讲课锦囊-GerdQ讲课12.2
微格教学第二讲PPT精品文档22页
构成要素
导入结构
引起注意 激发立示 创联差 设系距
形成期待
导入类型
1、激发兴趣的新课导入
（1）巧设悬念
思维永远是从问题开始的 “ 教学过程是一种提出问题和解决问题的持
续不断的活动 ” -------布鲁纳
（2）故事激趣（故事导入）
《春》导语设计
曾经有个盲人乞丐，胸前挂块写有“自幼双目失 明”字样的牌子，沿街乞讨，可很少有人肯施舍 与他。一次，他遇到一个穷困的诗人，诗人称自 己身无分文只能送他一句话。奇怪的是，自从诗 人在那块牌子上添了一句话后，人们变得乐善好 施，纷纷慷慨解囊了。请同学们猜猜，诗人送他 的究竟是一句什么样的话……诗人赠送的话是： 春天来了，可我什么也看不见！
导入技能
基本概念
定义：教师在进入新课题时，运用有效
的方法引起学生注意，激发学生兴趣和学 习动机，明确学习目的并建立知识间联系 的教学行为方式。(the skill of introductory procedures)
基本概念
功能： 1.提供必要的信息激发学生学习兴趣，引
起学生的学习动机和注意，使学生进入学 习的准备状态。 2.设置玩呢提情境和制造学习气氛，引起 学生关注，进入学习准备状态。 3.为学生学习新的学习内容做鼓动，使学 生产生学习期待。 4.通过对学生反应的强化，使学生产生进 一步参与教学活动的需要。
（3）热门话题
利用时事热点和学生比较关注的热门话 题导入新课，也是一种行之有效的吸引 学生注意力、激发学生兴趣、促进学生 参与的方法。
《蜀道难》导入实录（刘建松）
师：20世纪美国旅行家泰鲁。保罗在《游历中国》一书中断 言：“有昆仑山脉在，铁路就永远到不了拉萨。”公元2019 年七月三日22时20分，随着一声汽笛声长鸣，钢铁巨龙穿过 昆仑山，翻越唐古拉，骄傲地腾越在世界屋脊之上，青藏线 的贯通，让对中国人持怀疑论的洋大人们收回了他们的成见， 如果历史真的有轮回，还有一位具有诗坛统治力的大人物也 会大跌眼镜。Who？（生笑）
图解2024年《论教育》课件
PART-02
向前看
看未来
齐步走
走天下
a（编2）制高材处料作、业制人品员、须机穿具软的底详轻细质进鞋场，计所划需。材料事先准备齐全，工具事先放在工具袋内，拴稳挂牢。 施 本工中 程严 主禁 体在 设现 计场 中抽 ，烟 比，较严重格视执水行土防保火持规工定作；。库房应配备一定数量的灭火器具。
需要课件（带讲稿）
量 根q据0x≤xx1x.所6m在3区/m域.h。冷水滩区不属于省级"重点治理区"，xxxx区水土流失防治标准执行二级标准。 3柱.8砼、分维层修浇结筑束，后分，层移振交捣顾密客实检，查每验5收0c，m并为在一验层收，单振上签层字砼。时振动棒应插入下层5cm，以消除两层间隙缝，在柱混凝土浇筑过程中，要由专人用橡皮锤敲击模板面，特别是阴阳角部位，以保证混凝土密实。
3
大量出汗，汗液会把防晒霜冲散的。不要觉得只涂脸部就可以，耳后包括耳朵，脖子
尤其是后脖颈，还有小臂才是关键，防晒霜需30倍以上的。
6镀、膜宿层舍应内在照玻明璃不第准二使面用或6第0W三以面上（灯先泡钢，化灯，泡后离镀地膜高）度，不镀得膜低玻于璃2色.5差米控，制离：开△帐E子≤等2.物0(C品IE不LA少B)于。500MM； b1.、2 加玻工璃好到的货铝后板应应从立外放观，、下性部能垫要木求方、；尺寸偏差等几方面按照11944 进行检验。
包 用装 水应 准严 仪密 测、 出牢 两固 端， 支避 撑免面在上周小转车运轨输道中的散水包平，标产高品。在包装及搬运过程中避免装饰面的磕碰、划伤。 a、方玻钢璃管采主用龙符骨合、1预14埋中件一及等各品类的镀浮锌法角玻钢璃焊进接行破加坏工镀制锌作层。后均满涂两遍防锈漆（含补刷部分）进行防锈处理并控制第一道二道的间隔时间不小于12 小时。
地理微格教学讲座Microsoft Word
地理微格教学讲座主讲人: 黄新南“微格教学”已经不是一个陌生的名词了, 北京以至全国的许多学校都在开展这项活动, 用来提高教师课堂教学技能, 从而提高教学质量。
北京教育学院地理系自1991年在中学地理教师继续教育班开设这门课程以来, 很受培训教师的欢迎。
一、微格教学概述1. 什么是微格教学微格教学（Microteaching）是师范生和在职教师掌握课堂教学技能的一种培训方法, 它又被译为“微型教学”、“微观教学”、“小型教学”等。
微格教学是在1963年由美国斯坦福大学的D．W．阿伦（D．W．Allen）和他的同事W．伊芙（W．Eve）首先开发设立的。
在斯坦福大学, 微格教学原是为师范生在当教师之前提供一个教学实践的机会而设计。
微格教学可一般描述为一个缩减的教学实践, 它在班级大小、课程长短和教学复杂程度上都被缩减了。
因此, 英国的G．布朗（G．Brown）说：“它是一个简化了的、细分的教学, 从而使学员易于掌握。
”阿伦和伊芙把微格教学定义为：“一个有控制的实习系统, 它使师范生有可能集中解决某一特定的教学行为, 或在有控制的条件下进行学习”。
北京教育学院微格教学课题组经过7年的实践和研究认为：“微格教学是一个有控制的教学实践系统, 它使师范生和教师有可能集中解决某一特定的教学行为, 并在有控制的条件下进行学习和训练。
它是建筑在教育教学理论、科学方法论、视听理论和技术的基础上, 系统训练教师课堂教学技能的理论和方法。
”从斯坦福大学的研究者提出微格教学以后的30年来, 它的训练过程已形成了一定的系统模式, 一般包括以下几个步骤：（1）事前的学习和研究。
学习的内容主要是微格教学的训练方法、各项教学技能的教育理论基础、教学技能的功能和行为模式。
（2）组成微型课堂提供示范。
微型课堂由扮演教师角色（师范生或在职教师）、扮演学生角色（被培训者的同学、同事或真实的学生担当）、评价人员（被培训者同学、同事或指导教师等）、摄、录像设备操作人员（专业人员或被培训者同学、同事）和指导教师五部分人员组成。
牛津版必修五UnitReading-公开课
【名师示范课】牛津版必修五 UnitReading-公开课课件（推荐）
True or false questions
Pauline Carter thinks:
1. The nature will pay back if we toy with nature. 2. We should chlaovnee fewer babies to reduce the
human embryos D. the disadvantage of cloning
Scan the body and match the main idea.
