脊髓栓系综合症,经过手术,近日痊愈出院。
http://www.zxyy.cn/ftpdata/16/3888/index.aspx6月14日,小儿外科接收一名胸腔闭式引流新生儿,男,23天,黄疸,脐部感染,引流管堵塞,左胸呼吸音低。该患儿因被发现呼吸急促而就诊于外地医院,拍片示大量胸腔积液,当地医院给予胸腔穿刺引流,疗效欠佳,患儿家长很是着急,后经人介绍遂急症转诊于我院小儿外科。入院后小儿外科刘月忠主任考虑患儿为新生儿乳糜胸,并发现患儿同时合并新生儿黄疸、新生儿脐炎。刘主任分析病情后,医嘱先改善患儿一般情况,在治疗新生儿黄疸、新生儿脐炎的同时给予胸腔闭式引流。一周后患儿黄疸与脐炎治愈,遂开始禁食,静脉营养、持续胸腔闭式引流以及多次胸腔内注射沙培林等治疗,经保守治疗后治愈出院,出院后随访,现患儿一般情况良好,胸片无明显异常,患儿家长对治疗非常满意。新生儿乳糜胸是新生儿期比较罕见的疾病,但却是新生儿胸腔积液最常见的原因之一。Pisek在1917年首先描述此病。本病是由于胸导管或胸腔内大淋巴管破裂或阻塞导致淋巴液即乳糜在胸腔的异常积聚,并引起严重的呼吸、营养以及免疫障碍的一种疾病。先天性乳糜胸常见发病原因是胸导管闭锁,产伤等。乳糜胸一经发生,将引起一系列的重要病理生理改变。大量乳糜液在胸腔内潴留不但导致呼吸循环功能发生严重紊乱,还会引起代谢、营养和免疫系统功能的严重障碍。蓄积在胸腔内的乳糜液压迫肺使肺活量减少并引起纵隔摆动,患儿出现呼吸短促甚至明显的呼吸窘迫症状。乳糜胸所引起的临床症状一般是逐渐加重的。