慢性非传染性疾病

慢性非传染性疾病 慢性非传染性疾病，指从发现之日起算超过3个月的非传染性疾病。这些疾病主要由职业和环境因素，生活与行为方式等暴露引起，如肿瘤、心脏血管疾病，慢性阻塞性肺疾患，精神疾病等等，一般无传染性。 一、 概念。 指长期的，不能自愈的，几乎不能被治愈的疾病。并规范所涉及的慢病重点是指那些发病率、致残率、死亡率高和医疗费用昂贵的，并有明确预防措施的疾病。当前主要指以生活方式、环境危害因素为主引起的心脑血管疾病、恶性肿瘤、糖尿病、慢性阻塞性肺部疾病、精神心理性疾病等一组疾病。英文缩写NCD。 二、慢性非传染性疾病的特点 1 病因复杂，发病与多个行为因素有关; 2 潜伏期较长，没有明确的得病时间; 3 病程长，随着疾病的发展，现为功能进行性受损或失能，对健康损伤严重; 4 很难彻底治愈，表现为不可逆性。 三、慢性非传染性疾病的成因 Therapy. (D) respiratory diseases (2 months) 1. Rotary objective diagnosis, differential diagnosis and treatment of common diseases in respiratory medicine, familiar with the imaging changes of common respiratory diseases; correct analysis of arterial blood gas analysis, sputum culture result, familiar with application of antibiotics. 2. basic requirements (1) learning disease species and the cases number requirements: disease species cases number (?) Shang respiratory infection 10 pneumonia 10 acute or chronic support bronchitis 5 chronic blocked sex lung disease 5 breathing failure 5 (2) basic skills requirements: type cases number (?) sucking phlegm operation 10 times chest puncture operation 2 cases lung x line read tablets 20 Zhang lung CT read tablets 20 Zhang breathing machine operation 5... (G) psychiatric 2 months 1. purpose rotary master mental illness history, physical examination and scale testing requirements and methods. Learn about common diseases in psychiatric clinical manifestation, diagnosis, differential diagnosis and therapeutic principle. 2. basic requirements for studying diseases and the number of cases required: name number (?) 20 20 emotional disorder of schizophrenia 20 neurosis (VIII) medical imaging department 1 1 purpose, rotary control system, normal CT, MRI reading methods and neuroimaging manifestations of common diseases of the nervous system. 2, basic requirements for studying diseases and the number 武汉大学公共卫生学院郭毅教授8日公布的一项研究成果表明:肥胖、超重是导致脑血管病、冠心病、高血压等人类慢性非传染性疾病的一个主要原因。 据介绍，以郭毅教授为首的课题组在湖北省12个县市随机抽取了2811位年龄大于35岁的居民进行面访，其中男性1420人，女性1289人。从这项研究看，湖北省肥胖、超重状况目前在全国处于中等水平。 调查显示:男女性别间肥胖、超重患病率没有差别，但男性45至54岁、女性55至64岁人群中，肥胖、超重的患病率高;不同文化水平人群中，肥胖、超重群体患病率随文化程度的提高而上升，大专文化程度以上人群最高;不同职业人群中的肥胖、超重群体患病率存在明显差异，农民最低;不同家庭经济收入人群肥胖、超重患病率也有很大差异，月收入在2000元以上的人群患病率高，低于500元的人群则最低。 四、慢性非传染性疾病有哪些危险因素 1、吸烟 吸烟可以引起很多慢性非传染病性疾病，有人认为至少有20多种，如心脑血管病;肺癌、食管癌、膀胱癌、胃癌、唇癌、口腔癌、咽喉癌、胰腺癌;慢性阻塞性肺疾患，甚至新生儿低体重Therapy. (D) respiratory diseases (2 months) 1. Rotary objective diagnosis, differential diagnosis and treatment of common diseases in respiratory medicine, familiar with the imaging changes of common respiratory diseases; correct analysis of arterial blood gas analysis, sputum culture result, familiar with application of antibiotics. 2. basic requirements (1) learning disease species and the cases number requirements: disease species cases number (?) Shang respiratory infection 10 pneumonia 10 acute or chronic support bronchitis 5 chronic blocked sex lung disease 5 breathing failure 5 (2) basic skills requirements: type cases number (?) sucking phlegm operation 10 times chest puncture operation 2 cases lung x line read tablets 20 Zhang lung CT read tablets 20 Zhang breathing machine operation 5... (G) psychiatric 2 months 1. purpose rotary master mental illness history, physical examination and scale testing requirements and methods. Learn about common diseases in psychiatric clinical manifestation, diagnosis, differential diagnosis and therapeutic principle. 