78腕管综合征.pdf

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1、腕管综合征临床路径（县级医疗机构版）一、腕管综合征临床路径标准住院流程（一）适用对象第一诊断为腕管综合征（ICD-10：）（二）诊断依据根据外科学（下册）（8 年制和 7 年制临床医学专用教材，人民卫生出版社）。1.病史：常有职业病史。2.临床表现：（1）主诉：桡侧三个手指端麻木或疼痛，持物无力，中指为甚，夜间或清晨症状最重；（2）体征：拇、示、中指有感觉过敏或迟钝；鱼际肌萎缩，拇指对掌无力；腕部正中神经Tinel 征（+）；曲腕试验（Phalen征）阳性率70%左右；腕部有炎症或肿块者，局部隆起、有压痛或可扪及肿块边缘。3.电生理检查：鱼际肌肌电图及腕-指的正中神经传导速度测定有神经损害征。

2、（三）选择治疗方案的依据。根据外科学（下册）（8 年制和 7 年制临床医学专用教材，人民卫生出版社）。1.非手术治疗：早期，腕关节中立位制动，腕管内注射醋酸泼尼松龙。辅以药物或物理治疗。2.手术治疗：行腕管内占位病变切除术或腕横韧带切开复位术。（四）标准住院日为14 天。（五）进入路径标准。1.第一诊断必须符合ICD-10:腕管综合征疾病编码。2.当患者合并其他疾病，但住院期间不需要特殊处理也不影响第一诊断的临床路径流程实施时，可以进入路径。（六）明确诊断及入院常规检查应12 小时。1.必需的检查项目：（1）血常规、肝功能、肾功能、电解质、血糖；（2）凝血功能、输血前检查、血型、感染性疾病筛查

3、（乙肝、丙肝、梅毒、艾滋病）；文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2

4、L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B

5、2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编

6、码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z

7、6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4

8、Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3

9、R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4（3）X 线胸片、心电图；（4）腕部 X 片（5）电生理检查。2.根据患者病情，可选择的检查项目：腕部 CT 或 MRI、骨质疏松相关的骨

10、代谢检查、腹部B 超、心肺功能评估。（七）预防性抗菌药物选择与使用时机。1.抗菌药物：按照抗菌药物临床应用指导原则（卫医发 2004 285 号）选择用药。建议使用第一、二代头孢菌素，头孢曲松等；明确感染患者，可根据药敏试验结果调整抗菌药物。（1）推荐使用头孢唑林钠静脉注射：成人：0.5-1.0g/次，一日 2-3 次；儿童：一日量为20-30mg/kg体重，分三次给药；对本药或其他头孢菌素类药过敏者，对青霉素类过敏性休克史者禁用；肝肾功能不全者、有胃肠道疾病史者慎用；使用本药前须进行皮试。（2）推荐头孢呋辛钠静脉滴注。文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K1

11、0B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文

12、档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA

13、5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10

14、V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 H

15、K3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7

16、R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 Z

17、O2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4成人：0.75g-1.5g/次，一日三次；儿童：平均一日剂量为60mg/kg，分 3-4 次给予；肾功能不全患者按照肌酐清除率制订给药方案：肌酐清除率 20ml/min者，每日2 次，每次3g;肌酐清除率10-20ml/min患者，每次0.7

18、5g，一日 2 次；肌酐清除率10ml/min 患者，每次0.75g，一日 1 次；对本药或其他头孢菌素类药过敏者，对青霉素类药有过敏性休克史者禁用；肾功能不全者、有胃肠道疾病史者慎用；使用本药前须进行皮试。（3）推荐头孢曲松钠静脉滴注：成人：1g/次，一次静脉滴注；儿童：儿童用量一般按成人量的1/2 给予；对本药或其他头孢菌素类药过敏者，对青霉素类过敏性休克史者禁用；肝肾功能不全者、有胃肠道疾病史者慎用。2.预防性用抗菌药物，时间为术前0.5 小时，手术超过3 小时加用 1 次抗菌药物；总预防性用药时间一般不超过24文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10

19、B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档

20、编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5

21、Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V

22、4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK

23、3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R

24、8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO

25、2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4小时，个别情况可延长至48 小时。（八）手术日为入院当天。1.麻醉方式：臂丛神经阻滞。2.手术方式：腕管综合征的手术治疗。3.术中用药：麻醉用药、抗菌药、止血药物。5.输血：根据手术失血情况决定。（九）术后住院恢复7 天。1.必须复查的检查项目

