78腕管综合征.pdf
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1、腕管综合征临床路径(县级医疗机构版)一、腕管综合征临床路径标准住院流程(一)适用对象第一诊断为腕管综合征(ICD-10:)(二)诊断依据根据外科学(下册)(8 年制和 7 年制临床医学专用教材,人民卫生出版社)。1.病史:常有职业病史。2.临床表现:(1)主诉:桡侧三个手指端麻木或疼痛,持物无力,中指为甚,夜间或清晨症状最重;(2)体征:拇、示、中指有感觉过敏或迟钝;鱼际肌萎缩,拇指对掌无力;腕部正中神经Tinel 征(+);曲腕试验(Phalen征)阳性率70%左右;腕部有炎症或肿块者,局部隆起、有压痛或可扪及肿块边缘。3.电生理检查:鱼际肌肌电图及腕-指的正中神经传导速度测定有神经损害征。
2、(三)选择治疗方案的依据。根据外科学(下册)(8 年制和 7 年制临床医学专用教材,人民卫生出版社)。1.非手术治疗:早期,腕关节中立位制动,腕管内注射醋酸泼尼松龙。辅以药物或物理治疗。2.手术治疗:行腕管内占位病变切除术或腕横韧带切开复位术。(四)标准住院日为14 天。(五)进入路径标准。1.第一诊断必须符合ICD-10:腕管综合征疾病编码。2.当患者合并其他疾病,但住院期间不需要特殊处理也不影响第一诊断的临床路径流程实施时,可以进入路径。(六)明确诊断及入院常规检查应12 小时。1.必需的检查项目:(1)血常规、肝功能、肾功能、电解质、血糖;(2)凝血功能、输血前检查、血型、感染性疾病筛查
3、(乙肝、丙肝、梅毒、艾滋病);文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2
4、L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B
5、2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编
6、码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z
7、6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4
8、Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3
9、R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4(3)X 线胸片、心电图;(4)腕部 X 片(5)电生理检查。2.根据患者病情,可选择的检查项目:腕部 CT 或 MRI、骨质疏松相关的骨
10、代谢检查、腹部B 超、心肺功能评估。(七)预防性抗菌药物选择与使用时机。1.抗菌药物:按照抗菌药物临床应用指导原则(卫医发 2004 285 号)选择用药。建议使用第一、二代头孢菌素,头孢曲松等;明确感染患者,可根据药敏试验结果调整抗菌药物。(1)推荐使用头孢唑林钠静脉注射:成人:0.5-1.0g/次,一日 2-3 次;儿童:一日量为20-30mg/kg体重,分三次给药;对本药或其他头孢菌素类药过敏者,对青霉素类过敏性休克史者禁用;肝肾功能不全者、有胃肠道疾病史者慎用;使用本药前须进行皮试。(2)推荐头孢呋辛钠静脉滴注。文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K1
11、0B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文
12、档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA
13、5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10
14、V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 H
15、K3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7
16、R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 Z
17、O2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4成人:0.75g-1.5g/次,一日三次;儿童:平均一日剂量为60mg/kg,分 3-4 次给予;肾功能不全患者按照肌酐清除率制订给药方案:肌酐清除率 20ml/min者,每日2 次,每次3g;肌酐清除率10-20ml/min患者,每次0.7
18、5g,一日 2 次;肌酐清除率10ml/min 患者,每次0.75g,一日 1 次;对本药或其他头孢菌素类药过敏者,对青霉素类药有过敏性休克史者禁用;肾功能不全者、有胃肠道疾病史者慎用;使用本药前须进行皮试。(3)推荐头孢曲松钠静脉滴注:成人:1g/次,一次静脉滴注;儿童:儿童用量一般按成人量的1/2 给予;对本药或其他头孢菌素类药过敏者,对青霉素类过敏性休克史者禁用;肝肾功能不全者、有胃肠道疾病史者慎用。2.预防性用抗菌药物,时间为术前0.5 小时,手术超过3 小时加用 1 次抗菌药物;总预防性用药时间一般不超过24文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10
19、B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档
20、编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5
21、Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V
22、4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK
23、3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R
24、8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO
25、2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4小时,个别情况可延长至48 小时。(八)手术日为入院当天。1.麻醉方式:臂丛神经阻滞。2.手术方式:腕管综合征的手术治疗。3.术中用药:麻醉用药、抗菌药、止血药物。5.输血:根据手术失血情况决定。(九)术后住院恢复7 天。1.必须复查的检查项目
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