Para 1
Para 2 Para 3-5 Para 6
A. Different people's attitudes towards cloning human embryos. B. The first cloned mammal and different attitudes towards it. C. Research on cloning in China.
Step 1.Read the first and last paragraphs for an idea of what the article is about.
Step 2.Scan the body of the article.
Step 3.Read through the article a few times.
Wilmut Against on creating new _t_is_s_u_e_s and _o_rg_a_n_s_.
Faye
Wilson For
gerd诊治共识的认识 ppt课件
GERD的维持治疗
维持治疗的方法有三种
维持原剂量或减量 间歇用药 按需治疗
食管炎 D级
胃食管反流病的诊断
1、GerdQ（诊断敏感性50-70% ） 2、食管钡餐、胃镜、24小时pH监测、 食管测压、核素、食管滴酸试验、 质子泵抑制剂（PPI）试验
整个GerdQ问卷涉及阳性症状、阴性症状和阳性影响各2个问题： 阳性——烧心、反流；阴性——上腹痛、恶心；阳性影响—— 睡眠障碍、用 药负担。总分≥8分即可诊断GERD。GerdQ评分越高，诊断精确性越高。
对GERD可选择性使用促动力药物 （证据分类：II类）
手术与内镜治疗应综合考虑，慎重决定
中华消化杂志 2007;27:689-10
改变生活方式
证据等级 IV
抬高床头 减少脂肪摄入 戒烟 餐后3小时避免弯腰
减少食管下酸暴露时间
其他因素:巧克力、酒精、辣椒、咖啡、洋葱、大蒜 降低LES压力
食管酸暴露 (% ，pH <4时间百分比) 8
7 6
5
4
几乎完全的持续症状 每日有症状 偶发症状 健康个体
n=190
3
2
1
0 6–9 9–12 12–15 15–18 18–21 21–24 0–3 3–6
时间 (小时)
Joelsson & Johnsson 1989
炎症的严重程度与食管酸接触的时间相关
随着 pH<4 的%时间增加，病灶的严重程度增加
食管炎的分级 2 3
溃疡 Barrett食管
狭窄
pH< 4的时间% (24 小时期间) 8.8
10.2 15.7 22.6 22.0 30.5
ccq教学法
ccq教学法
CCQ教学法指的是Concept-Checking Questions（概念检测问题）教学法。
它是一种用于确认学生是否理解教学内容的教学策略。
CCQ教学法的基本原则是在教学过程中短暂停顿，向学生提出一些问题，以评估他们对所学概念的理解程度。
这些问题可通过是非题、选择题、填空题等形式呈现。
CCQ教学法的目的是帮助教师评估学生的理解程度并及时调整教学策略，以确保学生正确理解教学内容。
通过提问，教师可以判断学生是否掌握了关键概念、解释和应用并纠正任何误解。
CCQ教学法的优点在于：
1. 简单实用：教师可以通过简单的问题迅速评估学生的理解程度。
2. 即时反馈：教师可以立即了解学生的学习进展，并根据他们的回答调整教学内容。
3. 激发学生思考：CCQ可以激发学生思考，促使其更深入地思考教学内容。
4. 确保学习效果：通过CCQ教学法，教师可以确保学生正确掌握关键概念，避免后续学习中的误解。
因此，CCQ教学法是一种有效的教学策略，可以促进学生的学习效果和教师与学生之间的互动。
2024年儿童常见病健康讲座医学课件
2024年儿童常见病健康讲座医学课件一、教学内容本节课内容选自《儿童常见疾病预防与护理》教材第四章，主题为“2024年儿童常见病健康讲座”。
具体内容包括：儿童常见病的概念、分类、病因、预防措施及护理方法。
着重讲解感冒、扁桃体炎、肺炎、腹泻等儿童常见疾病的识别与处理。
二、教学目标1. 了解儿童常见病的概念、分类及病因。
2. 掌握儿童常见病的预防措施及护理方法。
3. 培养学生关爱儿童健康，提高自我保健意识。
三、教学难点与重点难点：儿童常见疾病的识别与处理。
重点：儿童常见病的预防措施及护理方法。
四、教具与学具准备1. 教具：PPT、实物模型、挂图。
2. 学具：笔记本、笔。
五、教学过程1. 导入：通过展示一组儿童常见病的图片，引发学生思考，进而引入本节课的主题。
2. 讲解：讲解儿童常见病的概念、分类、病因、预防措施及护理方法。
a. 感冒：介绍感冒的症状、传播途径、预防措施等。
b. 扁桃体炎：讲解扁桃体炎的病因、症状、治疗方法等。
c. 肺炎：阐述肺炎的病因、症状、护理要点等。
d. 腹泻：介绍腹泻的病因、症状、预防措施等。
3. 实践情景引入：邀请学生模拟家长角色，针对儿童常见病进行情景对话，提高学生的实际操作能力。
4. 例题讲解：讲解关于儿童常见病的典型例题，帮助学生巩固所学知识。
5. 随堂练习：布置与儿童常见病相关的练习题，让学生及时巩固所学内容。
六、板书设计1. 儿童常见病概念、分类、病因2. 儿童常见病预防措施及护理方法a. 感冒b. 扁桃体炎c. 肺炎d. 腹泻七、作业设计1. 作业题目：a. 请简述感冒的症状、传播途径及预防措施。
b. 请阐述肺炎的病因、症状及护理要点。
2. 答案：a. 感冒症状：发热、咳嗽、喉咙痛等。
传播途径：飞沫传播、接触传播。
预防措施：勤洗手、戴口罩、避免去人群密集场所等。
b. 肺炎病因：细菌、病毒、支原体等感染。
症状：发热、咳嗽、呼吸困难等。
护理要点：保持室内空气流通，给予高热量、高蛋白质饮食，遵医嘱用药等。
GERD-治疗篇课件
耐信40mg快速缓解症状，显著改善生活质量
耐信40mg治疗，显著改善患者生活质量1
前瞻性、多中心、队列研究(ProGERD)共入组6215例GERD患者， 给予耐信40mg治疗2周后，QOLRAD评分显著提高，与治疗前相比P < 0.001
1.Kulig M, et al. Aliment Pharmacol Ther 2003;18:767–776.
