心血管内科出入院标准

心血管内科出入院标准 不稳定心绞痛入院标准 1.临床发作特点:现为运动或自发性胸痛，休息或含服硝酸甘油可迅速缓解。 2.心电图表现:胸痛发作时相邻两个或两个以上导联心电图ST段压低或抬高,0.1mV ，或T波倒置?0.2mV，胸痛缓解后ST-T变化可恢复。 3.心肌损伤标记物不升高或未达到心肌梗死诊断水平。 不稳定的心绞痛出院标准 1标准住院日为7-10天 2.生命体征平稳。 3.血流动力学稳定。 4心肌缺血症状得到有效控制。 5无其他需要继续住院的并发症。 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 急性心肌梗死的入院标准 1,其性质与部位于心绞痛相似，但常于休息或睡眠中发生 2突然发作剧烈持久的胸骨后压榨性疼痛、休息和含硝酸甘油不能缓解，常伴烦躁不安、出汗、恐惧或濒死感 3发热、白细胞增高，血沉增快;胃肠道症状 4前壁心肌梗死易发生室性心律失常，下壁心肌梗死易发生房室传导阻滞 5发生急性左心衰竭，在起病的最初几小时内发生 6心界可轻到中度增大，心率增快或减慢，心音减弱，可出现第四心音或第三心音 7心电图特征性改变有Q波心梗的心电图特点。 (1)坏死区出现病理Q波，在面向透壁心肌坏死区导联出现。 (2)损伤区ST段弓背向上型抬高，在面向坏死区周围心肌损伤区导联出现。 (3)缺血区T波倒置，在面向损伤区周围心肌缺血区导联出现。 (4)背向心梗区R波增高，ST段压低和T波直立并增高。 8心肌酶谱CPK、GOT，LDH升高，最早(6小时内)增高为CPK，4d恢复正常。增高时间最长者为LDH，持续1,2周。其中CPK的同工酶CPK?MB和LDH的同工酶LDH1的诊断特异性最高。 9血象白细胞增多，中性粒细胞增多，嗜酸性粒细胞减少或消失，血沉加快，血清肌凝蛋白轻链增高 急性心肌梗死的出院标准 1 1周下床活动，2周在走廊内活动，3周出院，严重者适当延长卧床与住院时间 2无明显的心律失常 3倒置的T波恢复正常 4坏死的心肌经溶栓治疗24小时内发生再灌注性心律失常 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 5复查心肌酶谱无特异性改变 病毒性心肌炎的入院标准、 1，有消化道或呼吸道感染史。 2感染后1,3周内或与发病同时新出现的各种心律失常和(或)心电图异常而在未服 抗心律失常药物前出现心电图改变者: 3. 血清病毒中和抗体测定阳性结果，由于柯萨奇B病毒最为常见，通常检测此组病毒的中和抗体，在起病早期和2,4周各取血标本一次，如二次抗体效价示4倍上升或其中一次?1?640，可作为近期感染该病毒的依据。 4.心电图改变: 以R波为主的2个或2个以上主要导联(I、II、aVF、V5)的ST-T改变持续4天以上伴动态变化，窦房传导阻滞、房室传导阻滞，完全性右或左束支阻滞，成联律、多形、多源、成对或并行性早搏，非房室结及房室折返引起的异位性心动过速，低电压 及异常Q波。 5.CK-MB升高或心肌肌钙蛋白(cTnI或cTnT)阳性 病毒性心肌炎的出院标准、 1临床症状消失; 2不发生任何并发症，如心力衰竭、心律失常等; 3心电图及心肌酶学恢复正常; 4能参加同龄人的正常活动。 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma1111 life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 二尖瓣狭窄的入院诊断标准 1 约半数患者有链球菌感染及急性风湿热病史。 2.自觉劳力性心悸、气短或阵发性呼吸困难，咳嗽、咯血、颧部与口唇轻度紫绀， 重者有肝大、腹水、浮肿等右心衰竭表现。 3心前区隆起，胸骨左缘第3,4肋间有收缩期抬举样冲动，心尖搏动点略向左移。 4 心尖部有舒张期震颤，可扪及心尖部撞击感，及胸骨左缘处的收缩期抬举冲动。 5.心尖区可闻及第一心音亢进及隆隆样或雷鸣样舒张中晚期杂音，范围局限;肺动脉瓣第二心音亢进;沿胸骨左下缘或心尖可听到二尖瓣开放拍击音。若有严重 肺动脉高压可在胸骨左缘闻及舒张早期吹风样杂音。 6根据X线检查、心电图、多普勒超声心电图或右心导管一般即可确诊。 二尖瓣狭窄的出院标准 1窦性心律，无体循环栓塞史; 2成功的扩张术可以使患者心功能维持2,10年左右而不需其他特殊治疗 3 PBMV术施行多次，使换瓣时间大大推迟，甚至终身不需换瓣 4不合并二尖瓣关闭不全及其他瓣膜病变 5二尖瓣口面积》2.0cm2 6心功能恢复为NYHA I级。 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 心衰的入院和出院标准 右心衰入院标准 1上腹胀满:右心衰竭早期症状，伴食欲不振、恶心、呕吐、上腹胀痛。 2颈静脉怒张:右心衰竭的明显征象。 3水肿:心衰性水肿多先见于下肢，呈凹陷性水肿，重者可波及全身，多 于傍晚出现或加重，休息一夜后可减轻或消失。 4紫绀:右心衰竭者多有不同程度的紫绀。 5神经系统症状:可有神经过敏，失眠，嗜睡等症状。 6心脏体征:主要为原有心脏病表现。 右心衰出院标准 1胃肠道症状消失 2水肿消失 3无紫绀 4心功能恢复1级 左心衰诊断标准: , 1呼吸困难:左心衰最常见症状。包括劳力性呼吸困难、咳嗽、端坐呼 吸、阵发性夜间呼吸困难，是因肺部瘀血、肺活量减低引起。