案例教学法结合PDCA循环在1例长期不明原因发热病例诊断和治疗中的应用

目的 应用案例分析法结合PDCA(plan-do-check-action)循环模式分析1例不明原因发热(fever of unknown origin,FUO)患者诊断和治疗经过,演示PDCA循环在诊治长期不明原因发热的线路图。 方法 案例分析法结合PDCA循环分析1例FUO患者病史特点、体征变化、辅助检查变化、并发症的防治;第一个案例分析法结合PDCA循环,通过病史、体检、辅助检查将FUO原因确定为感染性发热;第二个案例分析法结合PDCA循环,通过体征、辅助检查的变化,在感染性发热中剔除病毒和细菌感染,怀疑组织胞浆菌病、寄生虫病等;第三个案例分析法结合PDCA循环,通过骨髓病理检验和血液rK39检测结果,确定患者病因为罕见、输入性黑热病;第四个案例分析法结合PDCA循环,应用案例分析法和既往文献,分析诊断标准,分析治疗方法,预测治疗效果,科学防治并发症。 结果 通过分析1例FUO患者应用案例分析法结合PDCA循环诊断和治疗过程,发现其可以提高FUO的病因诊断的质量和治疗效果,规范临床诊治FUO的水平。 结论 案例分析法结合PDCA循环对提高不明原因发热诊断和治疗水平有益。 

Application of case study and plan-do-check-action cycle in etiological diagnosis and treatment of Fever of unknown origin:One case report

Objective To analyze the diagnosis course and treatment procedure of a patient with fever of unknown origin (FUO) by adopting case analysis combined with the plan-do-check-action (PDCA) cycle,which demonstrates the circuit diagram of diagnosis and treatment for FUO.The procedure and effectiveness of PDCA for FUO was evaluated by one case study. Methods The case study combined PDCA cycle was performed in one case of FUO to analyze the medical history materials,physical examination results,auxiliary examination reports and prevention of complications,and this FUO case was diagnosed as infective fever;then eliminating viruses and bacterial infections and it was suspected to be histoplasmosis or parasitic diseases;the marrow biopsy and blood rK39-Test confirmed it input Kala-azar;the therapeutic efficacy was predicted and complication was prevented based on analysis of previously literature,diagnostic criteria and therapeutic method. Results The case analysis combined with PDCA cycle improved the diagnosis of pathogenic causes and therapeutic effect of FUO. Conclusion The case analysis combined with PDCA cycle is helpful to improve the diagnosis and therapy level of FUO.