2. basic requirements for studying diseases and the number of cases required: name number (?) 20 20 emotional disorder of schizophrenia 20 neurosis (VIII) medical imaging department 1 1 purpose, rotary control system, normal CT, MRI reading methods and neuroimaging manifestations of common diseases of the nervous system. 2, basic requirements for studying diseases and the number 等等。我国每年死于吸烟的人数为75万人，至2025年后将增至300万。 吸烟致病作用还反映在:与很多疾病呈多方面的剂量反应关系。如肺癌与吸烟的每天吸烟量、吸烟持续年限、吸烟开始的年龄等等均呈剂量反应关系。 吸烟与很多危险因素有互交作用，而且往往呈协同作用。如与饮酒、酸菜、血脂、家族史、病毒感染等等。因此吸烟不仅在疾病的早期启动阶段起作用，而且可能对疾病整个治病过程都有影响。 2、饮酒 过度饮酒与很多癌症、肝脏疾患、心血管疾病有关。在癌症中，主要和口腔、咽、食管与喉癌有关，和女性乳腺癌与男性结肠、直肠癌可能也有关系。据，每天饮6次酒比饮3次酒者有60%超额发病(癌症);在大量饮酒的人群中，肝癌的死亡率可增加50%;在中度严重饮酒者中，高血压的患病率远高于正常人群;酗酒可以增加脑出血的危险性。 3、膳食因素和肥胖 慢性非传染病的发生和人们膳食方式与结构有很大关系，和与膳食有关的血脂水平、肥胖也有很大关系。 Therapy. (D) respiratory diseases (2 months) 1. Rotary objective diagnosis, differential diagnosis and treatment of common diseases in respiratory medicine, familiar with the imaging changes of common respiratory diseases; correct analysis of arterial blood gas analysis, sputum culture result, familiar with application of antibiotics. 2. basic requirements (1) learning disease species and the cases number requirements: disease species cases number (?) Shang respiratory infection 10 pneumonia 10 acute or chronic support bronchitis 5 chronic blocked sex lung disease 5 breathing failure 5 (2) basic skills requirements: type cases number (?) sucking phlegm operation 10 times chest puncture operation 2 cases lung x line read tablets 20 Zhang lung CT read tablets 20 Zhang breathing machine operation 5... (G) psychiatric 2 months 1. purpose rotary master mental illness history, physical examination and scale testing requirements and methods. Learn about common diseases in psychiatric clinical manifestation, diagnosis, differential diagnosis and therapeutic principle. 2. basic requirements for studying diseases and the number of cases required: name number (?) 20 20 emotional disorder of schizophrenia 20 neurosis (VIII) medical imaging department 1 1 purpose, rotary control system, normal CT, MRI reading methods and neuroimaging manifestations of common diseases of the nervous system. 2, basic requirements for studying diseases and the number 和发病有关的膳食因素主要有脂类、维生素与纤维素。除此之外膳食因素中与慢性非传染性疾病发生有关的，还有微量元素，食盐，食物的加工与烹调以及进食方式等等。这些因素与地理环境、风俗习惯、社会经济水平等有关，所以，它们在发病中的作用在不同国家、不同地区表现不同。 4、缺少体力活动 由于现代交通工具的不断更新、工作与生活条件的改善，人们体力活动的时间逐渐减少，强度日益减弱。与不合理的膳食结构和方式一样，缺乏体力活动是慢性非传染性疾病很主要的危险因素。其与冠心病、高血压、糖尿病、多种癌症、骨质酥松、龋齿等发生有关。因为研究显示:缺乏体力活动可使人体超重与营养分布不均衡，而体力活动可以对体重，血脂，血压，血栓形成，葡糖糖耐量，胰岛素抗性，某些内分泌激素等发挥作用，使其产生有利于机体健康的变化，从而减少发病的危险。 5、病原体感染 病原体感染与慢性非传染性疾病的关系也很密切，病毒感染与肿瘤之间的关系研究得比较多。流行病学研究发现，约有15%—20%的癌症与病原体感染，特别是病毒的感染有关;如果能够控制相关的感染，占世界癌症五分之一的3种癌:胃癌、肝癌与子宫颈癌的大部分能预防。 Therapy. (D) respiratory diseases (2 months) 1. Rotary objective diagnosis, differential diagnosis and treatment of common diseases in respiratory medicine, familiar with the imaging changes of common respiratory diseases; correct analysis of arterial blood gas analysis, sputum culture result, familiar with application of antibiotics. 