2016年最新毛细支气管炎诊断及治疗标准操作规范.pdf

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1、精心整理毛细支气管炎（2016 年版）一、毛细支气管炎标准住院流程（一）适用对象。第一诊断为毛细支气管炎（ICD-10：J21）。（二）诊断依据。根据诸福棠实用儿科学（第八版）（人民卫生出版社），及中华医学会儿科学分会呼吸学组：毛细支气管炎诊断、治疗与预防专家共识（2014年版）本病诊断要点为：多见于2 岁以内婴幼儿，尤其以6 个月左右婴儿最为多见。多数先有上呼吸道感染症状，12 天后病情迅速进展，出现阵发性咳嗽，34 天出现喘息、呼吸困难、喘憋，重者出现紫绀，57 天达到疾病高峰。3 月的小婴儿可出现呼吸暂停。一般无全身症状。体检双肺闻及喘鸣音及细湿罗音。外周血象:外周血白细胞多偏低或正常，

2、合并细菌感染时多增高。胸片:提示明显肺气肿及小片状阴影。小部分病例出现肺不张。呼吸道病原学检测：本病可由不同病原所致，呼吸道合胞病毒（RSV）最常见，其次为副流感病毒、腺病毒等。血气分析：血气分析显示PaO2不同程度下降，PaCO2正常或增高，pH值与疾病严重性相关，病情较重的患儿可有代谢性酸中毒，可发生I 型或 II型呼吸衰竭。（三）治疗方案的选择。精心整理根据诸福棠实用儿科学（第八版）（人民卫生出版社）;及中华医学会儿科学分会呼吸学组：毛细支气管炎诊断、治疗与预防专家共识（2014年版）1.吸氧：2.加强呼吸道护理：增加室内空气湿度，合理应用雾化吸入，雾化后及时予以拍背、吸痰，以保持呼吸道

3、通畅。3.喘憋的治疗：喘憋较重者，根据病情吸入支气管扩张药物(短效 2受体激动剂或联合应用抗胆碱能药物)和雾化吸入糖皮质激素。如喘憋仍无缓解者可短期口服或静 脉使用糖皮质激素试验性治疗。4.抗感染治疗：合并细菌感染时，可用相应抗生素（遵循儿科用药的方法）。5.对症治疗：脱水的治疗：可给予口服或静脉补液，如有代谢性酸中毒，可予碳酸氢钠补碱。心力衰竭、呼吸衰竭按相应危重症治疗，必要时行气管插管进行机械通气。（四）标准住院日为5-7 天。（五）进入路径标准。1.第一诊断必须符合 ICD-10：J21 毛细支气管炎 疾病编码。2.当患儿同时具有其他疾病诊断，但在住院期间不需要特殊处理,也不影响第一诊断

4、的临床路径流程实施时，可以进入路径。3.以下情况容易发展为重症毛细支气管炎，因此不建议进入毛细支气管炎临床路径:（1）年龄小于3 个月；（2）胎龄小于34 周的早产儿；文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文

5、档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10

6、文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A1

7、0文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A

8、10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4

9、A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y

10、4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2

11、Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10精心整理（3）伴有基础疾病：如先天性心脏病、支气管肺发育不良、先天免疫功能缺陷、先天气道畸形、唐氏综合征等患儿。（六）入院后第12 天。1.必需的检查项目：（1）血常规、CRP、尿常规、粪常规；（2）心肌酶谱及肝肾功能；（3）呼吸道病毒检测；（4）呼吸道细菌培养及药敏；（5）血支原体、衣原体检测；（6）胸片检查；（7）心电图；（8）血气分析检测。2.必要的告知：入选临床路径、加强拍背 等护理、注意观察肺部症状变化。（七）入院后第35 天。1.根据患者病情可选择的检查项目：（1）血气分析检测；（2）肺

12、功能测定；（3）心电图复查；（4）血清过敏原检查；（5）超声心动图；（6）复查血支原体、衣原体；（7）支气管镜检查。文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8

