2 Basic Information Clinical Pathway of Benign Lung Tumors (Version 20 19) The Notice of the General Office of the National Health Commission on Printing and Distributing Clinical Pathway of Related Diseases (Version 20 19) was issued by the General Office of the National Health Commission on February 29th, 20 19 (National Health Office Medical Letter [2065438+).
Notice of the General Office of the National Health and Wellness Committee on Printing and Distributing the Clinical Pathway of Diseases (20 19 Edition)
National Health Office Medical Letter [2019] No.933
Health and Health Committees of all provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps:
In order to further promote clinical pathway management, standardize clinical diagnosis and treatment behavior, and ensure medical quality and safety, our Committee revised the clinical pathway of 19, and formed 224 clinical pathways of diseases (version 20 19). It is hereby printed and distributed to you (which can be consulted in the column of medical administration on the website of the National Health and Wellness Committee) for the reference of health administrative departments at all levels and various medical institutions at all levels.
General Office of National Health and Wellness Committee
20 19 12.29
4 Clinical Paths The full text of the clinical pathway of pulmonary benign tumor (version 20 19)
4. 1 1. Standard hospitalization procedure for clinical pathway of pulmonary benign tumor 4. 1. 1 (1) Applicable object The first diagnosis is pulmonary benign tumor (ICD10: d14.3/)
Tumor resection, local pneumonectomy or lobectomy were performed (ICD9CM3:32.232.4).
4. 1.2 (2) The diagnosis basis is based on Clinical Diagnosis and Treatment Guide, Volume of Thoracic Surgery (edited by Chinese Medical Association, People's Health Publishing House, 2009) and Surgery (edited by Zhao, etc. , eight-year teaching materials for national colleges and universities, People's Health Publishing House, 20 15) and Huang Jiasi Surgery (Wu)
1. Clinical symptoms: the onset age is wide, mostly young and middle-aged, with mild or asymptomatic symptoms. Some patients have cough, hemoptysis and mild chest pain, and hemoptysis is mostly blood in a small amount of sputum. The condition can remain unchanged for a long time, and a few patients have secondary infection symptoms due to tumor blocking bronchus.
2. Signs: not significant in the early stage.
3. Auxiliary examination: chest imaging examination, bronchoscopy, etc.
4. 1.3 (3) The selection of treatment plan is based on Clinical Diagnosis and Treatment Guide, Volume of Thoracic Surgery (edited by Chinese Medical Association, People's Health Publishing House, 2009 edition), Surgery (edited by Zhao et al., National College Eight-year Textbook, People's Health Publishing House, 20 15) and Huang Jiasi.
1. Open or thoracoscopic tumor resection.
2. Open or thoracoscopic local lung resection (including wedge resection and segmental resection).
3. Open or thoracoscopic lobectomy (including compound lobectomy and bronchial sleeve plasty).
4. 1.4 (4) Standard stay time ≤ 15 days, 4. 1.5 (5) Entry route standard is 1. The first diagnosis conforms to the first diagnosis ICD10: d14.3/d17.4/.
2. When the patient has other disease diagnosis at the same time, but the outpatient treatment does not need special treatment and does not affect the implementation of the first-visit clinical pathway, he can enter the pathway.
4. 1.6 (6) Preoperative preparation ≤5 days 1. Necessary inspection items:
(1) Blood routine and urine routine;
(2) Coagulation function, blood type, liver function test, renal function test, electrolyte and infectious disease screening (hepatitis B, hepatitis C, AIDS, syphilis, etc. ), as well as tumor markers;
(3) Pulmonary function, arterial blood gas analysis and electrocardiogram;
(4) sputum cytology, bronchoscopy and biopsy;
(5) Imaging examination: X-ray chest film, chest CT (plain scan+enhanced scan), abdominal ultrasound or CT.
2. According to the patient's condition, the following items can be selected: blood gas analysis, echocardiography, 24-hour dynamic electrocardiogram, etc.
4. 1.7 (7) Selection and application opportunity of preventive antibacterial drugs. 1. According to the Guiding Principles for Clinical Application of Antibacterials (Version 20 15) (No.43 of the National Health Office [2015]), the selection and use time of antibacterial drugs are determined according to the patient's condition. It is recommended to use the first and second generation cephalosporins. If infected patients are identified, antibiotics can be adjusted according to the results of drug sensitivity test.
(1) It is recommended to inject cefazolin sodium intramuscularly or intravenously:
① Adults: 0.5 ~ 1g/ time, 2 ~ 3 times a day;
② For those who are allergic to this product or other cephalosporins, penicillin anaphylactic shock is prohibited; Use with caution in patients with hepatic and renal insufficiency and those with a history of gastrointestinal diseases;
③ A skin test must be conducted before using this medicine.