2. basic requirements (1) learning disease species and the cases number requirements: disease species cases number (?) Shang respiratory infection 10 pneumonia 10 acute or chronic support bronchitis 5 chronic blocked sex lung disease 5 breathing failure 5 (2) basic skills requirements: type cases number (?) sucking phlegm operation 10 times chest puncture operation 2 cases lung x line read tablets 20 Zhang lung CT read tablets 20 Zhang breathing machine operation 5... (G) psychiatric 2 months 1. purpose rotary master mental illness history, physical examination and scale testing requirements and methods. Learn about common diseases in psychiatric clinical manifestation, diagnosis, differential diagnosis and therapeutic principle. 2. basic requirements for studying diseases and the number of cases required: name number (?) 20 20 emotional disorder of schizophrenia 20 neurosis (VIII) medical imaging department 1 1 purpose, rotary control system, normal CT, MRI reading methods and neuroimaging manifestations of common diseases of the nervous system. 2, basic requirements for studying diseases and the number 6、遗传与基因因素 几乎所有的慢性非传染性疾病的发病均有遗传因素的参与。已经有很多研究证实:家族史是癌症、心脑血管病、慢性阻塞性肺疾患、精神疾病的重要危险因素。不少疾病的家系研究、双生子研究证实了遗传因素在发病中的作用。随着分子流行病学与遗传流行病学的发展，以及近期人类基因组流行病学的建立，对慢性非传染性疾病的很多易感基因或相关基因进行了比较深入的研究。 五、慢性非传染性疾病的防治 慢性非传染性疾病(简称慢病)是一类与不良行为和生活方式密切相关的疾病，如心血管疾病、肿瘤、糖尿病、慢性阻塞性肺部疾病等。研究证实，慢病的发生与吸烟、酗酒、不合理膳食、缺乏体力活动、精神因素等有关。慢病具有病程长、病因复杂、迁延性、无自愈和极少治愈、健康损害和社会危害严重等特点。慢病是全球的一个重要公共卫生问题，据世界卫生组织报道，慢病是全球致死和致残的首位原因，慢病导致了全球疾病负担加重。我省居民的健康也同样面临着慢病的威胁，据2001年湖南省城乡居民主要疾病死亡构成比，城市居民死因位于前三位的是循环系统疾病、恶性肿瘤和呼吸系统疾病，农村居民死因顺位排在前三位的是循环系统疾病、呼吸系统疾病和恶性肿瘤。慢病的患病率呈上升趋势，据湖南省2001年高血压抽样调查结果显示，人群高血压患病率10年上升了73%，Therapy. (D) respiratory diseases (2 months) 1. Rotary objective diagnosis, differential diagnosis and treatment of common diseases in respiratory medicine, familiar with the imaging changes of common respiratory diseases; correct analysis of arterial blood gas analysis, sputum culture result, familiar with application of antibiotics. 2. basic requirements (1) learning disease species and the cases number requirements: disease species cases number (?) Shang respiratory infection 10 pneumonia 10 acute or chronic support bronchitis 5 chronic blocked sex lung disease 5 breathing failure 5 (2) basic skills requirements: type cases number (?) sucking phlegm operation 10 times chest puncture operation 2 cases lung x line read tablets 20 Zhang lung CT read tablets 20 Zhang breathing machine operation 5... (G) psychiatric 2 months 1. purpose rotary master mental illness history, physical examination and scale testing requirements and methods. Learn about common diseases in psychiatric clinical manifestation, diagnosis, differential diagnosis and therapeutic principle. 2. basic requirements for studying diseases and the number of cases required: name number (?) 20 20 emotional disorder of schizophrenia 20 neurosis (VIII) medical imaging department 1 1 purpose, rotary control system, normal CT, MRI reading methods and neuroimaging manifestations of common diseases of the nervous system. 2, basic requirements for studying diseases and the number 且发病年龄提前。人群中与慢病相关的主要行为危险因素暴露水平升高，成年男性吸烟率保持在较高水平，初次吸烟年龄有低龄化趋势，人们对被动吸烟有害健康还没有足够的认识。从我省居民营养调查结果看，居民营养水平全面提高，但膳食结构不合理，谷物类食品摄入减少，动物类食品摄入增加，特别是城市居民脂肪摄入所占总热能比超过世界卫生组织规定的理想比(30%)的上限。成年在职人员参加体育锻炼少，生活中半数以上的人静坐时间在5小时以上，人群中超重、肥胖检出率逐年上升。针对这一情况，在慢病的防治中，预防显得特别重要，由于慢病往往具有共同的危险因素，因此，在日常生活中，只要改变不良行为，选择健康的生活方式，戒烟、限酒、合理膳食、进行适当的体力活动，保持心理健康，就能防止或减少多种慢病的发生。慢病诊断容易，定期进行健康检查能及早发现慢病，通过及时治疗，促进康复，减少并发症和伤残的发生，以提高生活质量。 六、慢性非传染性疾病成为中国主导疾病 中国卫生部于2005年7月7日上午公布的最新全国卫生服务调查结果显示:过去10年，我国居民中患病人数增加，但去医院看病的人数却明显减少，有近一半的患者不到医院就诊。 本次调查显示，排除季节性影响，我国年患病人次为50.8亿，比1993年增加了7.3亿人次。其中多为高血压、糖尿病和脑血管病等常见病和多发病。由此看出慢性非传染性疾病，成为我国城乡居民的主导疾病。 