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目的分析北京大学第三医院神经内科不同阶段的会诊病例组成,总结住院总医师院内会诊的变化规律。方法北京大学第三医院神经内科执行24 h住院总医师值班制度,值班期间参与医院本部和北京大学第六医院的常规和急症会诊。采用对照研究方法,比较2006年6月1日至2006年11月30日和2009年9月1日至2010年8月31日两个阶段的会诊病例构成。结果第一阶段新会诊患者共512例,其中急会诊244例(47.7%),常规会诊268例(52.3%);内科系统患者286例(55.9%),外科系统226例(44.1%)。第二阶段新会诊患者共820例,其中急会诊304例(37.1%),常规会诊516例(62.9%);内科系统患者424例(51.7%),外科系统396例(48.3%)。第一阶段会诊7.11例/24 h,第二阶段5.69例/24 h。频数位于前三的疾病分别为系统性疾病神经系统表现(第一阶段230例,44.9%;第二阶段279例,34.0%;P<0.05),脑梗死(第一阶段88例,17.2%;第二阶段181例,22.1%;P=0.03)及医源性因素导致的神经系统损害(第一阶段44例,8.6%;第二阶段85例,10.4%;P=0.29)。第二阶段与第一阶段比较,系统性疾病神经系统表现的构成比减少、脑梗死构成比增加,差异均有统计学意义。结论第二阶段会诊数量减少考虑与上级医师会诊增多有关。系统性疾病的神经系统表现比例减少、脑梗死比例增多,考虑与他科医师对神经系统并发症的认识程度提高和住院患者脑血管病危险因素增加有关。
Objective To analyze the composition of the consultation at different stages of neurology in the Third Hospital of Peking University and summarize the changing rules of in-hospital consultation of the chief physician. Methods The Department of Neurology, Peking University Third Hospital conducted 24-hour resident physician on duty system and participated in the routine and emergency consultation of the hospital headquarters and Peking University Sixth Hospital on duty. A comparative study was conducted to compare the consultation cases between June 1, 2006 and November 30, 2006 and September 1, 2009 and August 31, 2010. Results A total of 512 patients were enrolled in the first phase, including 244 emergency consultations (47.7%) and 268 routine consultations (52.3%). There were 286 cases (55.9%) in medical system and 226 cases (44.1%) in surgical system. A total of 820 new cases were enrolled in the second phase, including 304 emergency consultations (37.1%), 516 routine consultations (62.9%), 424 (51.7%) medical systems and 396 surgical systems (48.3%). The first phase consultation 7.11 cases / 24 h, the second phase of 5.69 cases / 24 h. The frequency of the first three diseases were systemic neurological manifestations (230 cases, 44.9% in the first stage, 279 cases, 34.0% in the second stage, P <0.05), cerebral infarction (88 cases in the first stage, 17.2% 181 cases in the second stage, 22.1%; P = 0.03) and iatrogenic injury to the nervous system (44 cases in the first stage, 8.6%; 85 cases in the second stage, 10.4%; P = 0.29). Compared with the first phase of the second phase, the constituent ratio of the nervous system of the systemic disease decreased, the constituent ratio of the cerebral infarction increased, the differences were statistically significant. Conclusions The number of consultation in the second phase is related to the increase of doctor consultation at the higher level. Systematic disease has a reduced proportion of neurological manifestations and an increased proportion of cerebral infarctions, and is considered to be related to increased awareness among other physicians of neurologic complications and increased risk of cerebrovascular disease in hospitalized patients.