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（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。

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（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。

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。

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。

医疗集团常见病种双向转诊指南一、内科系统（一）呼吸内科上转县级医疗机构病种：1、呼吸系统常见病、多发病（如：支气管扩张症、肺源性心脏病等）急性加重期2、支气管哮喘和慢性阻塞性肺病（COPD）3、肺炎和COPD急性加重期4、肺癌5、大咯血6、自发性气胸、张力性气胸7、急、慢性呼吸衰竭8、呼吸道传染病（如：肺结核、SARS）9、急性肺栓塞10、需做肺功能检查、纤维支气管镜检查、血气及酸碱平衡检测下转基层医疗卫生机构标准：以上病种经诊治后，病情相对平稳，需后期巩固、康复、支持对症治疗者下转。

（二）消化内科上转县级医疗机构病种：1、消化系统常见病、多发病（如：消化道溃疡、肝纤维化和硬变、肝硬化、胃-食管反流、溃疡性结肠炎、其他非感染性胃肠炎和结肠炎等）急性加重期2、急性胰腺炎3、消化道大出血4、功能性胃肠道疾病5、肝硬化并发症6、胃癌、结直肠癌、原发性肝癌7、胃镜、结肠镜检查8、开展内镜下取异物、内镜下息肉圈套摘除术及电灼术下转基层医疗卫生机构标准：以上病种经诊治后，病情相对平稳，需后期巩固、康复、支持对症治疗者下转。

（三）心血管内科上转县级医疗机构病种：1、心血管系统常见病、多发病（如：风湿性心脏病、扩张型心肌病、心肌炎等）急性加重期2、心脏骤停、心源性休克、急性心功能不全、高血压危象等危急重症3、急性心肌梗塞药物溶栓治疗4、常见心律失常（如：心房纤颤和扑动、阵发性心动过速）经初步治疗不能纠正5、高血压（二级以上高血压，或出现心脑肾并发症者）6、慢性心功能不全经初步处理不能症状不缓解者7、冠状粥样动脉硬化性心脏病伴不稳定型心绞痛、心肌梗死者8、静脉临时起搏技术下转基层医疗卫生机构标准：以上病种经诊治后，病情相对平稳，需后期巩固、康复、支持对症治疗者下转。

（四）内分泌科上转县级医疗机构病种：1、内分泌系统常见病、多发病（如：亚急性甲状腺炎、单纯性甲状腺肿、痛风、原发性骨质疏松等）的急性加重期2、甲状腺危象、黏液性水肿昏迷、垂体危象、低血糖症、糖尿病酮症酸中毒、糖尿病非酮症高渗性综合征、乳酸酸中毒等急危重症的急诊处置3、单纯性甲状腺肿、甲状腺功能亢进、甲状腺功能低下、甲状腺炎、甲状腺结节和甲状腺肿瘤4、糖尿病的诊断、分型、规范化治疗，医源性低血糖的诊治5、代谢综合征的诊治6、可开展内分泌相关检查：甲状腺素（TSH）、甲状腺激素（T3、T4、FT3、FT4）、胰岛素、C肽等激素测定，甲状腺自身抗体（TRab、TGab、TPOab）等自身抗体测定，甲状腺摄碘功能、葡萄糖耐量试验等功能试验以及骨密度测定下转基层医疗卫生机构标准：以上病种经诊治后，病情相对平稳，需后期巩固、康复、支持对症治疗者下转。

基层卫生院收治外科住院病人范围
各类体表良性包块（周围无重要血管，神经）；
浅表软组织感染（不包括脓肿）；
简单骨折，不需手术治疗的，经过手法复位后，对位良好且无再次移位倾向的病人；
骨折病人术后康复训练；
单发肋骨骨折不伴有血气胸的患者；
单纯性阑尾炎不需手术的患者；
肾绞痛，结石直径小于6mm；
单纯性下尿路感染；
头皮裂伤；
浅表皮肤裂伤；
头外伤反应
县级医院向上级医院转诊范围（外科）
骨科：
颈椎骨折需要手术的；
四肢大血管损伤断裂；
各类重度骨性关节炎需要行关节置换；
老年骨折患者伴有心脑血管疾病且需要手术的；
四肢离断伤；
各指（趾）锐性离断伤可以行断指再植术的；
各类难愈性溃疡伴骨外露（包括皮肤坏死伴骨外露）；
膝关节交叉韧带腱性部分断裂需要重建的；（在县医院关节镜未购入之前）
外二科
肝脏、胰腺、胆道、肾脏、输尿管、膀胱、前列腺、甲状腺、十二指肠、胆囊、心、肺、食道等器官的恶性肿瘤。

肝内胆管结石
胃体、胃底或全胃癌
直肠下段癌
急性重症胰腺炎治疗效果不好或生命体征不稳定
泌尿系统结石需要内镜下治疗
良性前列腺增生年龄较大或合并心、肺、脑、肾功能不良
各种严重的内脏损伤
神经科
原发性蛛网膜下腔出血（动脉瘤，血管畸形）
颅底肿瘤
椎管肿瘤
重度脑炎
精神分裂症
部分功能外科疾病（癫痫，三叉神经痛等需手术治疗）
手术分级中需三级医院治疗的疾病
除上述疾病外，如在住院期间，病情逐渐加重，或患者及家属强烈要求转院，也属于转诊范围。

