纵膈良性肿瘤临床路径

纵膈良性肿瘤临床路径 ,2010年版, 一、纵膈良性肿瘤临床路径标准住院流程 ,一,适用对象。 第一诊断为纵膈良性肿瘤(包括纵膈囊肿)( ICD-10: D15.2～Q34.1) 行纵膈良性肿瘤切除术(ICD-9-CM-3:34.3)。 ,二,诊断依据。 根据《临床诊疗,胸外科分册》,中华医学会编著～人民卫生出版社, 1.病史。 2.胸部X线、胸部增强CT。 3.鉴别诊断:生殖细胞肿瘤、淋巴瘤、胸骨后甲状腺肿、侵袭性胸腺瘤等。 ,三,选择治疗的依据。 根据《临床诊疗指南,胸外科分册》,中华医学会编著～人民卫生出版社,。 行纵膈良性肿瘤切除术。 ,四,标准住院日?12天。 ,五,进入路径标准。 1.第一诊断必须符合ICD-10:D15.2～Q34.1纵膈良性肿singing songs progress, and breaks down barriers to air, widely welcomed by the Japanese youth. Soon, the political team was held in town "25 rent" forum to promote rent, attended by KMT County Government, county offices, Yan Tomb District Government and representatives from all walks of the local youth. The meeting, the objections raised by the representatives of the County Committee, the two sides hotly debated. The local gentry and County Committee of the Kuomintang have attacked political team for unusual activity, Zhuang Shaozhen became a major goal. Renewed from the flag publications, organized anti-Japanese campaign, then to convene "25 rent" Forum, sparking a burst of publicity heat to promote youth war played a role. But the second wave of anti-communist, Kuomintang is mulling, wujiangludong, Lu XI two local forces took the opportunity to launch the "Shen" (the KMT County Chief Shen Liqun) activity, they shouted "County Government with the Communist party activities," created unprecedented tensions. Shen Liqun feel nervous, he was accused of "accommodate the alien parties" and deal with danger, prophesy and found no Communist Party in his County, and caused the storm to Zhuang Shaozhen to open the new identity. Between October, rumors in southwest area of Wujiang in tianmu mountain, "Black said. South Bureau and ordered the withdrawal of Sunan County owned lands, to youth task 瘤疾病编码。 2.有适应证～无手术禁忌证。 3.当患者同时具有其他疾病诊断～但在门诊治疗期间不需要特殊处理也不影响第一诊断的临床路径流程实施时～可以进入路径。 ,六,术前准备?3天,指工作日,。 1.必需的检查项目: ,1,血常规、尿常规、粪便常规+隐血试验, ,2,肝功能测定、肾功能测定、电解质、凝血功能、输血前检查、血型, ,3,X线胸片、胸部增强CT、心电图、肺功能、腹部B超。 2.根据患者病情选择:葡萄糖测定、超声心动图、CTPA、心肌核素扫描、Holter、24小时动态血压监测等。 ,七,预防性抗菌药物选择与使用时机。 1.按照《抗菌药物临床应用指导原则》,卫医发〔2004〕285号,执行～并根据患者的病情决定抗菌药物的选择与使用时间。 2.建议使用第一、二代头孢菌素～头孢曲松。预防性用药时间为术前30 分钟。 ,八,手术日为入院第?4天。 1.麻醉方式:气管插管全身麻醉。 singing songs progress, and breaks down barriers to air, widely welcomed by the Japanese youth. Soon, the political team was held in town "25 rent" forum to promote rent, attended by KMT County Government, county offices, Yan Tomb District Government and representatives from all walks of the local youth. The meeting, the objections raised by the representatives of the County Committee, the two sides hotly debated. The local gentry and County Committee of the Kuomintang have attacked political team for unusual activity, Zhuang Shaozhen became a major goal. Renewed from the flag publications, organized anti-Japanese campaign, then to convene "25 rent" Forum, sparking a burst of publicity heat to promote youth war played a role. But the second wave of anti-communist, Kuomintang is mulling, wujiangludong, Lu XI two local forces took the opportunity to launch the "Shen" (the KMT County Chief Shen Liqun) activity, they shouted "County Government with the Communist party activities," created unprecedented tensions. Shen Liqun feel nervous, he was accused of "accommodate the alien parties" and deal with danger, prophesy and found no Communist Party in his County, and caused the storm to Zhuang Shaozhen to open the new identity. Between October, rumors in southwest area of Wujiang in tianmu mountain, "Black said. South Bureau and ordered the withdrawal of Sunan County owned lands, to youth task 2.