Therapy. (D) respiratory diseases (2 months) 1. Rotary objective diagnosis, differential diagnosis and treatment of common diseases in respiratory medicine, familiar with the imaging changes of common respiratory diseases; correct analysis of arterial blood gas analysis, sputum culture result, familiar with application of antibiotics. 2. basic requirements (1) learning disease species and the cases number requirements: disease species cases number (?) Shang respiratory infection 10 pneumonia 10 acute or chronic support bronchitis 5 chronic blocked sex lung disease 5 breathing failure 5 (2) basic skills requirements: type cases number (?) sucking phlegm operation 10 times chest puncture operation 2 cases lung x line read tablets 20 Zhang lung CT read tablets 20 Zhang breathing machine operation 5... (G) psychiatric 2 months 1. purpose rotary master mental illness history, physical examination and scale testing requirements and methods. Learn about common diseases in psychiatric clinical manifestation, diagnosis, differential diagnosis and therapeutic principle. 2. basic requirements for studying diseases and the number of cases required: name number (?) 20 20 emotional disorder of schizophrenia 20 neurosis (VIII) medical imaging department 1 1 purpose, rotary control system, normal CT, MRI reading methods and neuroimaging manifestations of common diseases of the nervous system. 2, basic requirements for studying diseases and the number 与此同时，居民对医疗服务的利用率却明显下降，也就是说，到医院看病的人数在减少。目前，我国居民年就诊人次为47.5亿，比1998年减少了5.8亿人次。在这些患者中，约有一半的人到医疗机构就诊，35.7%的人采取自我医疗，没采取任何治疗措施的占13.1%。许多居民在生病后不去医院就诊，而是跑到药店购药，采用自我药疗。专家分析，发生这一变化的主要原因是医疗服务费用的增长速度超过了人均收入的增长，医疗卫生消费支出已经成为家庭食物、教育支出后的第三大消费。专家指出，居民自我医疗比例的增加，表明人们更加关注健康知识与疾病预防，自我治疗能力在增强。在15岁以上的被调查者中，有47.2%的人能自己主动获取健康保健知识。还有过去10年，我国城乡居民吸烟率和饮酒率持续下降，与此同时，主动参加锻炼的人数在不断增加。本次调查显示，走路、慢跑和太极拳类形式成为居民主要的锻炼方式，他们平均每次锻炼时间约在50分钟左右。 另一方面，过去的10年，“看病贵”成为百姓关注的话题。此外，医疗保障覆盖水平不高也是患者就诊率降低的原因之一。调查发现城市享有城镇职工基本医疗保险的人口比例为30.2%，购买商业医疗保险的占5.6%，没有任何医疗保险的人占到44.8%。 Therapy. (D) respiratory diseases (2 months) 1. Rotary objective diagnosis, differential diagnosis and treatment of common diseases in respiratory medicine, familiar with the imaging changes of common respiratory diseases; correct analysis of arterial blood gas analysis, sputum culture result, familiar with application of antibiotics. 2. basic requirements (1) learning disease species and the cases number requirements: disease species cases number (?) Shang respiratory infection 10 pneumonia 10 acute or chronic support bronchitis 5 chronic blocked sex lung disease 5 breathing failure 5 (2) basic skills requirements: type cases number (?) sucking phlegm operation 10 times chest puncture operation 2 cases lung x line read tablets 20 Zhang lung CT read tablets 20 Zhang breathing machine operation 5... (G) psychiatric 2 months 1. purpose rotary master mental illness history, physical examination and scale testing requirements and methods. Learn about common diseases in psychiatric clinical manifestation, diagnosis, differential diagnosis and therapeutic principle. 2. basic requirements for studying diseases and the number of cases required: name number (?) 20 20 emotional disorder of schizophrenia 20 neurosis (VIII) medical imaging department 1 1 purpose, rotary control system, normal CT, MRI reading methods and neuroimaging manifestations of common diseases of the nervous system. 2, basic requirements for studying diseases and the number