耐信40mg治疗反流性食管炎愈合率更高
1. Kahrias PJ, et al. Aliment Pharmacol Ther. 2000;14:1249-58. 2. Castell DO,et al. Am J Gastroenterol. 2002;97:575-583. 3. Labenz,et al. Aliment Pharmacol Ther. 2005;21;739-746.
耐信： 抑酸治疗的信心之选
典型的烧心和反流症状使患者感到不适就可以拟诊为胃食管反流病1
耐信40mg快速缓解胃食管反流病症状2,3
【治疗篇】
有效期至2013是治疗胃食管反流病的基本方法
耐信40mg抑酸优势
耐信40mg治疗胃食管反流病的临床优势
胃酸是导致烧心的关键因素1
[药品名称] 通用名称：埃索美拉唑镁肠溶片 [适应症] 胃食管反流性疾病(GERD) -- 糜烂性反流性食管炎的治疗 -- 已经治愈的食管炎患者防止复发的长期维持治疗 -- 胃食管反流性疾病(GERD)的症状控制 与适当的抗菌疗法联合用药根除幽门螺杆菌 -- 愈合与幽门螺杆菌感染相关的十二指肠溃疡 -- 防止与幽门螺杆菌相关的消化性溃疡复发 [用法用量] -- 愈合与幽门螺杆菌相关的十二指肠溃疡 -- 预防与幽门螺杆菌相关的消化性溃疡复发 埃索美拉唑镁肠溶片20mg+阿莫西林1g+克拉霉素500m， 每日二次，共7天
一年级上册《汉语拼音j q x》公开课教案 (一)
一年级上册《汉语拼音(j q x)》公开课教案浏览《j q x》公开课教案 1一、教学要求1、学会ｊ、ｑ、ｘ3个声母，读准音，认清形，正确书写。
2、初步掌握ü上两点省写规则。
3、学会ｊ、ｑ、ｘ与单韵母拼读音节和带调拼读音节，准确拼读ｊ、ｑ、ｘ开头的三拼音节。
4、认识5个字，会读儿歌。
二、教学重点重点是学会j、q、x三个声母，认清形、读准音，能正确书写。
学会j、q、x与ü相拼两点省略的规则。
三、教学难点难点是j、q、x与ü相拼时，ü上两点省略。
四、教学准备1、配合学习ｊ、ｑ、ｘ发音的录音带；ｊ、ｑ、ｘ的字母卡片；拉动式拼音卡片；画有四线格的小黑板。
2、本课生字、词语卡片。
五、课时布置2课时第一课时教学内容：学会j q x3个声母，读准音，认清形，正确书写。
一、复习导入1、师：小朋友们，今天老师带你们去拼音乐园逛一逛。
准备——动身！（配上音乐，同学自由做动作。
）2、师：拼音乐园到了，这里我们已经认识了一些朋友，你们还记得他们的名字吗？瞧，他们来了！逐个出示拼音字母：g p h l k （自由读——指名读）3、师：小朋友们真了不起！把这些声母的名字都记住了，还有几个声母朋友，他们的模样长得差不多，谁能把他们给分出来呢？出示拼音字母：f t n m d p b。
（同桌互读——指名读）4、师：太棒了！看到小朋友们到拼音乐园里能认识这么多的好朋友，我们的老朋友小鱼娃（课件出示：ü戴帽子的形象）也眼馋极了，也想到拼音乐园去玩一玩。
那么，它会有什么收获呢？咱们来看一看！二、教学声母j q x1、学习“j q x”的发音。
（1）学习拼音“j”。
师：小鱼娃蹦蹦跳跳来到了拼音乐园，哇，里面可好玩啦！有喔喔叫的公鸡，有游来游去的小鱼……你看，小鱼娃还和一窝小鸟做了好朋友呢！小鱼娃在拼音乐园里又是骑马，又是游泳，又同拼音捉迷藏，跟小朋友做游戏。
draeger呼吸机相关培训内容 (3)
Curves and Loopsin Mechanical VentilationFrank RittnerMartin DöringCurves and Loopsin Mechanical VentilationFrank RittnerMartin Döring5 ContentsVentilation curve patterns Pressure-time diagram6s Flow-time diagram10s Volume-time diagram12s Interpretation of curve patterns14Loops – a good thing all rounds PV loops21s The static PV loop21s The dynamic PV loop in ventilation23s Interpretation of PV loops in ventilation26s PV loops before and after the tube34s Loops – other possibilities38s Flow-volume loop38Trends revieweds Documentation of a weaning process41s Lung parameters based on peak andplateau pressure43Capnography – locating problem areass The physiological capnogram46s Interpretations of capnograms476Ventilation curve pattern All the ventilators of the Evita family offer graphic representation of the gradual changes in ventilation pressure and breathing gas flow. Evita 4, EvitaScreen and the PC software EvitaView additionally show the gradual changes in the breathing volume. Two or in some monitors three curves can be shown on thescreen at the same time, and particularly the fact that pressure, flow and volume can be displayed simultaneously makes it easier to detect changes caused by the system or the lungs. The gradual change in pressure, flow and volume depend to an equal extent on the properties and settings of the ventilator, as well as on the respiratory properties of the lung.One respiratory cycle comprises an inspiratory and an expiratory phase. Under normal conditions these two periods contain a flow phase and a no flow pause phase. No volume passes into the lung during the no flow phase during inspiration.Pressure-time diagram Volume-controlled, constant flowThe pressure-time diagram shows the gradualchanges in the airway pressure. Pressure is given in mbar (or in cmH 2O,) and time in seconds.At a preset volume (volume-controlled ventilation)and constant flow the airway pressure depends on the alveolar pressure and the total of all airwayresistances, and can be affected by resistance and compliance values specific to the ventilator and the lung. As the ventilator values are constant, thepressure-time diagram allows conclusions to be drawn about the status of the lung and changes to it.The gradual changes in pressure, flow and volume depend to an equal extent on the properties and settings of the ventilator, as well as on the respiratory properties of the lung.Ventilation curve pattern 7Resistance = airway resistanceCompliance = compliance of the entire system(lungs, hoses etc.)At the beginning of inspiration the pressure between points A and B increases dramatically on account of the resistances in the system. The level of the pressure at break point B is equivalent to the product of resistance R and flow (*).∆p = R ∗*This relationship, as well as the following examples, is only valid if there is no intrinsic PEEP. The higher the selected Flow *or overall resistance R, the greater the pressure rise up to point B. Reduced inspiratory flow and low resistance values lead to a low pressure at point B.Pressure-time diagram for volume controlled constant flow ventilation.Ventilation curve pattern 8After point B the pressure increases in a straight line,until the peak pressure at point C is reached. The gradient of the pressure curve is dependent on theinspiratory flow *and the overall compliance C.∆p/∆t = */CAt point C the ventilator applies the set tidal volume and no further flow is delivered (*= 0).As a result, pressure p quickly falls to plateau pressure. This drop in pressure is equivalent to the rise in pressure caused by the resistance at thebeginning of inspiration. The base line between pointsA and D runs parallel to the lineB -C.Further on there may be a slight decrease inpressure (points D to E). Lung recruitment and leaks in the system are possible reasons for this. The level of the plateau pressure is determined by the compliance and the tidal volume. The difference between plateau pressure (E) and end-expiratory pressure F (PEEP) is obtained by dividing the delivered volume VT (tidal volume) by compliance C.