危重醫(yī)學(xué)與加強(qiáng)醫(yī)療病房課件

ICU學(xué)科建設(shè)危重醫(yī)學(xué)與加強(qiáng)醫(yī)療病房

ICU學(xué)科建設(shè)危重病醫(yī)學(xué)CriticalCareMedicine

研究危重病發(fā)生、發(fā)展及其預(yù)防與治療的臨床學(xué)科。為危及生命的危急重癥患者提供高技術(shù)、高質(zhì)量的生命器官支持手段的醫(yī)療服務(wù)。ICU學(xué)科建設(shè)何為ICU?Money?------BuyTimeMedicine?HospitalamongHospitalICU學(xué)科建設(shè)加強(qiáng)醫(yī)療科IntensiveCareUnit一種集現(xiàn)代醫(yī)療、護(hù)理技術(shù)為一體的醫(yī)療組織管理形式。把危重病人集中起來(lái)，對(duì)各種危重病人實(shí)施連續(xù)的監(jiān)測(cè)、治療和護(hù)理，為原發(fā)病的治療創(chuàng)造良好的基礎(chǔ)、贏得寶貴的時(shí)間，提高危重病救治的成功率。ICU學(xué)科建設(shè)19世紀(jì)50年代克里米亞戰(zhàn)爭(zhēng)時(shí)期Nightingale提出“分級(jí)護(hù)理”觀念1863年第一個(gè)術(shù)后恢復(fù)室（RecoveryRoom)建立二次大戰(zhàn)中，歐洲各地集中救治創(chuàng)傷及休克病員，形成早期外科ICU（SICU）1948-1953年間，洛杉磯、丹麥、瑞典等地脊灰大規(guī)模流行，促成呼吸治療單位（RespiratoryCareUnit，RCU)建立，是文獻(xiàn)報(bào)道的第一個(gè)ICU。60年代，歐美等國(guó)家相繼成立冠心病治療病房（CoronaryCareUnit)CCU,美國(guó)BaltimoreCityHospital建立了具有現(xiàn)代規(guī)范的綜合ICU1970年，美國(guó)危重病醫(yī)學(xué)會(huì)成立。ICU學(xué)科建設(shè)80年代初僅數(shù)家大型教學(xué)醫(yī)院設(shè)立ICU1989年北京召開第一次“加強(qiáng)醫(yī)療危重醫(yī)學(xué)座談會(huì)”1991年11月召開“全國(guó)首屆ICU專題討論會(huì)”，54所醫(yī)院共設(shè)ICU59個(gè)（綜合21個(gè)，?？?8個(gè)）1996年12月16日北京成立了“中國(guó)病理生理學(xué)會(huì)危重病醫(yī)學(xué)專委會(huì)籌委會(huì)1997年9月在北京正式成立中國(guó)病理生理學(xué)會(huì)危重病專委會(huì)，產(chǎn)生了第一屆全國(guó)專委會(huì)委員2005年5月，中華醫(yī)學(xué)會(huì)重癥醫(yī)學(xué)分會(huì)在北京成立ICU學(xué)科建設(shè)四個(gè)主體部分重癥病員。一支訓(xùn)練有素的醫(yī)護(hù)技術(shù)人員。完備的生理監(jiān)測(cè)設(shè)備及先進(jìn)的搶救治療措施。能動(dòng)態(tài)、定量觀察及捕捉瞬息變化，反饋治療效果；能作較長(zhǎng)時(shí)間生命支持，為治療原發(fā)病爭(zhēng)取時(shí)間。嚴(yán)格、科學(xué)的管理。ICU學(xué)科建設(shè)Physician(Intensivist)PhysicianAssistant*NursePractitioner*RegisterednurseNurseRespiratoryTherapistClinicalPharmacistNutritionistTechnician人員結(jié)構(gòu)ICU學(xué)科建設(shè)Physician,IntensivistNutritionistNursePractitionerClinicalPharmacistResidentRegisteredNurseFellowICU學(xué)科建設(shè)ICU學(xué)科建設(shè)ICU學(xué)科建設(shè)ICU學(xué)科建設(shè)ICU學(xué)科建設(shè)ICU學(xué)科建設(shè)ICU學(xué)科建設(shè)ICU學(xué)科建設(shè)TheICUModelinEuropeandintheUnitedStates----AnInterviewWithJean-LouisVincentandTimothyG.Buchman