手术方式:行纵膈良性肿瘤术。 3.手术置入物:止血。 4.术中用药:抗菌药物等。 5.输血:视手术出血情况决定。 ,九,术后住院恢复?8天。 1.必须复查的检查项目:血常规、肝功能测定、肾功能测定、电解质、胸部X线等。 2.术后用药:抗菌药物使用按照《抗菌药物临床应用指导原则》,卫医发〔2004〕285号,执行～并根据患者的病情决定抗菌药物的选择与使用时间。建议使用第一、二代头孢菌素～头孢曲松。 ,十,出院标准。 1.病人病情稳定～体温正常～手术切口愈合良好～生命体征平稳。 2.没有需要住院处理的并发症和/或合并症。 ,十一,变异及原因分析。 1.有影响手术的合并症～术前需要进行相关的诊断和治疗。 2.术后出现肺部感染、呼吸功能衰竭、心脏功能衰竭、肝肾功能衰竭等并发症～需要延长治疗时间。 二、纵膈良性肿瘤临床路径表单 singing songs progress, and breaks down barriers to air, widely welcomed by the Japanese youth. Soon, the political team was held in town "25 rent" forum to promote rent, attended by KMT County Government, county offices, Yan Tomb District Government and representatives from all walks of the local youth. The meeting, the objections raised by the representatives of the County Committee, the two sides hotly debated. The local gentry and County Committee of the Kuomintang have attacked political team for unusual activity, Zhuang Shaozhen became a major goal. Renewed from the flag publications, organized anti-Japanese campaign, then to convene "25 rent" Forum, sparking a burst of publicity heat to promote youth war played a role. But the second wave of anti-communist, Kuomintang is mulling, wujiangludong, Lu XI two local forces took the opportunity to launch the "Shen" (the KMT County Chief Shen Liqun) activity, they shouted "County Government with the Communist party activities," created unprecedented tensions. Shen Liqun feel nervous, he was accused of "accommodate the alien parties" and deal with danger, prophesy and found no Communist Party in his County, and caused the storm to Zhuang Shaozhen to open the new identity. Between October, rumors in southwest area of Wujiang in tianmu mountain, "Black said. South Bureau and ordered the withdrawal of Sunan County owned lands, to youth task 适用对象:第一诊断为纵膈良性肿瘤(ICD-10:D15.2，Q34.1) 行纵膈良性肿瘤切除术(ICD-9-CM-3:34.3)。 患者姓名: 性别: 年龄: 门诊号: 住院号: 住院日期: 年 月 日 出院日期: 年 月 日 标准住院日?12天 住院第2-3天 住院第2-4天 时间 住院第1天 (术前日) (手术日) ? 询问病史及体格检查 ? 上级医师查房 ? 术前留置尿管 ? 完成病历写 ? 完成入院检查 ? 手术 主 ? 开化验单 ? 影像学检查 ? 术者完成手术记录 要 ? 上级医师查房，初步确定诊? 继续对症支持治疗 ? 住院医师完成术后病程 诊 断 ? 完成必要的相关科室会诊 ? 上级医师查房 疗 ? 对症支持治疗 ? 完成上级医师查房记录等病? 观察生命体征 工 ? 向患者家属告病重或病危历书写 ? 向患者及家属交代病情及作 通知，并签署病重或病危通? 向患者及家属交待病情及其术后注意事项 知书(必要时) 注意事项 长期医嘱: 长期医嘱: 长期医嘱: ? 胸外科疾病护理常规 ? 患者既往基础用药 ? 胸外科术后护理常规 ? 一级护理 ? 其他医嘱 ? 特级或一级护理 ? 饮食 临时医嘱: ? 清醒后6小时进流食 ? 视病情通知病重或病危 ? 其他医嘱 ? 吸氧 ? 其他医嘱 ? 相关特殊检查 ? 体温、心电、血压、呼吸、 临时医嘱: ? 对症支持治疗 脉搏、血氧饱和度监测 重 ? 血常规、尿常规、粪便常规? 请相关科室会诊治疗 ? 胸管引流记量 点 +隐血试验 ? 术前相关准备 ? 持续导尿，记24小时出入医 ? 肝肾功能、电解质、血糖、 量 嘱 凝血功能、血型、输血前检 ? 雾化吸入 查 ? 镇痛药物 ? 胸部CT、X线胸片、心电图、 临时医嘱: 腹部B超、肺功能 ? 止血药物使用(必要时) ? 术前准备治疗 ? 其他医嘱 ? 相关对症支持治疗等 主要 ? 介绍病房环境、设施和设备 ? 宣教、备皮等术前准备 ? 观察病情变化 护理 ? 入院护理评估 ? 提醒患者术前禁食水 ? 术后心理和生活护理 工作 ? 辅助戒烟 ? 呼吸功能锻炼 ? 保持呼吸道通畅 病情 ?无 ?有，原因: ?无 ?有，原因: ?无 ?有，原因: 变异 1. 1. 1. 记录 2. 2. 2. 