儿科常见疾病双向转诊指南 .docx
八步区常见疾病分级诊疗双向转诊指南
八步区常见疾病分级诊疗双向转诊指南（12个专科、136种常见疾病）贺州市八步区卫生和计划生育局目录心内科常见疾病分级诊疗双向转诊指南.................................................. - 8 -冠心病 ................................................................................................. - 8 - 心律失常 ............................................................................................. - 9 - 先天性心脏病.................................................................................... - 15 - 高血压危象及顽固性高血压 ............................................................ - 16 - 顽固性心力衰竭................................................................................ - 18 - 严重瓣膜病........................................................................................ - 19 - 重症心肌炎........................................................................................ - 22 - 严重大血管疾病................................................................................ - 23 - 神经内科常见疾病分级诊疗双向转诊指南............................................ - 25 -阿尔茨海默病.................................................................................... - 25 - 癫痫 ................................................................................................... - 26 - 癫痫持续状态.................................................................................... - 27 - 多发性硬化........................................................................................ - 28 - 视神经脊髓炎谱系疾病（视神经脊髓炎） ..................................... - 29 - 格林-巴利综合征（吉兰-巴雷综合征） .......................................... - 31 - 肌病（注：原为肌肉原发性疾患）................................................. - 33 - 脊髓病 ............................................................................................... - 34 - 帕金森病 ........................................................................................... - 35 - 中枢神经系统感染 ............................................................................ - 37 - 重症肌无力........................................................................................ - 39 - 蛛网膜下腔出血................................................................................ - 40 - 脑出血 ............................................................................................... - 41 - 缺血性脑血管病................................................................................ - 42 -肾脏疾病分级诊疗双向转诊指南............................................................ - 45 -急性感染后急性肾小球肾炎 ............................................................ - 45 - 急进性肾炎综合征 ............................................................................ - 46 - 慢性肾炎综合征................................................................................ - 47 - 肾病综合征........................................................................................ - 48 - 狼疮性肾炎........................................................................................ - 50 - 过敏性紫癜性肾炎 ............................................................................ - 52 - 糖尿病肾病........................................................................................ - 53 - 乙型肝炎病毒相关性肾炎 ................................................................ - 55 - 多发性骨髓瘤肾病 ............................................................................ - 56 - 间质性肾炎........................................................................................ - 57 - 高血压肾病........................................................................................ - 58 - 急性肾损伤（急性肾衰竭） ............................................................ - 59 - 慢性肾脏病（慢性肾衰竭） ............................................................ - 61 - 普外科常见疾病分级诊疗双向转诊指南................................................ - 63 -急性胰腺炎........................................................................................ - 63 - 甲状腺结节........................................................................................ - 63 - 乳腺癌 ............................................................................................... - 65 - 胃、十二指肠、小肠肿瘤 ................................................................ - 66 - 胰腺肿瘤 ........................................................................................... - 68 - 腹股沟疝、股疝、切口疝 ................................................................ - 69 - 结直肠肛门外科常见疾病 ................................................................ - 70 - 肝脏外科常见疾病 ............................................................................ - 71 - 胆道外科常见疾病 ............................................................................ - 72 - 血管外科部分疾病 ............................................................................ - 73 - 腹主动脉瘤........................................................................................ - 73 -胸腹主动脉夹层动脉瘤 .................................................................... - 75 - 颈动脉体瘤........................................................................................ - 76 - 累及大血管的腹膜后肿瘤 ................................................................ - 77 - 肾动脉狭窄........................................................................................ - 77 - 下肢动脉硬化闭塞症 ........................................................................ - 78 - 颅外颈动脉硬化闭塞症 .................................................................... - 79 - 静脉血栓栓塞症（下肢深静脉血栓形成、肺栓塞）...................... - 80 - 骨科常见疾病分级诊疗双向转诊指南.................................................... - 82 -股骨颈骨折........................................................................................ - 82 - 骨盆骨折 ........................................................................................... - 82 - 胫骨平台骨折.................................................................................... - 83 - 踝关节骨折........................................................................................ - 83 - 四肢长骨干骨折................................................................................ - 84 - 股骨头缺血坏死/髋关节发育不良 ................................................... - 84 - 膝关节骨关节炎................................................................................ - 85 - 骨肿瘤 ............................................................................................... - 85 - 运动损伤 ........................................................................................... - 86 - 关节置换术后松动/感染................................................................... - 86 - 颈椎骨折（颈3-7）.......................................................................... - 87 - 胸腰椎脊柱骨折................................................................................ - 87 - 脊柱结核 ........................................................................................... - 88 - 腰椎间盘突出症................................................................................ - 89 - 妇科常见疾病分级诊疗双向转诊指南.................................................... - 91 -宫颈疾病 ........................................................................................... - 91 - 子宫内膜癌........................................................................................ - 92 - 卵巢恶性肿瘤.................................................................................... - 93 -子宫肌瘤 ........................................................................................... - 94 - 闭经 ................................................................................................... - 95 - 功能失调性子宫出血 ........................................................................ - 97 - 产科常见疾病分级诊疗双向转诊指南.................................................... - 99 -妊娠合并心脏病................................................................................ - 99 - 妊娠期肝病........................................................................................ - 99 - 妊娠期糖尿病.................................................................................. - 100 - 妊娠合并甲状腺功能异常 .............................................................. - 100 - 妊娠期高血压疾病 .......................................................................... - 101 - 早产 ................................................................................................. - 102 - 前置胎盘 ......................................................................................... - 103 - 双胎妊娠 ......................................................................................... - 104 - 儿科常见疾病分级诊疗双向转诊指南.................................................. - 105 -社区获得性肺炎.............................................................................. - 105 - 支气管哮喘...................................................................................... - 106 - 腹泻病 ............................................................................................. - 107 - 急性肾小球肾炎.............................................................................. - 108 - 肾病综合征...................................................................................... - 109 - 泌尿系感染...................................................................................... - 110 - 过敏性紫癜...................................................................................... - 111 - 心肌炎 ............................................................................................. - 112 - 心律失常 ......................................................................................... - 114 - 先天性心脏病.................................................................................. - 117 - 肺动脉瓣狭窄.................................................................................. - 118 - 主动脉缩窄...................................................................................... - 119 - 房间隔缺损...................................................................................... - 120 -室间隔缺损...................................................................................... - 121 - 动脉导管未闭.................................................................................. - 122 - 法洛四联症...................................................................................... - 122 - 完全型大动脉转位 .......................................................................... - 123 - 热性惊厥 ......................................................................................... - 124 - 化脓性脑膜炎.................................................................................. - 125 - 常见精神疾病分级诊疗双向转诊指南.................................................. - 127 -脑血管疾病所致精神障碍 .............................................................. - 127 - 难治性精神分裂症 .......................................................................... - 128 - 难治性抑郁症.................................................................................. - 129 - 强迫症 ............................................................................................. - 130 - 偏执性精神障碍.............................................................................. - 132 - 躯体疾病所致精神障碍 .................................................................. - 133 - 康复医学科常见疾病分级诊疗双向转诊指南...................................... - 135 -脑卒中康复...................................................................................... - 135 - 颅脑损伤康复.................................................................................. - 136 - 脊髓损伤康复.................................................................................. - 137 - 小儿脑瘫康复.................................................................................. - 138 - 骨折术后康复.................................................................................. - 139 - 人工关节置换术后康复 .................................................................. - 140 - 手外伤康复...................................................................................... - 141 - 周围神经损伤康复 .......................................................................... - 142 - 腰椎间盘突出症康复 ...................................................................... - 143 - 颈椎病康复...................................................................................... - 144 - 肩周炎 ............................................................................................. - 145 - 膝关节骨性关节炎 .......................................................................... - 146 -眼科常见疾病分级诊疗双向转诊指南.................................................. - 147 -角膜病变 ......................................................................................... - 147 - 白内障 ............................................................................................. - 148 - 复杂性白内障.................................................................................. - 150 - 急性闭角型青光眼/原发性开角型青光眼 ..................................... - 152 - 裂孔源性视网膜脱离 ...................................................................... - 153 - 糖尿病性视网膜病变 ...................................................................... - 154 - 玻璃体出血...................................................................................... - 156 - 复杂性眼外伤.................................................................................. - 158 - 化学性眼部烧伤.............................................................................. - 159 - 皮肤科常见疾病分级诊疗双向转诊指南.............................................. - 162 -红斑狼疮 ......................................................................................... - 162 - 皮肌炎 ............................................................................................. - 164 - 天疱疮 ............................................................................................. - 165 - 恶性黑色素瘤.................................................................................. - 167 - 尖锐湿疣 ......................................................................................... - 168 - 麻风病 ............................................................................................. - 170 - 梅毒 ................................................................................................. - 171 - 皮肤鳞状细胞癌.............................................................................. - 173 - 药疹 ................................................................................................. - 174 - 银屑病 ............................................................................................. - 178 - 硬皮病 ............................................................................................. - 181 -心内科常见疾病分级诊疗双向转诊指南冠心病冠心病是冠状动脉粥样硬化性心脏病的简称，是指供给心脏营养物质的血管——冠状动脉发生严重粥样硬化或痉挛，使冠状动脉狭窄或阻塞，以及血栓形成造成管腔闭塞，导致心肌缺血缺氧或梗塞的一种心脏病。
儿科常见病种入出院参考标准和转诊指导原则
儿科常见病种入出院参考标准和转诊指导原则一、儿内科疾病（一）母婴ABO 血型不合溶血病【ICD-10】P55.1【诊断标准】1.黄疸出现早，进展快，或黄疸程度重，达到病理性黄疸诊断标准；2.母婴 ABO 血型不合；3.实验室检查有血红蛋白下降、网织和/或有核红细胞升高、高间接胆红素血症等溶血依据；4.母子交叉免疫试验符合以下任意一条：（1）直接 Coombs（抗人球蛋白）试验阳性；抗体释放试验阳性；（2）子血清抗体筛查阳性，并结合临床；（3）母孕期抗 A 或抗 B I gG 效价明显升高，滴度≥1:64，并结合临床。
【入院标准】1.黄疸出现早，进展快，或黄疸程度重，达到病理性黄疸诊断标准；2.存在贫血；3.存在母婴 ABO 血型不合条件。
【转诊原则】1.黄疸未完全消退，需要临床干预，但不需换血治疗；2.贫血，但血红蛋白大于80g/L。
3.生命体征稳定，但需要临床监测。
【出院标准】1.血清胆红素稳定下降，结束光疗24-48 小时后，胆红素仍低于需要临床干预的黄疸标准；2.血红蛋白稳定，大于80g/L，不需要输血；3.患儿一般情况好，生命体征平稳。
（二）胃食管反流病【ICD-10】K21【诊断标准】1.无明显系统性疾病的频繁呕吐、反复发作的慢性呼吸道感染、治疗无效的哮喘、胸部及上腹痛、喂养困难、不明原因的营养不良、发育停滞等表现，应考虑胃食管反流病的可能；2.食管 24 小时pH 监测和/或阻抗监测阳性；3.食管压力测定下食管括约肌压力降低;4.胃镜或食管镜检查发现食管黏膜破损;5.上消化道钡餐造影显示反流。
【入院标准】1.临床症状严重，影响患儿生活、学习质量；2.出现消化道出血等并发症；3.出现反复呼吸道感染、哮喘、吸入性肺炎；4.并发重度营养不良和/或严重生长迟缓。
【出院标准】1.临床症状有所缓解；2.出血等并发症得到控制且不需要外科干预。
（三）消化性溃疡【ICD-10】K25-K27【诊断标准】1.病史：反复腹痛、恶心、呕吐，尤其是出现消化道出血，或原因不明的进行性贫血的患儿，应考虑到消化性溃疡可能；2.体征：剑突下或脐周压痛，并发穿孔可伴腹膜炎体征；3.实验室检查：上消化道钡餐造影发现溃疡征象；胃镜检查发现溃疡灶，幽门螺杆菌检测可阳性。
12岁以下儿童转诊流程
12岁以下儿童转诊流程背景转诊是指将患者从一家医疗机构转到另一家医疗机构接受进一步治疗或专科医生的建议。
对于12岁以下儿童的转诊流程，以下是一些建议和步骤。
步骤1. 初步评估：当12岁以下儿童出现疾病症状或需要接受专科治疗时，首先应由初级医疗机构进行初步评估。
初步评估包括对病情的评估、必要的检查和诊断。
2. 实施治疗：根据初步评估的结果，初级医疗机构可以开始必要的治疗。
在此阶段，如果初级医疗机构认为需要进一步的专科治疗，他们应提供转诊建议。
