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牛津急症医学手册,第4版
$62.61
急症医学在英国应运而生,面对来医院求诊的急诊患者,不仅需要急救处理,还需要进行各个专科急症疾病的早期诊断、鉴别诊断、即时处理和长期治疗,因此成为医院高质量医疗的组成部分。目前我国还是遵循急诊科的模式,急诊室是每个医院不可缺少的组成部分,每个毕业后的内科医生均需要在急诊科的内科进行轮转和培训,而一本好的教科书则能起到事半功倍的效果。《牛津急症医学手册》的编写是为了给低年资的医师以信心来有效和安全地处理急诊问题。我从事内科临床工作和教学50多年,这本手册给我带来了耳目一新的感觉,这样一本简洁、实用、内容先进的手册能够对内科医生、急诊医生甚至外科医生,不论年龄和资历都可以提供精确的帮助,尤其是对参加我国住院医师规范化培训的医生——这也是我组织翻译这本手册的初衷。与其他急诊手册不同的是,本手册一开始用较多的篇幅阐述了内科所有专科如心血管、呼吸、消化、肾病、神经、精神、感染、血液、皮肤、风湿免疫等的急症病种,以及休克、药物过量和老年患者的急症。在每个章节针对每种急症情况都从评估、临床表现、检查、诊断、鉴别诊断和处理等方面陈述。内容齐全,结构清晰。每一节均设有框,总结了常见的内科急症处理要点。这些精准和实用的处理要点对于在急诊室工作的低年资医师有十分有用的指导意义。作者书写简洁实用,借助于图解和流程图,便于读者获得信息。本手册的实用性还体现在“实践操作”和“常见症状的鉴别诊断”两章。前一章的实践操作信息详尽,几乎无所不包,阐述了每一项可能在急诊进行的操作的“适应证、禁忌证、操作前准备、设备要求、操作技术、风险、并发症及注意事项”,对于低年资的医师颇为有用。后一章阐述了37个常见症状的鉴别诊断,强调病史问诊和体格检查的重要性,列出常见症状简短而易记的鉴别诊断清单,是询问每个鉴别诊断和危险因素重要问题的指南。而且,正如原版序所述,“虽然许多执业临床医生并不需要承担所有这些操作,但他们将共同和患者及其亲属讨论这些问题,而这部分内容将是宝贵的指南。” 本手册另外一个特点是它的权威性,英国已经将急症医学发展为一门完善的学科,在国际上引领了该学科的发展。牛津大学出版的系列手册为许多在临床实践工作的医生提供了有用的信息。本手册简明和及时更新的内容反映了作者们的经验,更新的这一版手册,确保了所推荐医疗措施的每一个方面都与当前的临床指南一致。本手册的翻译团队由复旦大学附属中山医院和华山医院的内科教授组成。每个章节均由一位富有临床经验的专科主任或副主任医师翻译,并由该专科的高年资教授审校。后由主译逐字逐句审校译稿。本手册的读者主要是在急诊科和内科工作和培训的低年资医师,尤其是参加住院医师规范化培训的内科医生。本手册也适用于在急诊科及其他相关学科工作的高年资医生、内科各个专科的临床医生、医学生。希望他们能临床工作中遵循手册中的“黄金法则”。本手册的翻译得到复旦大学附属中山医院和华山医院专家们的大力支持和帮助,他们在繁忙工作中辛勤笔耕、严谨把关;学术秘书郭津生教授为本手册的早日出版付出了辛勤劳动,北京协和医院内科ICU杜斌教授在百忙中为本手册写读后感(代序),在此一并表示感谢。本手册的翻译如有疏漏不妥之处,均由我负责,尚祈读者指正。
王吉耀
牛津临床医学手册系列是为广大临床医生量身定制的“口袋书”,有较强的临床针对性。该系列内容实用、表达精炼、要点突出,查阅方便、快捷。本书为急症医学分册。全书共分16章,阐述了内科所有专科如心血管、呼吸、消化、肾病、神经、精神、感染、血液、皮肤、风湿免疫等的急症病种,以及休克、药物过量和老年患者的急症。在每个章节针对每种急症情况都从评估、临床表现、检查、诊断、鉴别诊断和处理等方面陈述,涵盖了疾病的评估、鉴别诊断、诊断、快速治疗,以及进一步治疗的内容。