护士 签名 医师 签名 singing songs progress, and breaks down barriers to air, widely welcomed by the Japanese youth. Soon, the political team was held in town "25 rent" forum to promote rent, attended by KMT County Government, county offices, Yan Tomb District Government and representatives from all walks of the local youth. The meeting, the objections raised by the representatives of the County Committee, the two sides hotly debated. The local gentry and County Committee of the Kuomintang have attacked political team for unusual activity, Zhuang Shaozhen became a major goal. Renewed from the flag publications, organized anti-Japanese campaign, then to convene "25 rent" Forum, sparking a burst of publicity heat to promote youth war played a role. But the second wave of anti-communist, Kuomintang is mulling, wujiangludong, Lu XI two local forces took the opportunity to launch the "Shen" (the KMT County Chief Shen Liqun) activity, they shouted "County Government with the Communist party activities," created unprecedented tensions. Shen Liqun feel nervous, he was accused of "accommodate the alien parties" and deal with danger, prophesy and found no Communist Party in his County, and caused the storm to Zhuang Shaozhen to open the new identity. Between October, rumors in southwest area of Wujiang in tianmu mountain, "Black said. South Bureau and ordered the withdrawal of Sunan County owned lands, to youth task 住院第3-5天 住院第4-11天 住院第10-12天 时间 (术后第1日) (术后第2-7日) (出院日) ? 上级医师查房 ? 上级医师查房 ? 切口拆线 ? 复查相关检查 ? 住院医师完成病程书写 ? 上级医师查房，明确是 ? 保护重要脏器功能 ? 视病情复查血常规、血生化否出院 主 ? 注意对症处理 及胸片 ? 住院医师完成出院小要 ? 完成病程记录 ? 视胸腔引流及肺复张情况拔结、病历首页等 诊 ? 围手术期管理 除胸腔引流管并切口换药 ? 向患者及家属交代出疗 ? 术后合并症预防与治疗 ? 必要时纤支镜吸痰 院后注意事项 工 ? 视情况停用或调整抗菌药物 ? 根据术后病理确定术作 后治疗方案 长期医嘱: 长期医嘱: 临时医嘱: ? 抗炎、化痰、止血、抑酸、改? 胸外科二级护理 ? 切口拆线 善肺功能、抗肿瘤等治疗 ? 停胸腔闭式引流计量 ? 切口换药 ? 营养对症，保护重要脏器:护? 停记尿量、停吸氧、停心电? 通知出院 肝、保护心肌、补充电解质等 监护 ? 出院带药 ? 其他医嘱 ? 停雾化 ? 定期复诊 ? 胸瓶或纵膈引流瓶护理 ? 停抗菌药物 重 临时医嘱: 临时医嘱: 点 ? 复查血常规 ? 拔胸腔闭式引流管 医 ? 复查血生化、电解质 ? 拔除尿管 嘱 ? 输血(有指征时) ? 切口换药 ? 对症支持 ? 复查胸片、血常规、肝肾功 ? 其他医嘱 能、电解质 ? 伤口换药拆线等 ? 其他特殊医嘱 ? 复查影像学资料 ? 相关合并症治疗 ? 主要 ? 观察患者病情 ? 观察患者病情 ? 观察病情变化 护理 ? 心理与生活护理 ? 心理与生活护理 ? 心理和生活护理 工作 ? 协助患者咳痰 ? 协助患者咳痰 ? 术后康复指导 病情 ?无 ?有，原因: ?无 ?有，原因: ?无 ?有，原因: 变异 1. 1. 1. 记录 2. 2. 2. 护士 签名 医师 签名 singing songs progress, and breaks down barriers to air, widely welcomed by the Japanese youth. Soon, the political team was held in town "25 rent" forum to promote rent, attended by KMT County Government, county offices, Yan Tomb District Government and representatives from all walks of the local youth. The meeting, the objections raised by the representatives of the County Committee, the two sides hotly debated. The local gentry and County Committee of the Kuomintang have attacked political team for unusual activity, Zhuang Shaozhen became a major goal. Renewed from the flag publications, organized anti-Japanese campaign, then to convene "25 rent" Forum, sparking a burst of publicity heat to promote youth war played a role. But the second wave of anti-communist, Kuomintang is mulling, wujiangludong, Lu XI two local forces took the opportunity to launch the "Shen" (the KMT County Chief Shen Liqun) activity, they shouted "County Government with the Communist party activities," created unprecedented tensions. Shen Liqun feel nervous, he was accused of "accommodate the alien parties" and deal with danger, prophesy and found no Communist Party in his County, and caused the storm to Zhuang Shaozhen to open the new identity. Between October, rumors in southwest area of Wujiang in tianmu mountain, "Black said. South Bureau and ordered the withdrawal of Sunan County owned lands, to youth task