∆P = P plat - PEEPBy reversing this equation the effective compliance can easily be calculated.C = V T /∆pThe level of the plateau pressure is determined by the compliance and the tidal volume.Ventilation curve patterns9 During the plateau time no volume is supplied to thelung, and inspiratory flow is zero. As alreadymentioned, there is a displacement of volume onaccount of different time constants, and this results inpressure compensation between differentcompartments of the lung.Expiration begins at point E. Expiration is a passiveprocess, whereby the elastic recoil forces of the thoraxforce the air against atmospheric pressure out of thelung. The change in pressure is obtained bymultiplying exhalation resistance R of the ventilator byexpiratory flow *exp.∆p = R∗*exp.Once expiration is completely finished, pressure onceagain reaches the end-expiratory level F (PEEP).Pressure-orientedIn pressure-oriented ventilation (e.g. PCV/BIPAP) thepressure curve is quite different.Pressure-time diagramm for pressure controlled ventilation.Ventilation curve pattern 10Pressure increases rapidly from the lower pressure level (ambient pressure or PEEP) until it reaches the upper pressure value P Insp.and then remains constant for the inspiration time T insp.set on the ventilator.The drop in pressure during the expiratory phase follows the same curve as in volume-oriented ventilation, as expiration is under normal conditions a passive process, as mentioned above. Until the next breath pressure remains at the lower pressure level PEEP.As pressure is preset and regulated in the case of pressure-oriented ventilation modes such as BIPAP,pressure-time diagrams show either no changes, or changes which are hard to detect, as a consequence of changes in resistance and compliance of the entire system. As a general rule it can be said that the pressure curves displayed reflect the development of pressure measured in the ventilator. Real pressures in the lung can only be calculated and assessed if all influential factors are taken into account.Flow-time diagram The flow-time diagram shows the gradual changes in the inspiratory and expiratory flows *insp and *exsp respectively. Flow is given in L/min and time in seconds. The transferred volume is calculated as the integration of the flow *over time, and is thusequivalent to the area underneath the flow curve.During inspiration the course of the flow curve is dependent on or at least strongly influenced by the ventilation mode set on the ventilator. Only the course of the flow in the expiratory phase permits conclusions to be drawn as to overall resistance and compliance of the lung and the system.The course of the flow in the expiratory phase permits conclusions to be drawn as to overall resistance and compliance of the lung and the system.Ventilation curve pattern 11In normal clinical practice constant flow and decelerating flow have become established as the standard forms for ventilator control.As yet there has been no evidence to suggest that particular therapeutic success could be achieved using other flow forms.In the case of constant flow the volume flow rate during inspiration remains constant throughout the entire flow phase. When inspiration starts the flow value very quickly rises to the value set on theventilator and then remains constant until the tidal volume V T , likewise set on the ventilator, has been delivered (this is the square area under the curve.) At the beginning of the pause time (plateau time) the flow rapidly returns to zero. At the end of the pause time expiratory flow begins, the course of whichdepends only on resistances in the ventilation system and on parameters of the lung and airways. Constant flow is a typical feature of a classic volume-oriented mode of ventilation.Flow-time diagramVentilation curve pattern 12In decelerating flow the flow falls constantly after having reached an initially high value. Under normal conditions the flow returns to zero during the course of inspiration. Decelerating flow is a typical feature of a pressure-oriented ventilation mode.The difference in pressure between the pressure in the lung (alveoli) and the pressure in the breathing system, maintained by the ventilator at a constant level, provides the driving force for the flow.As the filling volume in the lung increases the pressure in the lung also rises. In other words, the pressure difference and thus the flow drop continuously during inspiration. At the end of inspiration the pressure in the lung is equal to the pressure in the breathing system, so there is no further flow.If at the end of inspiration and at the end of expiration flow =0, compliance can also be calculated in a pressure-oriented ventilation mode using the V Tmeasured by the ventilator.C = V T /∆Pwhere ∆P = P insp.