26、：血常规、肝功能、肾功能、电解质、电生理检查等。2.术后用药：抗菌药物使用按照抗菌药物临床应用指导原则（卫医发 2004 285 号）执行，并根据患者的病情决定抗菌药物的选择与使用时间。明确感染患者，可根据药敏试验结果调整抗菌药物。3.每 2-3 天手术切口换药一次。4.术后 7 天拆除手术切口缝线，或根据病情酌情延长拆线时间。（十）出院标准。文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文

27、档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA

28、5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10

29、V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 H

30、K3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7

31、R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 Z

32、O2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K1

33、0B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V41.病人病情稳定，体温正常，手术切口愈合良好，生命体征平稳。2.没有需要住院处理的并发症和/或合并症。（十一）变异及原因分析。本病可伴有其他损伤，应当严格掌握入选标准。腕管综合征的诊断主要根据临床症状和特征性的物理检查结果，确诊需要电诊断检查。最重要的诊断依据是患者存在典型的临床症状，即正中神经分布区的麻木不适，夜间加重。除了主观性的症状，客观检查也非常重要。明确出现手指感觉减退或散失以及大鱼际肌肉萎缩是病情严重的表现

34、，而在出现这些表现之前就应该进行治疗干预。基于诱发诊断试验的客观性检查也有利于帮助诊断，包括Tinel 征，Phalen 试验和正中神经压迫试验。多数腕管综合征患者具有典型的症状和体征，但仍有一些不典型的患者，需要与其他一些神经系统疾患进行鉴别。主要鉴别诊断包括：颅内肿瘤，多发性硬化，神经根性颈椎病，颈髓空洞症，胸腔出口综合征，外周神经肿瘤，特发性臂丛神经炎，臂丛下干或其他正中神经病变。文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3

35、R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8

36、V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2

37、L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B

38、2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编

39、码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z

40、6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4

41、Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4二、腕管综合征临床路径表单适用对象：第一诊断为 腕管综合征（ICD-10:）行腕管综合征手术治疗（ICD-9-CM-3：）患者姓名：性别：年龄：住院号：门诊号：住院日期：年月日出院日期：年月日标准住院日14 天时间住院第 1 天住院第 2 天住院第 3-6 天（术前日）主要诊疗工作询问病史及体格检查上级医师查房初步的诊断和治疗方案完成住院志、首次病程、上级医师查房等病历书写开

42、检查检验单完成必要的相关科室会诊行患肢制动上级医师查房与手术前评估确定诊断和手术方案完成上级医师查房记录完善术前检查项目收集检查检验结果并评估病情请相关科室会诊上级医师查房，术前评估和决定手术方案完成上级医师查房记录等向患者及/或家属交待围手术期注意事项并签署手术知情同意书、输血同意书、委托书（患者本人不能签字时）、自费用品协议书麻醉医师查房并与患者及/或家属交待麻醉注意事项并签署麻醉知情同意书完成各项术前准备文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z

43、6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4

44、Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3

45、R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8

46、V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2

47、L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B

48、2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编

49、码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4文档编码:CA5Z6T10V4Y5 HK3R7M7R8V3 ZO2L8K10B2V4重点医嘱长期医嘱：骨科常规护理二级护理饮食患肢制动临时医嘱：血常规、血型、尿常规凝血功能电解质、肝肾功能传染性疾病筛查胸部 X 线平片、心电图根据病情：肺功能、超声心动图、血气分析锁骨正侧位（包括邻近关节）长期医嘱：骨科护理常规二级护理饮食患者既往内科基础疾病用药临时医嘱：根据会诊科室要求安排检查和化验单镇痛等对症处理长期医嘱：同前临时医嘱：术前医嘱明

50、日在臂丛神经阻滞麻醉下行腕管综合征手术治疗术前禁食水术前用抗菌药物皮试术前留置导尿管（全麻）术区备皮其他特殊医嘱主要护理工作入院介绍入院护理评估观察患肢制动情况及护理观察患者病情变化防止皮肤压疮护理心理和生活护理做好备皮等术前准备提醒患者术前禁食水术前心理护理病情变异记录无有，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 7 天（手术日）住院第 8 天（术后第1 日）住院第 9 天（术后第2 日）主要诊疗工作手术向患者及/或家属交代手术过程概况及术后注意事项术者完成手术记录完成术后病程上级医师查房麻醉医师查房观察有无术后并发症并做相应处理上级医师查房完成常