13、C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M

14、8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4

15、M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H

16、4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10

17、H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z1

18、0H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z

19、10H4M8C10 ZG7E7P2Y4A10精心整理2.必要的告知：如出现心力衰竭、呼吸衰竭等并发症时应当及时退出毛细支气管炎临床路径。（八）出院标准。1.喘息消失，咳嗽明显减轻。2.连续 3 天腋温 37.5。3 肺部体征明显改善。（九）变异及原因分析。毛细支气管炎患儿住院经综合治疗7天，仍有反复咳、喘发作，迁延难愈，应当及时退出毛细支气管炎临床路径，寻找病因。二、毛细支气管炎临床表单适用对象：第一诊断为毛细支气管炎（ICD-10：J21）患者姓名：性别：年龄：门诊号：住院号：住院日期：年月日出院日期：年月日标准住院日：5-7 天日期住院第 1 天住院第 2 天住院第 3 天主要诊疗工作询问

20、病史及体格检查完成病历书写开化验单上级医师查房，初步确定诊断初步评估病情，有可能出现并发症向患者家属告知病情上级医师查房完成入院检查完成上级医师查房记录等病历书写根据病情变化给予进一步处理（营养心肌、保护肝脏等）收集并追问各类实验室检查报告，向上级医师汇报重要实验室检查结果上级医师查房完成上级医师查房记录等病历书写结合化验结果及入院后治疗反应进一步评估病情文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E

21、7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7

22、E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG

23、7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 Z

24、G7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10

25、ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10

26、 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C1

27、0 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10精心整理重要医嘱长期医嘱：儿内科一级护理常规饮食吸氧吸痰压缩雾化吸入其他治疗临时医嘱：血尿便常规胸片、心电图血气分析心肌酶谱及肝肾功能呼吸道病毒检测、呼吸道细菌培养和药敏血支原体、衣原体检测其他检查长期医嘱：儿内科一级护理常规饮食吸氧吸痰压缩雾化吸入保护肝脏、营养心肌（必要时）其他治疗临时医嘱：酌情肺功能检查复查

28、血气分析（必要时）其他检查长期医嘱：儿内科一级护理常规饮食吸氧吸痰压缩雾化吸入抗生素（必要时）保护肝脏、营养心肌（必要时）其他治疗临时医嘱：复查血气分析（必要时）血清过敏原检查（必要时）心电图（必要时）其他检查主要护理工作入院护理评估入院宣教叮嘱患儿卧床休息，定时测量体温观察体温波动观察咳嗽和喘息程度保持呼吸道畅通，及时清除呼吸道分泌物协助患儿排痰观察体温波动观察咳嗽和喘息程度保持皮肤清洁、口腔清洁鼓励患儿少食多餐，多饮水，保证液体摄入量病情变异记录无有，原因：1.2.无有，原因：1.2.无有，原因：1.2.护士签名医师签名时间住院第 4 天住院第 57 天（出院日）主要诊疗工作观察患儿病情（

29、体温波动、肺部体征）完成病程录，详细记录医嘱变动情况（原因和更改内容）上级医师查房进行体格检查上级医师查房，同意其出院完成出院小结出院宣教：向患儿及其家长交代出院后注意事项，如来院复诊时间、预防交叉感染等文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M

30、8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4

31、M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H

32、4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10

33、H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z1

34、0H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z

35、10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6

36、Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10精心整理重要医嘱长期医嘱：儿内科护理常规饮食吸氧吸痰压缩雾化吸入抗生素（必要时）保护肝脏、营养心肌（必要时）其他治疗临时医嘱：复查血尿便常规（必要时）复查心电图（必要时）其他检查出院医嘱：出院带药主要护理工作观察体温波动观察咳嗽、喘息程度观察药物副作用（皮疹、胃肠道反应）详细告知各注意事项（勤洗手、减少公众地带活动、如咳嗽和喘息加剧等及时就诊）告知药物使用方法出院宣教病情变异记录无有，原因：1.2.无有，原因：1.2.护士签名医师签名文档编码:CS3F5E9X3P

37、1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3

38、P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X

39、3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9

40、X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E

41、9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5

42、E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10文档编码:CS3F5E9X3P1 HR6Z10H4M8C10 ZG7E7P2Y4A10