王吉耀 复旦大学内科学二级教授,博士研究生导师,复旦大学附属中山医院终身荣誉教授,国家有突出贡献的消化病和肝病专家,中国临床流行病学和循证医学的创始人和奠基人之一。1944年生于上海,1967年毕业于原上海医科大学医学系。1981年和1986年分别获上海医科大学内科消化医学硕士和加拿大McMaster大学临床流行病学科学硕士学位。曾任复旦大学附属中山医院内科教研室主任、消化科主任、复旦大学学术委员会委员、复旦大学学术规范委员会委员、复旦大学上海医学院内科学系主任、中国临床流行病学工作网主席、中华医学会临床流行病学分会主任委员、中华医学会消化分会委员兼肝胆协作组副组长、中国医师协会循证医学分会副主任委员。现任复旦大学国际临床流行病资源和培训中心/循证医学中心主任、中国临床实践指南联盟共同发起人兼学术委员会主任。多年来致力于胃肠病和慢性肝病的临床和研究,发表论文300余篇,获国家科技进步二等奖,科技进步二等奖,上海市医学科技一等奖、三等奖,上海市科技进步二等奖、三等奖等16项,发明专利3项。主编七年制规划教材《内科学》 (2005年获全国优秀教材一等奖)和全国“十五”“十一五”规划教材七/八年制第1版和第2版《内科学》(2008年获上海市优秀教材一等奖)。主编《循证医学与临床实践》第1~4版,获上海市普通高校优秀教材奖。任《大百科全书》第3版现代医学副主编、《实用内科学》第14~16版主编。曾获 “上海市三八红旗手”“上海市高校教学名师”“上海市卫生系统高尚医德奖”“上海市医务职工科技创新能手”、首届“国之大医——特别致敬”“上海市白玉兰医学巾帼成就奖”“2021年上海市住院医师规范化培训杰出贡献奖”等荣誉,并荣获“庆祝中华人民共和国成立70周年”纪念章“首批教育世家”的殊荣。
●章心血管系统疾病急症/1第二章呼吸系统疾病急症/179第三章消化系统疾病急症/239第四章肾脏病急症/307第五章休克/349第六章神经系统疾病急症/370第七章感染性疾病急症/498第八章HIV阳性患者的急症/537第九章糖尿病及内分泌系统疾病急症/576第十章血液系统疾病急症/647第十一章风湿免疫系统疾病急症/703第十二章皮肤病急症/735第十三章精神障碍急症/756第十四章药物过量/781第十五章实践操作/826第十六章常见症状的鉴别诊断/904第十七章老年患者的急症/936黄金法则/950符号和缩略词/951彩图/974附录/978索引/986
读《牛津急症医学手册》有感
作为年轻医生,在完成了为期3年的住院医师规范化培训后,进入心仪的专科成为一名专科医生,似乎是必由之路。然而,随着人口老龄化趋势的日益凸显,社区医疗服务的不断进步,越来越多的住院患者罹患多种基础疾病,原发疾病也更为疑难复杂。这一现实不可避免地给以专科医生为主导的诊疗模式带来了挑战。对于其负责的专科疾病,专科医生往往具有非常深入的研究和较为丰富的诊疗经验;但是,对于专科以外的其他基础疾病却知之甚少。此外,患者一旦入住与其原发疾病不符的专科病房,主治医生更加难以做出正确的医疗决策。此时,必须依靠其他专科医生甚至多个专科医生的会诊,不仅严重降低医疗工作效率,甚至可能影响患者预后。为解决上述矛盾,急症医学(acute medicine)在英国应运而生。因急症住院的内科患者初在急症病房(acute medical units)接受急症医学医生的诊治。如果48?72小时后仍不能出院,则转由相应的专科医生负责患者的后续诊疗。作为普通内科学的亚专科,急症医学的医生需要接受为期4年的培训,而且应当掌握一门专科技能(如心脏超声、内镜等)。我国尚没有与急症医学对应的临床医学专科。那么,翻译这部《牛津急症医学手册》的意义何在?当然,读者可以在王吉耀老师的主译前言中找到这个问题的答案。读了这部译著后,我的感悟如下:对于住院医生而言,这是对内科常见急症进行的系统梳理;对于专科医生而言,则是重拾内科常见急症及其处理要点的便捷方式。然而,这部手册中所反映的患者需求,以及现行的专科医生主导诊疗模式所带来的问题,更值得医院的管理者们、临床医学发展方向的引领者和医疗体系的设计者们深思,究竟什么才是以患者为中心 (patient-centered) 的医疗模式?
杜斌北京协和医院副院长、内科ICU主任医师、教授中国医师协会重症医学医师分会会长
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