- PEEPVolume-time diagramThe volume-time diagram shows the gradual changes in the volume transferred during inspiration and expiration. Volume is usually given in ml and time in seconds.During the inspiratory flow phase the volume increases continuously. During the flow pause (plateau time) it remains constant as there is no further volume entering the lung. This maximum volume value is an index of the transferred tidal At the end of inspiration the pressure in the lung is equal to the pressure in the breathing system, so there is no further flow.Ventilation curve patterns13 volume and does not represent the entire volume inthe lung. The functional residual capacity (FRC) isnot taken into account. During expiration thetransferred volume decreases as a result of passiveexhalation.The relationships between pressure, flow andvolume are particularly obvious when theseparameters are all displayed at the same time.Pressure, flow and volumediagram of volume-orientedand pressure-orientedventilationVentilation curve pattern14patternsincreasing compliance→plateau and peak pressuresfalldecreasing compliance→plateau and peak pressuresriseVentilation curve pattern15remains the same.increasing resistance→peak pressure risesdecreasing resistance→peak pressure fallsThe expiratory lung resistance cannot be seen on the pressure curve as the alveolar pressure would need to be known. Conclusions can be drawn however from the expiratory flow curve (see «Flow curve at increased expiratory resistances»).The expiratory lung resistance cannot be seen on the pressure curve as the alveolar pressure would need to be known.Ventilation curve pattern16or, even better, changing to a mode of ventilationwhere the patient is allowed to breathe spontaneouslyeven during a mandatory breath, is an option worththinking about. BIPAP or AutoFlow®are examples ofsuitable modes.Ventilation curve pattern17applying the set tidal volume at the lowest possibleairway pressure. The constant flow typical of volume-oriented ventilation modes (square) becomes at thesame time a decelerating flow form, while tidalvolume remains constant even if the compliance inthe patient’s lung changes.Pressure limitation at a constant tidal volume canalso be achieved in Dräger ventilators by using theP max setting. If the compliance of the patient changesthis set value may need to be checked and reset.Ventilation curve pattern18apply the volume which could be achieved for the setpressure.Ventilation curve pattern19This results in an increase in lung pressure in thecase of volume-controlled ventilation.In Evita ventilators it is possible to measure intrinsic PEEP and trapped volume directly. An intrinsic PEEP can have considerable effects on the exchange of gases and pulmonary blood circulation.In some applications, however, there may be attempts to establish an intrinsic PEEP on purpose (Inverse Ratio Ventilation IRV), due to the fact that this will probably then only occur in certain desired sections of the lung, while a PEEP set on the ventilator will affect the entire lung.In Evita ventilators it is possible to measure intrinsic PEEP and trapped volume directly.Ventilation curve pattern20increased expiratory resistances which may be causedby expiratory filters which have become damp orblocked as a result of nebulization. This may lead to aconsiderable increase in expiration time and adeviation from the set PEEP value.21 Loops – a good thing all roundPV Loops The static PV loop (classic)The static PV loop (pressure-volume curve) is obtainedas a result of the «super-syringe» method, and is usedpredominantly in scientific papers [1]. Most of what isknown about the PV loop is thus based on this method.The most important feature of this PV loop is that theindividual points of measurement (pressure andvolume) are recorded when breathing gas flow=0.Using a super-syringe, the volume in the lung isincreased step by step. A few seconds after eachincrease in volume the resulting pressure is measured[2]. By connecting the individual points the PV loop iscreated.Loops – a good thing all round 22The relationship of volume to pressure reflects compliance (C = ∆V/∆P). Thus the PV loop shows how compliance develops as volume increases. The lower and upper inflection points can be taken from the PV loop. When the super-syringe method is used the volume measured value does not return to zero during expiration, but the reasons for this are as yet not entirely clear. However, errors in measurement and oxygen consumption during measurement play a significant role [2].In the lower section (A) the pressure per volume increase rises particularly rapidly and only continues in a straight line (B) once a lung-opening pressure (lower inflection point) has been exceeded. If the lung reaches the limits of its compliance, the rise in pressure per volume increase becomes bigger again (upper inflection point) (C).It is generally accepted that ventilation should take place as far as possible within the linear compliance area (B), as dangerous shear forces occur as a result of the collaborating and reopening of individual areas of the lung. The lower inflection point can be overcome by setting a PEEP. The ventilation volume (in IPPV/CMV, SIMV) or inspiratory pressures (in BIPAP, PCV) must then be selected such that the upper inflection point will not be exceeded.Dynamic PV loops in ventilationPV loops which are generated during ventilationdo not fulfil the condition