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小儿心脏病史:避免额外的诊断检查。

Pediatric Cardiac Anamnesis: Prevention of Additional Diagnostic Tests.

作者信息

Masic Izet, Begic Zijo, Naser Nabil, Begic Edin

机构信息

Department of Science Editing, AMNuBiH, Sarajevo, Bosnia and Herzegovina.

Department of Cardiology, Pediatric Clinic, CCU Sarajevo, Sarajevo, Bosnia and Herzegovina.

出版信息

Int J Prev Med. 2018 Jan 15;9:5. doi: 10.4103/ijpvm.IJPVM_502_17. eCollection 2018.

Abstract

Pediatrics is defined as the science of a healthy and sick child from birth to end of adolescence. Diseases of the cardiovascular system are the leading causes of mortality in adults, with frequent onset in childhood. The cardiologic examination starts with anamnesis in a pleasant atmosphere, refined space, enough time and patience, detailed measurements, and preferably a noncrying child. Anamnesis, regardless of the development of diagnostic procedures, still constitutes the basis of every clinical examination. The basic characteristics of pediatric cardiac anamnesis are comprehensiveness, that is, details, clarity, concurrency, and chronology. Proper and conscientiously taken anamnesis with a thorough clinical examination of a sick child is a solid protection against dehumanizing the relationship between a physician and patient. Pediatric cardiac anamnesis can be variable, completely negative, but very rich. Anamnesis should, first of all, clarify whether only a child is sick or it is perceived like that be his or her environment. Preschool and school-age children are normally attending anamnesis. High-quality, comprehensive medical history can keep the patient at one level of health care, with a strict focus primarily on the diagnostic processes, reduce crowds in specialist and subspecialist institutions, and make economic savings. A large number of patients in specialist and subspecialist clinics can be reduced by proper screening and by developing primary health-care system (from the local health-care center). Taking patient's medical history with thoroughness has a strong educative character for young doctors at the beginning of their careers.

摘要

儿科学的定义是研究从出生到青春期结束的健康和患病儿童的科学。心血管系统疾病是成年人死亡的主要原因,且常在儿童期发病。心脏检查始于在愉快的氛围、优雅的空间、充足的时间和耐心的条件下进行问诊,进行详细测量,最好是在孩子不哭的情况下。无论诊断程序如何发展,问诊仍然是每次临床检查的基础。儿科心脏问诊的基本特点是全面性,即细节性、清晰性、连贯性和时序性。对患病儿童进行恰当且认真的问诊,并进行全面的临床检查,是防止医患关系变得冷漠的有力保障。儿科心脏问诊可能各不相同,完全为阴性,但也可能非常丰富。问诊首先应弄清楚是孩子本身患病,还是其周围环境认为孩子患病。学龄前和学龄儿童通常能配合问诊。高质量、全面的病史能使患者维持在一定的医疗保健水平,严格专注于诊断过程,减少专科和亚专科机构的就诊人数,并节省费用。通过适当的筛查和发展初级卫生保健系统(从当地卫生保健中心开始),可以减少专科和亚专科诊所的大量患者。认真询问患者病史对初入职场的年轻医生具有很强的教育意义。

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