(2) It is suggested that intramuscular injection or intravenous drip of cefuroxime sodium:
① Adults: 1.5 ~ 3.0g/ time, 2 ~ 3 times a day;
② The patients with renal insufficiency made the administration plan according to creatinine clearance rate: creatinine clearance rate >; 20ml/min, 3 times a day, 0.75 ~1.5g each time; Creatinine clearance rate 10 ~ 20 ml/min, twice daily, 0.75 g each time; Creatinine clearance rate
③ If allergic to this product or other cephalosporins, allergic shock of penicillin drugs is prohibited; Use with caution in patients with hepatic and renal insufficiency and those with a history of gastrointestinal diseases;
④ A skin test must be conducted before using this medicine.
(3) intramuscular injection, intravenous injection or intravenous drip of ceftriaxone sodium are recommended:
① Adult: 1g/ time, intramuscular injection or intravenous drip once;
② For those who are allergic to this product or other cephalosporins, penicillin anaphylactic shock is prohibited; Use with caution in patients with hepatic and renal insufficiency and those with a history of gastrointestinal diseases.
2. Prophylactic use of antibacterial drugs 0.5 hours before operation, and antibacterial drugs 1 time for more than 3 hours after operation; The total preventive medication time is generally less than 24 hours, and in some cases it can be extended to 48 hours.
3. If there are signs of secondary infection, start empirical treatment with antibacterial drugs as soon as possible.
4. 1.8 (8) Operation day ≤ 5 days after admission. Anesthesia: general anesthesia with tracheal intubation.
2. Surgical consumables: use according to the patient's condition (sealer, cutting suture device, etc. ).
3. Intraoperative medication: antibacterial drugs, etc.
4. Surgical implants: hemostatic materials.
5. Blood transfusion: It depends on intraoperative bleeding. Blood group identification, antibody screening and cross matching are needed before blood transfusion.
6. Pathology: intraoperative frozen section, postoperative paraffin section+immunohistochemistry.
4. 1.9 (9) Postoperative hospitalization recovery ≤ 10 days 1. Items that must be rechecked: blood routine, liver function test, renal function test, electrolyte, chest X-ray, etc.
2. According to the patient's condition, the following items can be selected: blood gas analysis, bronchoscopy, bedside ultrasound, sputum culture+drug sensitivity test, etc.
3. Postoperative medication:
(1) Antibacterials: The drugs were selected according to the Guiding Principles for Clinical Application of Antibacterials (Wei [2015] No.43). If infected patients are identified, antibiotics can be adjusted according to the results of drug sensitivity test.
(2) If there are signs of secondary infection, start empirical treatment with antibacterial drugs as soon as possible.
(3) Optional drugs: such as antacids, hemostatic agents, expectorants, etc.
4. 1. 10 (X) emission standard 1. The patient's condition was stable, his body temperature was normal, the surgical incision healed well, and his vital signs were stable.
2. No complications and/or complications requiring hospitalization.
4. 1. 1 1 (XI) Variation and Cause Analysis 1. Complications affecting surgery need to be diagnosed and treated.
2. Postoperative complications such as lung infection, respiratory failure, heart failure and bronchopleural fistula need to be prolonged.
2. Applicable objects of the clinical pathway table of pulmonary benign tumor: the first diagnosis is pulmonary benign tumor (ICD10: D14.3/D17.4/D18.0165438) and inflammatory pseudotumor (ICD).
Tumor resection, local pneumonectomy or lobectomy were performed (ICD9CM3:32.232.4).
Patient's name: gender: age: outpatient number: hospitalization number:
Date of hospitalization:? Year, month and day? Date of discharge:? Year, month and day? Standard residence time: ≤ 12 days
time
1 day hospitalization
Stay in hospital for 2 ~ 5 days
(One day before operation)
Stay in hospital for 3 ~ 4 days
(Operation Day)
owner
ask
examination
treat cordially
worker
work
□ Ask about medical history and physical examination.
□? Complete medical record writing
□ Hua Kai Inspection Form and Inspection Application Form
-Chief physician rounds
□ Initially determine the treatment plan.
□? Senior physician rounds
□? Preoperative preparation and evaluation
□? Discuss and determine the surgical plan before operation.
□? According to the needs of the disease, complete the consultation of relevant departments.
□? Residents complete the course log, preoperative summary, superior doctor rounds and other medical records.
□? Sign the informed consent form of operation, the agreement on self-funded articles, the consent form of blood transfusion and the authorization form.
□? Explain perioperative precautions to patients and their families.
□ Preoperative indwelling catheter
□ Operation
□ Record of the performer's completion of the operation
□ The resident completes the postoperative course of disease.
□ Senior physician rounds
□ Observe vital signs
-explain the condition and postoperative precautions to patients and their families.
heavy
main points
doctor
order
Long-term doctor's advice:
□? Secondary nursing care of thoracic surgery
□? Ordinary diet
□? The patient's previous basic drug treatment
Temporary medical advice:
-blood routine, urine routine, stool routine+occult blood test
-Coagulation function, blood type, liver and kidney function, electrolyte, infectious disease screening and tumor marker examination.