3. 转诊建议：如果初级医疗机构认为12岁以下儿童需要进一步的专科治疗，他们应提供转诊建议。
建议应包括转诊至哪家医疗机构，转诊的原因和必要的文档和检查结果。
4. 家长同意：在接到转诊建议后，12岁以下儿童的家长应同意转诊。
他们可以选择接受转诊，并前往指定的医疗机构接受进一步的治疗。
5. 转诊过程：一旦家长同意转诊，初级医疗机构应与接收医疗机构联系，安排转诊。
转诊过程应确保患者的病历记录、检查结果和其他相关文档的顺利转移。
6. 接受进一步治疗：一旦完成转诊，12岁以下儿童将前往接收医疗机构接受进一步治疗或专科医生的建议。
接收医疗机构应根据转诊建议进行进一步评估和治疗。
7. 后续跟进：初级医疗机构应与接收医疗机构保持沟通，了解12岁以下儿童的治疗进展情况。
他们还应记录转诊的结果和影响，以便对转诊流程进行改进和评估。
结论12岁以下儿童转诊流程涉及初步评估、转诊建议、家长同意和转诊过程的步骤。
这些步骤旨在确保儿童能够及时接受进一步治疗和专科医生的建议。
转诊流程需要初级医疗机构和接收医疗机构之间的有效沟通和协调，以最大化儿童的治疗效果。
儿科转科及转院制度
转科及转院病情病历资料交接制度一.转科病情病历资料交接制度1.1当主管医生发现病人患有其他专业的疾病并需专科治疗时，经科主任同意邀请相关专业的专家会诊，双方共同评估病情，确需转科治疗，才可以转科。
在会诊或转诊前，要进行必要的诊断性检验检查。
对需转科治疗的病员，应告知转诊、专科理由，履行知情同意手续，做好相应准备，选择适宜时机。
对不适宜转诊转科的病员，应告知转诊转科利弊，可能导致的后果，同样履行知情同意手续。
1.2转科前，由主管医生开出转科医嘱，完成本科所有处置记录，并书写《转科记录》，按照预定时间转科。
普通病人由责任护士/值班护士陪送到转入科室，危重病人按《危重病人转运规程》处理。
1.3转科后，双方科室医护人员要对病人的病情进行交接，具体操作按照《病人转运规程》和《危重病人转运规程》执行。
接诊后医生、护士应立即察看病人，评估病情，修订医疗护理计划，接诊医生在病人转入后半小时内，根据《医嘱制度》开出转科医嘱。
并按照《病历书写规程》要求写好转入记录。
1.4转科时药物处理病人转科时，转出科室及转入科室负责病人交接的护士，应将病人在转出科室当日尚未使用完的所有医嘱药品的名称及数量在《患者转科交接记录单》“交/接患者所带物品栏”中详细记录并做好药品交接。
病人转入后，转入科室医生应详细了解病人在转出科室的用药情况及转入时所带人的药品情况，根据病情下达转入医嘱时，临时医嘱注意使用病人转科时所带人的药品，对于不可继续使用的药品，由转入科室护土负责在当日交予药学部各调剂室统一处理。
对存在质量隐患不可作退费处理的药品，由药学部各调剂室回收统一销毁并做好记录。
1.5病案要求1.5.1病人入院2小时以内转科者，转出科应在门诊病历上作记录，不必写住院病案，转科后由转入科写住院病案。
如果病情危重，应在本科按疾病诊疗规范及时抢救治疗，不要转诊，并请有关科室会诊，待病情稳定后再转诊。
同时在门诊病历上详细记录抢救治疗情况。
1.5.1.1住院期间:按转入科(现科)的“转入记录”、“病程记录”，转出科(前科)的“转出记录”、“住院病历”“首次病程记录”、“病程记录”次序排列，其余项目按《病历书写规程》执行。
儿童保健高危儿童双向转诊协议书
儿童保健高危儿童双向转诊协议书English Response:Child Health High-Risk Children Bi-Directional Referral Protocol.This protocol establishes a bi-directional referral process between child health and special education services for the purpose of identifying, assessing, and providing early intervention services to high-risk children.Purpose.The purpose of this protocol is to:Ensure that all high-risk children are identified and referred for appropriate services.Provide a mechanism for communication andcollaboration between child health and special educationservices.Facilitate the early identification and provision of services to high-risk children.Definitions.High-risk child: A child who is at risk for developmental delay or disability due to biological, environmental, or social factors.Child health services: Services provided by health care providers, such as pediatricians, nurses, and social workers, to children from birth to adolescence.Special education services: Services provided by special education teachers and related service providers, such as speech therapists, physical therapists, and occupational therapists, to children with disabilities.Procedures.Referral from Child Health to Special Education.Child health providers will refer children who are suspected of having a developmental delay or disability to special education services.Referrals will be made in writing and will include the child's name, date of birth, contact information, and a brief description of the concerns.Child health providers will provide special education services with any relevant medical records or other information that may be helpful in the evaluation process.Referral from Special Education to Child Health.Special education teachers will refer children who have been identified as having a disability or who are suspected of having a medical condition that may be impacting their education to child health services.Referrals will be made in writing and will include thechild's name, date of birth, contact information, and a brief description of the concerns.Special education teachers will provide child health services with any relevant educational records or other information that may be helpful in the evaluation process.Evaluation and Assessment.Once a referral is received, the receiving agency will conduct an evaluation and assessment to determine if the child meets the eligibility criteria for services.The evaluation will include a review of the child's medical and educational records, as well as an observation of the child.The assessment will be conducted by a team of professionals, including a child health provider and a special education teacher.Service Provision.If the child is found to be eligible for services, the receiving agency will develop an individualized service plan (ISP) for the child.The ISP will outline the specific services that the child will receive, as well as the goals and objectives for those services.Services may be provided by child health providers, special education teachers, or other related service providers.Monitoring and Follow-Up.The child's progress will be monitored regularly by the receiving agency.The child's ISP will be reviewed and updated on a regular basis to ensure that the child is making progress towards their goals and objectives.The receiving agency will communicate with the referring agency on a regular basis to provide updates on the child's progress.Termination of Services.Services will be terminated when the child no longer meets the eligibility criteria for services.The receiving agency will notify the referring agency of the termination of services.Confidentiality.All information collected and shared under this protocol will be kept confidential.Information will only be shared with those individuals who have a need to know in order to provide services to the child.中文回答：儿童保健高危儿童双向转诊协议书。