病人常在 熟睡中憋醒，有窒息感，咳嗽频繁。 , 2咳嗽、咳痰、咯血:肺泡和支气管粘膜淤血所致，常于夜间发生，坐位 时咳嗽可减轻，白色浆液性泡沫状痰为其特点。若支气管粘膜下扩张的 血管破裂，则可引起大咯血。 , 其它:可有心脏扩大、疲乏无力、失眠、心悸、少尿及肾功能损害症状等。 , , 左心衰出院标准 , 1劳力性呼吸困难不发作 , 2咳嗽、咳痰、咯血停止3心功能恢复1级 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma1111 life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 脑栓塞的入院标准 (1)心电图、超声心动图、胸部X线摄片及监测血压等，可提供原发疾病的征象，如高血压病及不同类型的心脏疾病等。 (2)头颅X线摄片有时可发现颈内动脉虹吸部有钙化影;梗死范围较广者可在发病2-3日后出现中线波移位，持续约两周。 (3)脑血管造影可发现动脉闭塞或狭窄的部位，脑水肿所致血管受压、移位和侧支循环等情况。 (4)脑CT及核磁共振(MRI)检查可显示脑梗死的部位、大小及其周围脑水肿情况和有无出血征象等，是最可靠的无创性诊断手段。 脑栓塞的出院标准 1CT扫描脑栓塞消失 2脑血管造影可发现动脉闭塞或狭窄的部位消失 3脑CT及核磁共振(MRI)检查可显示脑梗死的部位无出血水肿，钙化灶消失 4 意识清，血压平稳，肢体运动、感觉及语言功能恢复好，能自理生活，可遗留轻度神经损害体征。 5.好转:意识清，肢体及语言功能有不同程度改善。 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 脑出血的入院标准 1.有程度不同的意识障碍,早期多血压显著升高,重症者脉洪缓慢,呼吸深缓,常伴中枢性高热,病情恶化时呈现中枢性呼吸、循环衰竭，瞳孔形状不规则、双侧缩小或散大、双侧大小不等，光反应迟钝或消失。脑膜刺激征阳性，眼底可见视网膜动脉硬化和视网膜出血，偶有视乳头水肿，可有上消化道出血，心律不齐、肺水肿等。 2.局限性定位体征: ?壳核型出血主要有三偏征(偏瘫偏盲偏身感觉障碍)双眼同向凝视,左侧半球可有失语; ?丘脑型可有偏瘫,偏身感觉障碍,双眼垂直性注视麻痹和会聚不能,瞳孔缩小; ?脑叶型意识障碍轻,抽搐发作和脑膜刺激征多较明显,局灶体征因受损脑叶不同而异; ?桥脑型昏迷深瞳孔小高热呈去大脑性强直或四肢瘫(重型者)轻型者有交叉性麻痹和感觉障碍眼球运动障碍(眼外肌麻痹同向凝视麻痹核间性眼肌麻痹); ?小脑型为眩晕眼球震颤共济失调(轻型)重型者昏迷四肢松软等; ?脑室型者针尖样瞳孔昏迷深高热和去大脑性强直 . 脑出血的出院标准 1病人无意识障碍，血压恢复到正常范围且较平稳，生命体征平稳，病情不再进展 2CT示无再次出血，出血大部分被吸收 3肢体及语言功能有不同程度改善 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma1111 life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 蛛网膜下腔出血入院标准 1)头痛与呕吐 突发剧烈头痛、呕吐、颜面苍白、全身冷汗。如头痛局限某处有定位意义，如前头痛小脑幕上和大脑半球(单侧痛)、后头痛表示后颅凹病变。 2)意识障碍和精神症状 多数患者无意识障碍，但可有烦躁不安。危重者可有谵妄，不同程度的意识不清及至昏迷，少数可出现癫痫发作和精神症状。 3)脑膜刺激征 青壮年病人多见且明显，伴有颈背部痛。老年患者、出血早期或深昏迷者可无脑膜刺激征。 4)低热、腰背腿痛等。亦可见轻偏瘫，视力障碍，第?、?、?、?等颅神经麻痹，视网膜片状出血和视乳头水肿等。此外还可并发上消化道出血和呼吸道感染等。 5)腰穿颅内压多增高，脑脊液早期为血性，3,4天后开始黄变。发病初期部分患者周围血中白细胞可增高，且多伴有核左移。心电图可有心律失常，并以心动过速、传导阻滞较多见。4天内头颅CT扫描，阳性率为75-85%，表现为颅底各池、大脑纵裂及脑沟密度增高，积血较厚处提示可能即系破裂动脉所在处或其附近部位。 蛛网膜下腔出血出院标准 1 2,3周的治疗后，病情会趋向稳定 2无头痛恶心呕吐症状 3病人精神好意识清，血压平稳，肢体运动、感觉及语言功能恢复好，能自理生活，可遗留永久性残疾。 4:意识清，肢体及语言功能有不同程度改善。 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 短暂性脑缺血发作的入院标准 1.起病突然～迅速出现局灶性神经系统症状和体征。 2.神经系统症状和体征多数持续十至数十分钟～并在1小时内恢复～但可反复发作。 3.神经影像学未发现任何急性梗死病灶。 短暂性脑缺血发作的出院标准 1.患者病情稳定。 2.没有需要住院治疗的并发症。 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma1111 life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 峄城区人民医院 内一科 ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung 医学誓言 健康所系，性命相托。 