□ Pulmonary function, arterial blood gas analysis, electrocardiogram
Sputum cytology, bronchoscopy and biopsy were performed when necessary.
□ Imaging examination: X-ray chest film, chest CT, abdominal ultrasound or CT.
□ If necessary: mediastinoscopy, 24-hour dynamic electrocardiogram, whole body bone scan, MRI or CT of head, echocardiography, percutaneous lung biopsy, etc.
Long-term doctor's advice:
□ Secondary nursing routine of thoracic surgery
□? prescribe a diet
□ Patients' previous basic drug treatment
Temporary medical advice:
-tomorrow under general anesthesia.
Tumor resection local resection of lung
◎ Lobectomy ◎ Pneumonectomy
thoracotomy
-Fasting and drinking water before operation.
□ preoperative skin preparation
□ Prepare blood
□ Preoperative sedative drugs (if applicable)
□ Prepare antibacterial drugs during operation.
□ Other special orders
Long-term doctor's advice:
□ Postoperative nursing routine of thoracic surgery
□ Super or first-class care
□ Eat liquid food 6 hours after waking up.
□ Oxygen inhalation
□ Monitor body temperature, electrocardiogram, blood pressure, respiration, pulse and blood oxygen saturation.
□ Record the drainage of chest tube.
-Continuous catheterization, recording 24-hour entry and exit.
□ Atomization inhalation
□ Preventive application of antibacterial drugs
□ Analgesic drugs
Temporary medical advice:
□ Use hemostatic drugs (if necessary)
□ Other special orders
primary
nurse
work
□? Introduce the ward environment, facilities and equipment.
□? Admission nursing evaluation
□? Auxiliary smoking cessation
□? Preoperative preparation such as publicity and skin preparation.
□? Remind patients to fast and drink water before operation.
□? Respiratory function exercise
□? Observe the change of illness
□? Postoperative psychological and life care
□? Keep the respiratory tract unobstructed
state of illness
change
record
□ None? □ Yes, the reason is:
1.
2.
□ None? □ Yes, the reason is:
1.
2.
□ None? □ Yes, the reason is:
1.
2.
nurse
symbol
Certified doctor
symbol
time
Stay in hospital for 4 ~ 5 days
After operation 1 day
Hospitalization for 5 ~ 13 days
2 10 day after operation
10 ~ 15 days of hospitalization
(discharge date)
owner
ask
examination
treat cordially
worker
work
□ Senior physician rounds
□ Resident completes course writing.
□ Observe thoracic drainage.
□ Pay attention to vital signs, oxygen saturation and lung breathing sounds.
□ Encourage and assist patients to expectorate.
□ Aspiration of sputum through fiberoptic bronchoscope when necessary.
□ Senior physician rounds
□ Resident completes course writing.
According to the condition, check blood routine, blood biochemistry and X-ray chest film.
-according to the chest drainage and lung recruitment, pull out the chest drainage tube, incision dressing change.
□ Aspiration of sputum through fiberoptic bronchoscope when necessary.
□ Stop or adjust antibacterial drugs as appropriate.
□ Incision suture removal
-The superior doctor makes rounds to make sure whether to leave the hospital.
-Resident's complete discharge summary, first page of medical records, etc.
□ Explain the matters needing attention after discharge to patients and their families.
□ Determine the postoperative treatment plan according to postoperative pathology.
heavy
main points
doctor
order
Long-term doctor's advice:
□ Primary care in thoracic surgery
□ Ordinary diet
□ Oxygen inhalation
□ ECG monitoring
□ Atomization inhalation
□ Record the drainage of chest tube.
-Continuous catheterization, recording 24-hour entry and exit.
□ Analgesic drugs
Temporary medical advice:
□ Replenish water appropriately according to the situation.
□ Blood gas analysis (if necessary)
□ Other special orders
Long-term doctor's advice:
□ Secondary care in thoracic surgery
-Stop closed thoracic drainage measurement.
-Stop recording urine volume, oxygen inhalation and ECG monitoring.
□ Stop atomization
□ Stop using antibacterial drugs.
Temporary medical advice:
□ Pull out the closed thoracic drainage tube.
Remove the catheter.
□ dressing change and stitches removal of incision.
□ Review chest X-ray, blood routine, liver and kidney function and electrolyte.
□ Other special orders
Temporary medical advice:
□ dressing change through incision
□ Notice of discharge
□ Take medicine after discharge
□ Regular follow-up
primary
nurse
work
□ Observe the patient's condition.
Psychological and life nursing
□ Assist patients in expectoration.
□ Observe the patient's condition.
Psychological and life nursing
□ Assist patients in expectoration.
□ Observe the change of illness.
Psychological and life nursing
□ postoperative rehabilitation guidance
state of illness
change
record
□ None □ Yes, reason:
1.
2.
□ None □ Yes, reason:
1.
2.
□ None? □ Yes, the reason is:
1.
2.
nurse
symbol
Certified doctor
symbol
5 Clinical Paths Clinical Paths of Benign Lung Tumors (20 19 Edition). document