that at the time whenthe individual measured values are recorded the breathing gas flow should equal zero. The breathing gas flow generates an additional pressure gradient due to the inherent resistances like tube, airways etc. (see also page7).PV-Loop with upper and lower inflection point.Since ventilators open the exhalation valve either to ambient pressure or set PEEP at the beginning of expiration, the pressure displayed by the PV loop also falls almost immediately to this value.In the static PV loop, on the other hand, the reduction is again a gradual process.As regards the PV loop obtained for controlled ventilation it can generally be said that the slower the lung is filled the better the rising branch reflects the course of compliance.A number of studies and publications have shown that PV loops recorded during the course of ventilation correlate well with loops from standard procedures, so long as the inspiratory flow is constant [3]. The studies are based on the assumption that the drop in pressure resulting from inspiratory resistances will also remain constant at constant flow, and that the steepness of the inspiratory loop will thus reflect only the elastance of thorax and lung. Although as a result the PV loop recorded by the ventilator is offset (the rising branch shifts position), it otherwise retains its original shape, on the basis of which conclusions can be drawn about compliance.This also shows that in ventilation modes with decelerating flow (BIPAP, PCV etc.) it is not possible to draw conclusions from the PV loop concerning the development of compliance of the lung.In ventilation modes with decelerating flow (BIPAP, PCV etc.) it is not possible to draw conclusions from the PV loop concerning the development of compliance of the lung.Volume-controlled ventilation with constant flowDuring inspiration the lung is filled with a preselected constant flow of gas, during which process thepressure in the breathing system gradually increases.The pressure in the lung increases to the same extent and, at the end of inspiration, reaches the same value as the pressure in the breathing system (plateau pressure).During expiration the ventilator opens theexhalation valve wide enough to maintain the level of PEEP set. Due to the pressure difference, which is now inverted (pressure in the lung greater than PEEP pressure), the breathing gas now flows out of the lung and the lung volume slowly falls. This is why PV loops during controlled ventilation run anti-clockwise.Interpretation of PV loops in ventilation.Even during pressure-controlled ventilation thePV loops run anti-clockwise. However, in this case the lung is not filled with an even gas flow. At the beginning of inspiration the ventilator generates a greater pressure in the ventilation system than in the lung, which is then kept constant by the ventilator throughout the entire inspiration. As a result of this difference in pressure air flows into the lung and the volume of the lung slowly increases. As the volume increases the pressure in the lung also rises and the difference between the lung pressure and the pressure in the breathing system becomes smaller.Since due to the laws of physics the difference in pressure determines the resulting breathing flow,the breathing flow becomes ever smaller during inspiration, thus creating a decelerating flow.The pressure in the breathing system is kept at a constant level by the ventilator throughout inspiration, giving the PV loop during pressure-controlled ventilation a more or less box-like shape.about the course of lung compliance. When the breathing gas flow is equal to zero at the end of inspiration, however, the steepness of a line drawn between the start of inspiration (A) and the point at the end of inspiration (B) does represent a measure of dynamic compliance. This presupposes, however, that flow equals zero both at the end of inspiration and at the end of expiration.CPAP spontaneous breathingIn spontaneous breathing the PV loops run clockwise. The patient’s inspiratory effort creates a negative pressure in the lung, which then has an effect in the breathing system where the pressure is measured byenough breathing gas to ensure that the set CPAP pressure is maintained at a constant level, although a slight negative deviation is inevitable. The area to the left of an imaginary vertical axis (A) at the set CPAP pressure is thus a measure of the patient’s efforts to combat the inspiratory resistances of the ventilator.PV loop in CPAP with ASB/P.supp.A characteristic feature of respiratory support synchronized with the inspiratory effort of the patient (ASB/P.supp., SIMV etc.) is a small twist just above the zero point. The patient first generates a negative pressure in the lung. Once the trigger threshold has been passed, however, the ventilator generates a positive pressure in the breathing system. The area to the left of the vertical axis which is enclosed by the small twist (A) is a measure of how much work the patient needs to do to trigger the ventilator. The area to the right of the axis (B) represents the work done by the ventilator to support the patient, in so far as thePV loops in the case of compliance changesAs compliance decreases, in other words as the