Posted06/30/2005

ICU學(xué)科建設(shè)TimothyG.Buchman,PhD,MD,pastpresidentoftheSocietyofCriticalCareMedicineandProfessorofSurgeryatWashingtonUniversitySchoolofMedicineinSt.Louis,Missouri.Jean-LouisVincent,MD,PhD,pastpresidentoftheEuropeanSocietyofIntensiveCareMedicineandtheEuropeanShockSocietyICU學(xué)科建設(shè)OpenversusClosedICUsitisveryimportanttoplacecriticallyillpatientsinthehandsofaproperlytrained,experienceddoctorwhoispartofateamavailable24hoursaday.Thekeyfeatureisanintegratedteamofdedicatedexpertsthatbringsmultiprofessionalperspectivetobearontheneedsofeachpatient.Intensivistsaretrainedandideallysuitedtoprovidethissortofleadership,whichiswhyIpersonallypracticeandsupporttheintensivist-ledmodel.ICU學(xué)科建設(shè)RelativeRisk=0.71(95%CI=0.62–0.82)

29%ReductioninMortalityRelativeRisk=0.61(95%CI=0.50–0.75)

39%ReductioninMortalityHigh-Intensityvs.LowIntensity

ICUPhysicianStaffingPronovostPJetal,JAMA,288:2151(2002)ICU學(xué)科建設(shè)FinancialsolutiontotherisingICUrequirementsThefutureof"minimallyreasonable"healthcarewillbetough,asthecostofmedicinecontinuestoincreasedramaticallyandthepopulationwillcontinuetoage.Inthefuturewemayfaceaneedtolimittheexpensesforthoseattheendoftheirlives.makeourcareaseffectiveandasefficientaspossible.Butthegreaterimperativeistoidentifythosepatientsforwhomcarewithcurativeintentwillnotreturnthemtoasatisfactoryqualityoflife.Thiswillrequireagreatdealofeducationbothintheprofessionalcommunityaswellasinthegeneralpublic,whichincludesallofourpatientsandtheirfamilies.ICU學(xué)科建設(shè)TheseparateICUspecialtycurriculum,trainingand…ThiswouldbetheSpanishmodel:amixtureofinternalmedicine,anesthesiology,surgery,andemergencymedicine.criticalcarebenefitsfromthemultipleperspectivesthatintensivistswithdiversebackgroundsbringtothebedside.Ibelievethatourdisciplinewouldbecomemoreattractivetomedicalstudentsifweofferedapathwaythatdidnotrequirepriortraininginanotherdiscipline.ICU學(xué)科建設(shè)AboutNursingshortage…withanumberofingredients,includingafantasticheadnurse,improvementincommunication,andthe"teamapproach,"wenowhaveenoughICUnurses!WecertainlyneedmorenursesintheUSA,especiallythosewhohaveachievedadvancedcompetenciesandcertificationsinthecareofthecriticallyillpatient.Wealsoespeciallyneedstrategiesthatwillpreserveandusetheyearsofaccumulatedwisdomthatarecontainedintheagingbodiesofourmostexperiencednurses.ICU學(xué)科建設(shè)Thenursingcurriculumandeducation…

MostnursingschoolsinEuropenowhaveaseparatespecialtyinintensivecareandemergencymedicine,suchaspecialtyhasincreasednurses'interestinourdiscipline.Nursesareprofessionalswhovaluethesamethingsasphysicians:WeneedtoensurethattheICUremainsanenvironmentinwhichprofessionalismismaintained,whereideasarevalued,andwherecaregiversfeelassafeandascaredforasthepatientstheytreat.weshouldbuildaprofessionthatpeopleflocktobecauseitisexcitingandrewarding.ICU學(xué)科建設(shè)thephysicianassistantand

nursepractitioner…

ForthelackofICUphysiciansinthefuture,Iverymuchbelieveintheapplicationsoftelemedicine.IthinkitismuchbettertohaveanICUphysiciancontrollingtheICUatadistanceThisisnotamatterofphysicianshortagesomuchasitisastrategytousetheirtrainingandwisdommosteffectively.Advancedpracticenurseswhopartnerwithintensivecarephysicianscanprovideoutstandingcaretocriticallyillpatients.ICU學(xué)科建設(shè)RelationshipbetweentheED

andtheICU

Inourinstitution,wemanageaso-called"shocklab"withtheemergencydoctors.ThismeansthatwearecalledimmediatelywhenacriticallyillpatientisadmittedtotheED.Acutecaremedicinespansmanyareasofthemodernmedicalcenter,Innovativetrainingprogramsthatleadtowell-trained,hospital-basedmedicalspecialistswhopracticesafelyandeffectivelyacrossthiscontinuumhavegreatpotentialtoimproveprofessionalsatisfactionandpatientcare.ICU學(xué)科建設(shè)AnICUcrisisisapproachinginthenearfuture…Criticalc