双向转诊制度一、凡遇到危重、不能确诊的疑难病例、传染病人、恶性肿瘤病人、精神疾病急性发作期病人以及其它因技术、设备条件限制不能处置的病人，应及时向上级医院转诊。

同时向病人或家属解释转诊原因，征得病人同意。

二、征得病人同意后，全科医师应填写双向转诊登记薄和双向转诊通知单，随患者转交医院。

如为危重病人转诊必须谨慎，应就地抢救处理，待病情稳定后方可转院。

转院时应安排医务人员护送，确保转院途中的安全和顺利。

三、上级医院负责双向转诊的职能部门接到双向转诊通知单，应及时、妥善、安排患者进行相应的诊断治疗。

病人转诊期间全科医师要跟踪随诊，与病人保持固定联系，定期向接诊的专科医师了解病人治疗情况。

病人转诊期间专科医师有义务接受全科医师的咨询，将病人的治疗情况反馈给全科医师。

四、上级医院的住院病人病情稳定进入康复期时，专科医师应填写双向转诊通知单，写明处理过程、继续治疗的建议及注意事项，随病人返回社区卫生服务机构。

全科医师应就继续治疗和预后情况与专科医师保持密切联系，以取得帮助和指导，更有效地指导康复。

五、中心应与转诊医院签订双向转诊协议，规定双方的权利和义务，并制定转诊流程，以确保转诊的通顺。

呼市妇幼保健院医务科2016.9.8保障措施（1）双向转诊管理办公室设在医务科，医务科指定双向转诊服务流程及有关双向转诊工作细则等管理措施，并定期评价和持续改进。

（2）医务科确定专人负责接待双向转诊病人，并完成有关事务及有关资料登记、整理工作。

（3）本院各临床科室指定1-2名医务人员为双向转诊接待联络员，负责本科病人的具体接待事务。

（4）对双向转诊病人认真做好接待工作，明确流程，渠道畅通，减少环节。

（5）对协助转诊工作的外院医务人员要主动热情，积极配合，提供方便。

（6）各联合医疗机构确定1-2名联络员，负责双向转诊的联络工作。

5、明确转诊指征（1）上转指征：临床各科极危重疑难杂症或限制于技术、设备条件或者超出当地医疗机构诊疗科目范围等范围等原因需要转诊进一步诊治的病人。

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。

潜山县医院分级诊疗、双向转诊工作实施方案一、指导思想以党的十八大和十八届二中、三中、四中全会精神为指导，深入贯彻落实科学发展观，坚持以人为本，因病施治；统筹共享，合理配置利用医疗资源，构建科学有序的就医秩序，有效缓解人民群众“看病难、看病贵”的问题。

坚持“合理就诊、基层首诊、自主选择、畅通转诊、稳步推进”的原则，保证医疗质量、确保医疗安全，提升医疗服务，统筹医疗卫生体系发展，合理利用卫生资源，为公众提供安全、有效、方便、价廉的基本医疗卫生服务，促进人民健康水平不断提高。

二、工作目标建立我院与县我院医共体成员单位分工合理、服务规范、分级诊疗、双向转诊、运转有效的医疗服务管理机制，引导一般常见病、慢性病、康复等患者下沉到基层医疗卫生机构；及时将危重患者转送上级医院救治，确保人民群众健康与生命安危。

形成“小病在基层、大病进医院、康复回基层”的就医格局。

力争实行基层首诊率55%以上，县域内就诊率90%以上；到2016 年底，形成较为完善的分级诊疗制度体系。

三、工作措施（一）健全组织，加强领导。

为加强对此项工作的领导，成立医院分级诊疗工作领导小组，负责分级诊疗工作的组织、领导、协调、监管与考核。

组长：华德法副组长：程捍东秦业权成员：汪军、程芳、陈尚春、占竹青、吴珂、各临床科室主任、护士长领导小组下设办公室，由汪军兼任办公室主任。

（二）完善制度，加强控管。

1、建立健全首诊制度、首接制度、双向转诊制度、分级诊疗制度和分级诊疗工作实施方案，将分级医疗工作实施情况与具体任务科室绩效考核挂钩。

2、完善双向转诊流程：规范本院转诊程序，明确转出、转入标准。

建立有效、严密、实用、畅通的上下转诊渠道，为病人提供整体性、连续性的医疗服务，对下级医疗机构转入我院的病人开通绿色通道，方便转入患者及时获得诊疗服务；同时协助和指导转出的病人选择合适的三级医院，并提供相关诊疗资料，方便转入医院获得可靠信息，减少重复检查。

3、把分级诊疗工作列入医疗质量、安全与服务考核的指标体系，同步进行监管、考核与持续改进的分析评价，与科室和个人的绩效考核挂钩。

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。