八步区常见疾病分级诊疗双向转诊指南
八步区常见疾病分级诊疗双向转诊指南（12个专科、136种常见疾病）贺州市八步区卫生和计划生育局目录心内科常见疾病分级诊疗双向转诊指南.................................................. - 8 -冠心病 ................................................................................................. - 8 - 心律失常 ............................................................................................. - 9 - 先天性心脏病.................................................................................... - 15 - 高血压危象及顽固性高血压 ............................................................ - 16 - 顽固性心力衰竭................................................................................ - 18 - 严重瓣膜病........................................................................................ - 19 - 重症心肌炎........................................................................................ - 22 - 严重大血管疾病................................................................................ - 23 - 神经内科常见疾病分级诊疗双向转诊指南............................................ - 25 -阿尔茨海默病.................................................................................... - 25 - 癫痫 ................................................................................................... - 26 - 癫痫持续状态.................................................................................... - 27 - 多发性硬化........................................................................................ - 28 - 视神经脊髓炎谱系疾病（视神经脊髓炎） ..................................... - 29 - 格林-巴利综合征（吉兰-巴雷综合征） .......................................... - 31 - 肌病（注：原为肌肉原发性疾患）................................................. - 33 - 脊髓病 ............................................................................................... - 34 - 帕金森病 ........................................................................................... - 35 - 中枢神经系统感染 ............................................................................ - 37 - 重症肌无力........................................................................................ - 39 - 蛛网膜下腔出血................................................................................ - 40 - 脑出血 ............................................................................................... - 41 - 缺血性脑血管病................................................................................ - 42 -肾脏疾病分级诊疗双向转诊指南............................................................ - 45 -急性感染后急性肾小球肾炎 ............................................................ - 45 - 急进性肾炎综合征 ............................................................................ - 46 - 慢性肾炎综合征................................................................................ - 47 - 肾病综合征........................................................................................ - 48 - 狼疮性肾炎........................................................................................ - 50 - 过敏性紫癜性肾炎 ............................................................................ - 52 - 糖尿病肾病........................................................................................ - 53 - 乙型肝炎病毒相关性肾炎 ................................................................ - 55 - 多发性骨髓瘤肾病 ............................................................................ - 56 - 间质性肾炎........................................................................................ - 57 - 高血压肾病........................................................................................ - 58 - 急性肾损伤（急性肾衰竭） ............................................................ - 59 - 慢性肾脏病（慢性肾衰竭） ............................................................ - 61 - 普外科常见疾病分级诊疗双向转诊指南................................................ - 63 -急性胰腺炎........................................................................................ - 63 - 甲状腺结节........................................................................................ - 63 - 乳腺癌 ............................................................................................... - 65 - 胃、十二指肠、小肠肿瘤 ................................................................ - 66 - 胰腺肿瘤 ........................................................................................... - 68 - 腹股沟疝、股疝、切口疝 ................................................................ - 69 - 结直肠肛门外科常见疾病 ................................................................ - 70 - 肝脏外科常见疾病 ............................................................................ - 71 - 胆道外科常见疾病 ............................................................................ - 72 - 血管外科部分疾病 ............................................................................ - 73 - 腹主动脉瘤........................................................................................ - 73 -胸腹主动脉夹层动脉瘤 .................................................................... - 75 - 颈动脉体瘤........................................................................................ - 76 - 累及大血管的腹膜后肿瘤 ................................................................ - 77 - 肾动脉狭窄........................................................................................ - 77 - 下肢动脉硬化闭塞症 ........................................................................ - 78 - 颅外颈动脉硬化闭塞症 .................................................................... - 79 - 静脉血栓栓塞症（下肢深静脉血栓形成、肺栓塞）...................... - 80 - 骨科常见疾病分级诊疗双向转诊指南.................................................... - 82 -股骨颈骨折........................................................................................ - 82 - 骨盆骨折 ........................................................................................... - 82 - 胫骨平台骨折.................................................................................... - 83 - 踝关节骨折........................................................................................ - 83 - 四肢长骨干骨折................................................................................ - 84 - 股骨头缺血坏死/髋关节发育不良 ................................................... - 84 - 膝关节骨关节炎................................................................................ - 85 - 骨肿瘤 ............................................................................................... - 85 - 运动损伤 ........................................................................................... - 86 - 关节置换术后松动/感染................................................................... - 86 - 颈椎骨折（颈3-7）.......................................................................... - 87 - 胸腰椎脊柱骨折................................................................................ - 87 - 脊柱结核 ........................................................................................... - 88 - 腰椎间盘突出症................................................................................ - 89 - 妇科常见疾病分级诊疗双向转诊指南.................................................... - 91 -宫颈疾病 ........................................................................................... - 91 - 子宫内膜癌........................................................................................ - 92 - 卵巢恶性肿瘤.................................................................................... - 93 -子宫肌瘤 ........................................................................................... - 94 - 闭经 ................................................................................................... - 95 - 功能失调性子宫出血 ........................................................................ - 97 - 产科常见疾病分级诊疗双向转诊指南.................................................... - 99 -妊娠合并心脏病................................................................................ - 99 - 妊娠期肝病........................................................................................ - 99 - 妊娠期糖尿病.................................................................................. - 100 - 妊娠合并甲状腺功能异常 .............................................................. - 100 - 妊娠期高血压疾病 .......................................................................... - 101 - 早产 ................................................................................................. - 102 - 前置胎盘 ......................................................................................... - 103 - 双胎妊娠 ......................................................................................... - 104 - 儿科常见疾病分级诊疗双向转诊指南.................................................. - 105 -社区获得性肺炎.............................................................................. - 105 - 支气管哮喘...................................................................................... - 106 - 腹泻病 ............................................................................................. - 107 - 急性肾小球肾炎.............................................................................. - 108 - 肾病综合征...................................................................................... - 109 - 泌尿系感染...................................................................................... - 110 - 过敏性紫癜...................................................................................... - 111 - 心肌炎 ............................................................................................. - 112 - 心律失常 ......................................................................................... - 114 - 先天性心脏病.................................................................................. - 117 - 肺动脉瓣狭窄.................................................................................. - 118 - 主动脉缩窄...................................................................................... - 119 - 房间隔缺损...................................................................................... - 120 -室间隔缺损...................................................................................... - 121 - 动脉导管未闭.................................................................................. - 122 - 法洛四联症...................................................................................... - 122 - 完全型大动脉转位 .......................................................................... - 123 - 热性惊厥 ......................................................................................... - 124 - 化脓性脑膜炎.................................................................................. - 