lung becomes less elastic, and the ventilator settings remain the same, the PV loop in volume-controlled ventilation takes an increasingly flat course.The change in steepness of the inspiratory branch of the PV loop is proportional to the change in lung compliance.PV loops in the case of resistance changesIf resistance changes during constant flow ventilationIf during constant flow ventilation the loop startsto become flatter in the upper part of the inspiratory branch, then this could be an indication of over-extension of certain areas of the lung. See alsoLoops – a good thing all round33PV loop in ASB/P.supp.If during ASB/P.supp. the patient is only able tomanage the trigger impulse and then does notcontinue to breathe, then only a volume equal to thesupport pressure in accordance to current lungcompliance will be reached. However, if the patientcontinues an inspiratory effort throughout the entiresupport phase then he or she will be able to inhalegreater volumes, whilst the support pressureremaining unchanged.A change in the height of the PV loop is thus aset pressure support (without the patient’s ownbreathing) is smaller than the patient’s individualneeds. On the other hand, the support pressure shouldat least compensate for the artificial airwayresistances (tube) (see also «PV loops before and afterthe tube»).Loops – a good thing all round 34PV loops before and after the tube The PV loop measured by the ventilator gives only half the picture. As described in the section «dynamic PV loop», further pressure drops occur after the point where the ventilator takes the pressure measurement (Y-piece) e.g. across the tube length and the physio-logical airways. PV loop in CPAP before and after the tube The PV loop displayed by the ventilator shows a narrow loop for purely spontaneous patient breathing at an increased pressure level (CPAP). The narrower the area to the left of the vertical axis, the less additional work of breathing needs to be done to combat the ventilator’s inspiratory resistances. The area to the right of the axis, on the other hand, is only deter-mined by the expiratory resistances of the ventilator.The entire area which the loop encompasses is thus at the same time a measure of the quality of the ventilator, although it should be remembered that for the purposes of a direct comparison of ventilators the same system of measurement needs to be used for all ventilators, since the specifications of the various systems may differ considerably from one another. A further consideration is the fact that some ventilators apply a small additional support pressure (some 3mbar) even when no support pressure has been set,thus making a direct comparison no longer possible.The narrower the area to the left of the vertical axis, the less additional work of breathing needs to be done to combat the ventilator’s inspiratory resistances.Loops – a good thing all round35less work of breathing for the patient is not correct inevery case.A comparison with a loop recorded directly afterthe tube shows that this loop covers a considerablygreater area. Due to the comparatively small diameterof the tube the patient must do considerably morework of breathing.Loops – a good thing all round36has to work to combat the tube’s resistance [4], a factwhich is shown by the different area covered by theloops recorded after the tube.A PV loop taken downstream from pathologicallyincreased airway resistances would cover an evenLoops – a good thing all round37Assistance from pressure support (ASB)Increased airway resistances, whether caused bydisease or intubation, thus result in increased work ofbreathing for the patient.The reason for setting assisted spontaneous breath-ing (ASB/P.supp.) is generally to try to compensate forthese airway resistances. A comparison with loopsrecorded during CPAP shows that the area of the looptaken after the tube can also be reduced withvertical line of the CPAP set value, the tube resistancewill only just be compensated for. If the inspiratorybranch lies to the right of the CPAP line then supportis provided above and beyond merely compensating forthe tube resistance, thus compensating for possiblepathological resistances in the lower airways. If theLoops – a good thing all round38support pressure is inadequate and the patient isbeing forced to inhale, however, negative pressuremay still occur at the distal end of the tube.Unfortunately, the PV loop at the distal end of thetube is not usually available. Taking a pressuremeasurement at the tip of the tube is also extremelyprone to errors due to the collection of secretion andmucous etc. An incorrect measurement could theneasily result in misinterpretations.However, research is underway to find ways toimprove this situation.For the time being we have to estimate theoptimal pressure support to compensate for airwayresistances.Loops – other possibilitiesIn addition to pressure-volume (PV) loops, othercombinations of parameters are also possible. Some ofthese are already used in pulmonology but are notparticularly widespread in intensive care medicine.Some diagnostic procedures require the patient’scooperation.Flow-volume loopThe flow-volume loop is occasionally used to obtaininformation about airway resistance, when aspirationshould be carried out and about the patient’s reactionto bronchial therapy.Increased airway resistances as a result of sputumetc. can in many patients be recognized by a saw-toothed-shape loop. A smoother loop then verifies thatmeasures such as suctioning which have been takento improve airway resistance have been successful. [5]In patients with obstructive diseases the expiratorybranch of the loop only changes shape when the setLoops – a good thing all round39 PEEP is greater than intrinsic PEEP. The fact that theshape of the loop does not change, however, does notnecessarily have anything to do with flow limitation.