CAJ | 학술논문

目的了解综合医院精神科紧急会诊服务需求的特点,与普通会诊服务需求的区别,探索综合医院急诊精神医学的发展方向.方法汇总北京协和医院2009年7月至2012年6月期间精神科紧急会诊和普通会诊共2789例次,其中紧急会诊249例,普通会诊2540例.分析比较紧急会诊与普通会诊服务在人口学资料、会诊科室、会诊原因、精神科诊断及处理的区别.结果 3年来249例次紧急会诊中,会诊患者225人,男性患者比例(51.1％)高于普通会诊患者(43.2％),二者在年龄构成差异无统计学意义.急诊科、加强医疗科、手术科室选择提请紧急会诊的比例明显高于非手术科室,分别为35.2％、34.8％、15.6％和4.2％.紧急会诊中最常见的会诊原因是精神病性症状,占41.4％,其次为情绪症状,占30.1％.精神病性症状、自杀相关问题、不配合治疗作为会诊原因,在紧急会诊中的比例高于其在普通会诊中的比例.器质性精神障碍是紧急会诊中最常见的精神科诊断(37.8％),远高于其在普通会诊中所占的比例(15.5％).会诊后发现紧急会诊中存在自杀问题的比例为20.5％,远高于紧急会诊中将自杀相关问题作为会诊原因的比例(8.0％),也高于普通会诊中存在自杀问题的比例(8.2％).在紧急会诊中接受药物治疗的比例为79.9％,其中60.8％的患者使用了抗精神病药物,二者均高于普通会诊中的相应比例(63.7％、24.1％)；接受心理治疗的比例为26.9％,低于普通会诊中的比例(53.0％).结论目前综合医院精神科紧急会诊服务以精神病性症状的鉴别与处理为主.自杀的识别、评估和干预是综合医院急诊精神医学的重要内容.因此,建立综合医院精神科会诊的紧急程度分层体系,有助于合理运用会诊资源.
목적 료해종합의원정신과긴급회진복무수구적특점,여보통회진복무수구적구별,탐색종합의원급진정신의학적발전방향.방법 회총북경협화의원2009년7월지2012년6월기간정신과긴급회진화보통회진공2789례차,기중긴급회진249례,보통회진2540례.분석비교긴급회진여보통회진복무재인구학자료、회진과실、회진원인、정신과진단급처리적구별.결과 3년래249례차긴급회진중,회진환자225인,남성환자비례(51.1％)고우보통회진환자(43.2％),이자재년령구성차이무통계학의의.급진과、가강의료과、수술과실선택제청긴급회진적비례명현고우비수술과실,분별위35.2％、34.8％、15.6％화4.2％.긴급회진중최상견적회진원인시정신병성증상,점41.4％,기차위정서증상,점30.1％.정신병성증상、자살상관문제、불배합치료작위회진원인,재긴급회진중적비례고우기재보통회진중적비례.기질성정신장애시긴급회진중최상견적정신과진단(37.8％),원고우기재보통회진중소점적비례(15.5％).회진후발현긴급회진중존재자살문제적비례위20.5％,원고우긴급회진중장자살상관문제작위회진원인적비례(8.0％),야고우보통회진중존재자살문제적비례(8.2％).재긴급회진중접수약물치료적비례위79.9％,기중60.8％적환자사용료항정신병약물,이자균고우보통회진중적상응비례(63.7％、24.1％)；접수심리치료적비례위26.9％,저우보통회진중적비례(53.0％).결론 목전종합의원정신과긴급회진복무이정신병성증상적감별여처리위주.자살적식별、평고화간예시종합의원급진정신의학적중요내용.인차,건립종합의원정신과회진적긴급정도분층체계,유조우합리운용회진자원.
Objective To explore the characteristics of psychiatric acute consultation in general hospital.Methods During 3 years (2009.07..01-2012.06.30),2789 referrals of psychiatric consultations were enrolled,among which 249 referrals were acute consultations,while others were common consultations as control group.The demographic characteristics,reasons for referral,referral department,psychiatric diagnosis according to the International Statistical Classification of Diseases 10th Revision,management were analyzed.Results In acute consultations,the rate of male patients (51.1％) was higher than that in common consultations.The age range of patient in the two groups was similar.The rates of acute consultation in the referrals from emergency department (35.2％),intensive care unit (34.8％) and surgical department (15.6％) were higher than that from nonsurgical department (4.2％).The major reason of acute consultation was " psychotic symptoms" (41.4％) followed by " emotional symptoms" (30.1％) which was the major reason of common consultation.The rates of " psychotic symptoms"," suicide-related issues" (8.0％)," uncooperative behavior" (14.8％) as referral reasons were higher in acute consultation group than in common consultation group.The most common psychiatric diagnosis among acute consultations was organic mental disorder (37.8％).Medication was given in 199 out of 249 acute consultations.The rate of medication was higher in acute consultation group,while the rate of psychotherapy was higher in common consultation group.Antipsychotics were the most common medications given in acute consultations.Conclusions Psychotic symptom is the most common referral reason for psychiatric acute consultation.The doctors have to pay attention to identification,evaluation and management of suicide risk.Setting up triage model can optimize the psychiatric consultation management.