125 - 常见精神疾病分级诊疗双向转诊指南.................................................. - 127 -脑血管疾病所致精神障碍 .............................................................. - 127 - 难治性精神分裂症 .......................................................................... - 128 - 难治性抑郁症.................................................................................. - 129 - 强迫症 ............................................................................................. - 130 - 偏执性精神障碍.............................................................................. - 132 - 躯体疾病所致精神障碍 .................................................................. - 133 - 康复医学科常见疾病分级诊疗双向转诊指南...................................... - 135 -脑卒中康复...................................................................................... - 135 - 颅脑损伤康复.................................................................................. - 136 - 脊髓损伤康复.................................................................................. - 137 - 小儿脑瘫康复.................................................................................. - 138 - 骨折术后康复.................................................................................. - 139 - 人工关节置换术后康复 .................................................................. - 140 - 手外伤康复...................................................................................... - 141 - 周围神经损伤康复 .......................................................................... - 142 - 腰椎间盘突出症康复 ...................................................................... - 143 - 颈椎病康复...................................................................................... - 144 - 肩周炎 ............................................................................................. - 145 - 膝关节骨性关节炎 .......................................................................... - 146 -眼科常见疾病分级诊疗双向转诊指南.................................................. - 147 -角膜病变 ......................................................................................... - 147 - 白内障 ............................................................................................. - 148 - 复杂性白内障.................................................................................. - 150 - 急性闭角型青光眼/原发性开角型青光眼 ..................................... - 152 - 裂孔源性视网膜脱离 ...................................................................... - 153 - 糖尿病性视网膜病变 ...................................................................... - 154 - 玻璃体出血...................................................................................... - 156 - 复杂性眼外伤.................................................................................. - 158 - 化学性眼部烧伤.............................................................................. - 159 - 皮肤科常见疾病分级诊疗双向转诊指南.............................................. - 162 -红斑狼疮 ......................................................................................... - 162 - 皮肌炎 ............................................................................................. - 164 - 天疱疮 ............................................................................................. - 165 - 恶性黑色素瘤.................................................................................. - 167 - 尖锐湿疣 ......................................................................................... - 168 - 麻风病 ............................................................................................. - 170 - 梅毒 ................................................................................................. - 171 - 皮肤鳞状细胞癌.............................................................................. - 173 - 药疹 ................................................................................................. - 174 - 银屑病 ............................................................................................. - 178 - 硬皮病 ............................................................................................. - 181 -心内科常见疾病分级诊疗双向转诊指南冠心病冠心病是冠状动脉粥样硬化性心脏病的简称，是指供给心脏营养物质的血管——冠状动脉发生严重粥样硬化或痉挛，使冠状动脉狭窄或阻塞，以及血栓形成造成管腔闭塞，导致心肌缺血缺氧或梗塞的一种心脏病。
儿童保健高危儿童双向转诊协议书
儿童保健高危儿童双向转诊协议书英文回答：Child Health High-Risk Child Bi-Directional Referral Protocol.Purpose.The purpose of this protocol is to establish a bi-directional referral process between child health and other sectors for high-risk children and their families. This protocol aims to ensure that children and families receive the necessary support and services to promote their health, well-being, and development.Definitions.High-risk child: A child who has multiple risk factors that put them at an increased risk of poor health outcomes, such as poverty, neglect, abuse, violence, or mental healthissues.Referral: The process of transferring a child andfamily from one sector to another for additional assessment, support, or services.Procedure.1. Identification of High-Risk Children.Child health professionals will identify children who meet the criteria for a high-risk referral.These criteria may include:Multiple risk factors.Concerns about the child's health, development, or well-being.History of abuse or neglect.Involvement with child protection services.Parents