当我步人神圣医学学府的时刻，谨庄严宣誓。 我志愿献身医学，热爱祖国，忠于人民。恪守医德，尊师守纪， 刻苦钻研，孜孜不倦，精益求精，全面发展。 我决心竭尽全力除人类之病痛，助健康之完美，维护医术的圣洁 和荣誉。救死扶伤，不辞艰辛执著追求，为祖国医药事业的发展和人 类身 心健康奋斗终生。 THE OATH OF A MEDICAL STUDENT Health related， life entrusted. The moment I step into the hallowed medical institution，I pledge solemnly. I will volunteer myself to medicine with love for my motherland and loyalty to the people. I will scrupulously abide by the medical ethics ,respect my teachers and discipline myself. I will strive diligently for the perfection of technology and for all-round development of myself. I am determined to strive diligently to eliminate man' s suffering， enhance man' s health conditions and uphold the chasteness and honor of medicine. I will heal the wounded and rescue the dying ,regardless of the hardships. I will always be in earnest pursuit of better achievement . I will work all my life for the development of the nation' s medical enterprise as well as menkind' s physical and mental health. ncluding based life support (BLS), and senior heart life support (ACLS), and based trauma life support (BTLS) and senior trauma1111 life support (ATLS) of based knowledge; common emergency technology of application; common emergency of causes identification, and clinical performance and the processing specification; common emergency auxiliary check of select refers to levy, and results judge and the clinical meaning; Indications, effects of common emergency drugs, side effects, as well as specific applications (medicine, for expansion of vasoactive drugs, cardiac diuretic, antispasmodic and anti-asthmatic drugs, analgesic drugs, Hemostatic, antiarrhythmic drugs, such as Cortina). Understand: the new development of the theory of life support; cardiac respiratory and cardiopulmonary resuscitation after cardiac syndrome etiology, pathophysiology, clinical manifestations, diagnosis, and treatment. 2. basic requirements (1) species and cases of study requirements: disease disease fever acute abdominal pain chest pain and difficulty breathing faint coma shock in acute poisoning with cardiac respiratory arrest bleeding (hemoptysis, hematemesis, hematuria, etc) requires at least 45 cases of arrhythmia. (2) basic skills requirements name name heart lung