A study of diagnosis and treatment process of upper respiratory tract infections in children for community health centers in China
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摘要: 目的 通过前期的调研及文献检索发现,西安市社区医生乃至全国专科医生对小儿上呼吸道感染(简称"上感")的诊疗存在认识不足,导致治疗上的盲目性,存在重复用药、不恰当联合用药和过多使用抗病毒、抗生素等诸多问题,使得部分社区医院未能完全承担起小儿上感的首诊之责。现有的小儿上感诊疗流程都是针对儿科专科医生,缺乏完全适宜全科医生使用的规范流程。为了提升全科医生的能力,迫切需要适宜于全科医生使用的小儿上感诊疗流程。本研究目的是总结出适合社区全科医生使用的小儿上感诊疗及管理流程,引导社区全科医生规范诊疗小儿上感。 方法 经检索多个数据库及相关文献,共收集、筛选出最新国内外小儿上感诊疗指南、规范或专家共识7个,从全科医生岗位实际出发,就小儿上感诊断标准、鉴别诊断、治疗原则、合理用药4个维度进行逐个对比、分析和归纳。 结果 总结出适宜社区全科医生使用的小儿上感诊断和治疗、管理流程各1个。 结论 按照该流程社区全科医生应对首诊上感患儿进行全面评估,根据上感不同类型及病情给予适当治疗。如在急性期以病情观察和对症治疗为主,仅在有指征时才能使用抗生素,流感患儿应尽早用抗病毒药物。Abstract: Objective Through the preliminary investigation and literature search, it is found that the community doctors in Xian and even the national specialists have insufficient understanding of the diagnosis and treatment of the upper respiratory tract infections (URTIs) in child, which leads to the blindness of therapy such as repeated medication, improper combination of drugs and excessive use of antiviral and antibiotics, etc. All of these lead to the result that some community hospitals were not able to fully assume the responsibility for the first diagnosis of URTIs in child. The current pediatric diagnosis and treatment process for URTIs is aimed at pediatric specialists; there are no complete rules and procedures suitable for general practitioner (GP). In order to enhance the ability of general practitioners, there is an urgent need for the diagnosis and treatment of URTIs in children. The aim of this paper is to summarize the diagnosis, treatment and management process of URTIs in children which could be applicable in community health centers in China. Methods Seven items of the latest guidelines, norms or expert consensus about the diagnosis and therapy of URTIs in children both from domestic areas and foreign countries were involved in. Upon general practitioner jobs, all of them were compared and analyzed according to the following four-dimension, such as diagnostic criteria, differential diagnosis, treatment principles and rational administration, etc. Results The process for diagnosis, treatment and management of URTIs in children suitable for General Physicians in community health centers were formed. Conclusion Following this process, an overall assessment of URTIs in children should be given by the first visited GPs, appropriated therapy could be provided depending on the different varieties, severity and course of URTIs. For the patients in acute period, the priority of therapy should be given to symptomatic treatment on the basis of clinical observation. Antibiotics can only be used if there is at least a proper indication for it. Children with influenza should accept antiviral drugs as early as possible.
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