with mental health or substance use issues.2. Bi-Directional Referral Process.Child health to other sectors:Child health professionals will make a referral to other sectors, such as mental health, social services, or education, when they identify a child and family in need of additional support.Other sectors to child health:Professionals from other sectors, such as social workers, mental health counselors, or teachers, will make a referral to child health when they identify a child and family who may benefit from health-related services.3. Referral Form.A standardized referral form will be used to document the referral.The form will include information about the child, the family, the reasons for referral, and the desired outcome.4. Communication.Communication between child health and other sectorsis crucial to ensure a smooth and effective referral process.Regular communication should occur to discuss thechild's progress and to adjust the referral plan as needed.5. Monitoring and Evaluation.The referral process will be monitored and evaluated regularly to ensure that it is meeting the needs of high-risk children and their families.Data will be collected on the number of referrals, thereasons for referral, and the outcomes of the referrals.Roles and Responsibilities.Child health professionals are responsible for identifying high-risk children, making referrals, and coordinating care with other sectors.Professionals from other sectors are responsible for providing assessments, support, and services to high-risk children and their families.Parents and caregivers are involved in the referral process and should be informed about the reasons for referral and the expected outcomes.Benefits.Improved coordination of care for high-risk children and their families.Reduced duplication of services.Early identification and intervention for children at risk.Improved health, well-being, and development for high-risk children.Revision History.Date: [Date]Version: 1.0。
双向转诊8个病种讲解
脑卒中等8各常见病种(手术)康复医疗双向转诊标准(试行)脑卒中一、三级综合医院转出标准(一)由三级综合医院转出至康复医院(含以康复医疗服务为主的二级综合医院,下同)的标准。
1.生命体征平稳。
2.神经科专科处理结束3.脑卒中相关临床实验室检查指标基本正常或平稳。
4.接受系统康复诊疗后仍存在较重的功能障碍,有并发症或合并症,如意识或认知障碍、气管切开状态、急性心肌梗死、吞咽障碍等,需继续住院康复治疗。
(二)由三级综合医院转入社区或家庭的标准。
1.生命体征平稳,脑卒中相关临床实验室检查指标基本正常。
2.没有需要住院治疗的并发症或合并症。
3.存在轻度功能障碍,无需住院康复治疗,可进行社区康复或居家康复。
二、转至三级综合医院标准(一)出现颅内活动性出血或进行性脑水肿、严重肺部感染、泌尿道感染、败血症或重度压疮等。
(二)意识障碍或功能障碍加重。
(三)出现多嚣官功能衰竭。
(四)出现严重的心理-精神障碍,需转至精神科或精神专科医院治疗。
脑卒中等8各常见病种(手术)康复医疗双向转诊标准(试行)脑外伤一、三级综合医院转出标准(一)由三级综合医院转出至康复医院的标准。
1.生命体征平稳。
2.神经外料专科处理结束。
3.脑外伤相关临床实验室检查指标基本正常或平稳。
4.转出前24小时内无癫痫发作。
5.接受系统康复诊疗后仍存在较重的功能障碍.有并发症或合并症。
如意识或认知障碍、气管切开状态、急性心肌梗死、肺栓塞、吞咽障碍等,需继续住院康复治疗。
(二)由三级综合医院转入社区或家庭的标准。
1.患者生命体在平稳,脑外伤相关临床实验室检查指标基本正常。
2.没有需要住院治疗的并发症或合并症。
3.轻度功能障碍,无需住院康复治疗,可进行社区康复或居家康复。
二、转至三级综合医院标准(一)出现颅内活动性出血。
脑水肿进行性加重或其他需要手术治疗的情况。
(二)出现肺水肿、肺感染、败血症或重度压疮等本级医疗机构不能处理的并发症。
(三)出现多嚣官功能衰竭。
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儿科常见疾病双向转诊指南
（试行）
新生儿状况
一、凡是满足新生儿危重评分单项指标十项中其中任意一条, 则应尽快转往三级医院接受治疗
1.需要气管插管机械通气或反复呼吸暂停，对刺激无反应；
2.严重心律紊乱：阵发性室上性心动过速合并心衰、心房扑动和心房纤颤、阵发性室性心动过速、心室扑动和纤颤、房室传导阻滞（II度II型以上）、心室内传导阻滞（双束支以上）；
3 .弥散性血管内凝血；■沪
4.反复抽搐，经处理抽搐仍然持续24小时以上不能缓解；
5.昏迷患儿、弹足底5次无反应；'"f
6.体温＜30度或〉41度；
8.血糖＜1. 7mmol/L;
9•有换血指征的高胆红素血症；
10.出生体重＜1000g o
二、出生孕周W32周或出生体重＜15OOg的新生儿需转诊到三级医院
新生儿疾病
一、新生儿呼吸窘迫综合症需转三级医院治疗
二、新生儿重度高胆红素血症（达到换血指征的）需转三级
医院治疗
儿童感染性疾病
—、儿童结核病
（一）上转指征。
1.儿童结核病初治：儿童结核病初治时确诊以及抗结核方案
制定；
2.儿童结核病发生并发症，包括：肝损害、药物热、皮疹、
合并感染；
3.儿童结核病复发、复治；=
4•扌童结夢病怀疑耐药结核。
* __
1•儿童结核病诊断明确，抗结核方案已制定，需长期观察疗效者；
2.符合第一条，并存在需长期住院治疗病例，包括：结核性脑膜炎需管喂、静脉营养支持，所有需要长期康复训练者。
二、儿童肝炎
（一）上转指征。
1•婴儿肝炎综合征无法明确病因者；
2.巨细胞病毒肝炎：年龄小于2月龄发病者；需明确先天感
染（宫内感染）诊断者；需抗病毒治疗者；凝血酶原活动度低于40%者；有多器官功能障碍者；年长儿肝功异常超过6个月者；
3.嗜肝病毒肝炎：慢性肝炎（包括慢乙肝、慢丙肝）需抗病
毒治疗者；急性肝炎凝血酶原活动度低于40%者；有腹水、感染、肝性脑病并发症者；
4•其它不明原因的肝病：无法明确病因者；凝血酶原活动度低于40%者；有腹水、感染、肝性脑病并发症者。
（二）下转指征。
1.各种慢性肝炎病因明确，病情稳定，需维持治疗或监测随访者；
2.终末期肝病需要临终支持治疗者。
儿童泌尿系统疾病
一、急性链球菌感染后肾小球肾炎
：1•少尿或无尿超过48h,应尽快转上级医院；二"
2.肾功能衰竭或出现肾功能进行性恶化，有发展为急进性肾
炎的趋势；严重水钠储溜，有肺水肿、脑水肿的倾向；严重的水电VV ■11 I ■ vy vy III
3.难以控制的高血压、高血压脑病，表现为剧烈头痛、呕吐, 甚至抽搐，应尽早转上级医院；
4.严重的充血性心力衰竭。
（二）下转指征。
1.典型的病例；
2•不伴有严重并发症患儿。
二、肾病综合征
（一）上转指征。
1•经4周以上正规治疗无效病例，应尽快转上级医院进行有关检查，明确肾病综合征的病理类型，调整治疗方案；
2•肾病综合征（肾炎型）；
3.—旦出现以下病情演变的表现，如肢体不对称水肿、发热、胸痛、少尿无尿等，应立即转上级医院诊治；
4.使用环磷酰胺过程中出现发热、黄疸、血尿等要及时转诊;
5.在使用利尿剂过程中患者若表现为疲软乏力、神经精神兴
奋性增高、甚至呼吸肌麻痹的情况，应尽快转诊。
（二）下转指征。
单纯型肾病综合征，初治患儿。
三、IgA肾病
1•血探蒔续皐年诙上：需行肾活检患儿；亠• 7
2.反复出现的血尿、蛋白尿，甚至出现肾功能损害的患儿；
（二）下转指征。
仅有轻微血尿患儿。
四、系统性红斑狼疮、狼疮性肾炎
（一）上转指征。
1.诊断系统性红斑狼疮的患儿建议转上级医院治疗；
2.伴有狼疮性肾炎患儿；
3.有神经及精神系统异常的狼疮性脑炎的患儿；
4.有血液系统损害的患儿。
五、过敏性紫瘢
（一）上转指征。
1•反复复发的患儿；
2•伴有肾脏损害的患儿；
3•腹痛难以控制，消化道出血患儿；
4.有神经系统、呼吸系统及心脏损害的患儿。
（二）下转指征。
1.单纯的皮肤型过敏性紫瘢；
2.初治的过敏性紫瘢患儿。
六、急性肾损伤
（一）上转指征。
1.少尿或无尿2d以上；
2.出血尿毒症症状，尤其是神经精神症状；
3：巧重水鯉诸溜或充血性心力衰竭、肺水肿或水肿；
4.血尿素氮3
5. 7 mmol / L （ lOOmg / dL ）或增加速度每日9mmol/L （25. 2mg / dL）;
5.难以纠正的酸中毒；
6.血钾〉6. 5 mmol / L;
V7.急性中毒，可通过血液净化清除的药物、毒物。
（二）下转指征。
1.肾前性急性肾损伤，通过补液治疗能够缓解患儿；
2.肾后性急性肾损伤，通过碎石（泌尿系结石）或抗感染（尿路感染）能够缓解的患儿。
七、慢性肾功能衰竭
原则上均应转诊；对于诊断明确的患儿，在进行规律血液透析或腹膜透析的患儿可在基层医院治疗。
儿童常见心脏疾病
一、心肌炎
（一）上转指征。
1.出现心功能不全，心源性休克或心脑综合征；
2.超声或x线示心脏扩大、或心包积液；
3.心电图明显异常，即提示窦房传导阻滞，房室传导阻滞，完全右或左束支阻滞，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;
4•伴有多脏器功能损害；
5.治疗效果欠佳、或加重；
6.^断不明确的疑难病例。
:
：1•生命体征平稳；
2.经治疗后，病情稳定、进入康复期；或诊断明确，仅需常规保弁相濟离岁不科料杯匚门cc m
二、常见心律失常
（一）上转指征。
1.伴有心功能不全，心源性休克或心脑综合征；。