神经科总住院医师607例会诊病例分析

目的分析神经科总住院医师会诊病例的构成特点,从一个方面反映总住院医师的工作情况。方法统计北京协和医院神经科1名总住院医师在2003年8月1日至2004年1月31日会诊的病例。结果共新会诊患者607例,女性305例,男性302例,年龄5个月至92岁,平均年龄55·2岁,平均每周新会诊24例。急症会诊208例(34·3%),常规会诊399例(65·7%)。362例(59·6%)继发于系统性疾病;66例(10·9%)与医源性因素有关。急症会诊以代谢性脑病最多(92例),占急症会诊的44·2%,病因包括呼吸衰竭、肾功能衰竭、多器官功能衰竭等;其次为急性脑血管病51例;第三为癫发作23例。内科常规会诊病例以周围神经病最多(69例),占内科常规会诊的17·3%(69/398),病因包括糖尿病、血管炎/结缔组织病、肿瘤相关的周围神经病等。外科和妇科约请神经科常规会诊主要目的是围手术期的神经科疾病评估和预防。结论会诊工作具有特殊性和挑战性,神经科总住院医师应该了解会诊病例特点,在会诊中学习和积累经验。

Retrospective analysis of 607 cases consulted by a neurology chief resident

Objective To describe consultation practice patterns of a neurology chief resident in China. Methods The pattern and frequency of patient encounters during the Peking Union Medical College Hospital neurology residency program for one chief resident were retrospectively analyzed. Results A total of 607 new inpatients (302 males, 307 females, mean age 55.2 years) were consulted during a 6-month period of neurology residency, including emergency consultation for 208 cases (34.3%) and routine consultation for 399 cases (65.7%). The chief resident consulted an average of 24 new patients per week. Most cases were diagnosed as neurologic complications secondary to systemic disorder ( 362 cases, 59.6%) or induced by some iatrogenic factors (66 cases,10.5%). The most common diagnosis for an emergency consultation was metabolic encephalopathy (92 cases, 44.2% of emergency consultation), characterized by acute onset of cognitive and /or behavioral disorders secondary to respiration failure , renal failure or multiple organ failure. For routine consultation on general internal medicine, peripheral neuropathy (n=69) was the most common disorder, secondary to diabetes, vasculitis, connective tissue disease and paraneoplastic conditions et al. For consultation on surgery, most cases were concerned about preoperative evaluations (n=89) of the chronic neurologic disorders,eg, residue of stroke (n=41) and epilepsia (n=10) and postoperative complications (n=46). Conclusion This should be the first reported summary of all patients one chief resident actually consulted during neurology training in China. Consultation is an unique clinic practice and challenge to neurology residents. The patient encounter profile suggests that chief residents should be prepared for the consultation practice. Accumulation of associated data from other residencies and hospitals is necessary and can help residency directors assess and guide the residency program in practice patterns .