[1]40Trends reviewedGraphic trend displays enable ventilation processes tobe assessed at a later stage, with the development ofcontinuously measured values displayed in graphicform. Trend displays may be of interest in a variety ofdifferent applications, and each application willrequire a different period of observation. For instance,for assessing a process of weaning, several days oreven weeks will need to be displayed in one diagram,while an event which occurs suddenly calls for asmuch detail as possible to be shown in the diagram.The areas of application for trend displays in ventilationare extremely varied due to the wide range of possiblecombinations of the individual parameters. Thefollowing are just a few examples, designed to makethe reader think of further possible applications.Trends reviewed41was reduced there was a drop in minute volume (MV),although this drop was compensated for after a shorttime by the MV (MVspont.) spontaneously breathed bythe patient.Trends reviewed42pressure support was reduced. Initially this reductionwas also compensated for by the patient, though lateron a lasting reduction in MV can be seen, after whichthe ventilator support was once again increased.。
临床小讲课技巧ppt课件
授 课 准 备（二）
授课方法 ➢听课主体：演示、情景模拟、讨 论、讲授、护理查房等 ➢题目决定：纯理论、现场示范、 理论结合操作、视频等
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授 课 准 备（三）
资料收集 ➢专业书籍 ➢上网搜索 ➢图书馆 ➢经验总结
6
授 课 准 备（四）
课件制作（PPT） ➢合适的幻灯片模版 ➢字体设计 ➢标题清晰 ➢内容简明扼要、重点突出 ➢适当图片或动画
7
现场授课
➢个人仪表 ➢熟练、脱稿最好 ➢声音洪量、表达清晰 ➢适当交流互动 ➢突出重点、难点 ➢注意时间把握
8
个人分享
➢善于发现问题，寻求解决 ➢善于收集临床资料 ➢善于总结
小讲课就在身边！
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10
Байду номын сангаас
临床小讲课技巧
1
分享主要内容
➢了解小讲课 ➢授课准备 ➢现场授课
2
小讲课特点
➢一种常用临床教学方法 ➢结合专业实际开展理论教学 ➢注重运用理论知识解决临床实际问题 ➢提高临床授课能力 ➢开阔思维、补充教材与理论的不足
3
授 课 准 备（一）
题目设计 ➢新知识、新技术 ➢新理念、新观点 ➢目前需要解决的问题 ➢以点切入，横向延伸
2024年小讲课阑尾炎课件
2024年小讲课阑尾炎课件一、教学内容本节课选自《人体生理学》第九章“消化系统疾病”的第三节“急性阑尾炎”。
详细内容主要包括：阑尾的结构与功能，急性阑尾炎的病因、病理生理、临床表现、诊断及治疗。
二、教学目标1. 了解阑尾的结构和功能，掌握急性阑尾炎的病因和病理生理。
2. 掌握急性阑尾炎的临床表现，学会诊断及鉴别诊断。
3. 了解急性阑尾炎的治疗原则，提高学生的临床思维能力和实践操作技能。
三、教学难点与重点难点：急性阑尾炎的病理生理和诊断。
重点：急性阑尾炎的病因、临床表现和治疗。
四、教具与学具准备1. 教具：PPT课件、阑尾模型、病理切片、诊疗视频。
2. 学具：笔记本、教材、阑尾炎病例分析。
五、教学过程1. 导入：通过一个病例，让学生了解急性阑尾炎的危害，激发学习兴趣。
2. 讲解：（1）阑尾的结构与功能。
（2）急性阑尾炎的病因、病理生理。
（3）急性阑尾炎的临床表现、诊断与鉴别诊断。
（4）急性阑尾炎的治疗原则及方法。
3. 实践情景引入：分析病例，让学生进行诊断和鉴别诊断。
4. 例题讲解：讲解典型病例，引导学生掌握急性阑尾炎的诊断和治疗。
5. 随堂练习：设计相关问题，巩固所学知识。
六、板书设计1. 阑尾炎的定义、病因、病理生理。
2. 急性阑尾炎的临床表现、诊断、鉴别诊断。
3. 急性阑尾炎的治疗原则。
七、作业设计1. 作业题目：（1）简述阑尾的结构和功能。
（2）列举急性阑尾炎的病因、临床表现。
病例：患者，男，20岁。
近日来出现右下腹疼痛，呈持续性，伴恶心、呕吐。
查体：体温38.5℃，右下腹压痛明显，反跳痛阳性。
答案：（1）阑尾是位于盲肠末端的一个小器官，具有免疫功能。
（2）病因：阑尾腔内阻塞、细菌感染等。
临床表现：右下腹疼痛、恶心、呕吐、发热等。
（3）诊断：急性阑尾炎。
治疗方案：手术切除阑尾，抗感染治疗。
八、课后反思及拓展延伸1. 反思：本节课是否达到了教学目标，学生的掌握程度如何，有哪些需要改进的地方。
《GERD治疗》PPT课件
指内镜下可见食管远段黏膜破损
Barrett 食管(Barrett’s esophagus, BE)
指食管远段的鳞状上皮被柱状上皮所取代
医学PPT
GERD 治疗目的
GERD治疗目的
缓解症状、治愈食管炎 •烧心 •反酸 •治愈食管炎
100
８周ＲＥ愈合率(％)
80
60
40
20
0
2
4
6
8 10 12 14 16 18 20 22
胃内pH＞4的时间（小时）
胃内pH值维持在4以上的时间与8周后患者的治愈率呈线性相关，
时间越长，愈合率越高
医学PPT
1、Joelsson B, et al.Gut 1989;30:1523-5.
2、Ael, et al.Digestion 1992;51 Suppl 1:59-67.
促动力药单独使用疗效不理想，可与抑酸药 合并应用
医学PPT
引起酸反流最主要的机制TLESR
咽部
40
(mmHg)
0
7
pH
4
1
40
LES
(mmHg)
0
10-30 s
胃内压
20
(mmHg)
0
30 sec 医学PPT
4-8 s
TLESRs调节机制
食管纵行肌收缩 选择性抑制膈角
LES长时间完全松弛 膈肌
Grade B
Grade C
Grade D
医学PPT
Sjöstedt et al Gut 2004
抑酸对GERD的治疗小结
目前最有效的治疗方法 PPI效果优于其他抑酸剂 常规剂量无效时可考虑加倍剂量 食管外表现、夜间酸突破、Barrett可考虑加
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GSRS
GerdQ
评估GERD患者生活质量
GIS
监测GERD治疗效果
RDQ：Reflux Disease Questionnaire，反流病问卷 GSRS：Gastrointestinal Symptom Rating Scale，胃肠道症状评定量表 GIS：GERD Impact Scale，胃食管反流病影响量表 1. Jones R, et al, Aliment Pharmacol Ther. 2009 Nov 15; 30(10):1030-8. Epub 2009 Sep 8.
GerdQ拓展了RDQ的功能1
减少诊断时间
功能 设计简单
GerdQ
RDQ
避免延误治疗时机
诊断率高 生活质量 治疗监测
关注患者生活质量
方便评估疗效
症状频率 严重程度
符合蒙特利尔定义
1. Jones R, et al, Aliment Pharmacol Ther. 2009 Nov 15; 30(10):1030-8. Epub 2009 Sep 8.
11-18分
1. Jones R, et al, Aliment Pharmacol Ther. 2009 Nov 15; 30(10):1030-8. Epub 2009 Sep 8.
GerdQ全面管理GERD患者的工具1
结果
1
初诊患者
+ + + + ---+ + + + ---+ + + + ----
【包装和价格】
（1）耐信20mg*7片（￥98） （2）耐信40mg*7片（￥140）
*价格为现阶段国家批准零售价
上述简短处方资料摘自药品 使用说明书，详细内容请参 见药品使用说明书全文。 仅供医学专业人士参考
谢 谢！
GerdQ的敏感性和特异性与 消化专科医师水平一致1
72 70 68 66 64 62 60 65 63 63 67
%
Байду номын сангаас
71
71
敏感性 特异性
58
GerdQ 消化专科医师 社区医师
1. Jones R, et al, Aliment Pharmacol Ther. 2009 Nov 15; 30(10):1030-8. Epub 2009 Sep 8.
典型烧心和反流症状使患者感到不适 即可拟诊为GERD1
1. Vankil N,et al. Am J Gastroenterol.2006;101:1900-1920. 2. Jones R,et al, Aliment Pharmacol Ther. 2009 Nov 15;30(10):1030-8. Epub 2009 Sep 8. 3. Labenz J et al. Am J Gastroenterol. 99;1652-6(2004). 4. Papa A, Urgesi R,Grillo A et al. Minerva Gastroenterol Dietol. 2004 Sep,50(3):215-26.
GerdQ经过严格的有效性验证1 、2
DIAMOND STUDY
由J Dent, N Vakil 等国际知名 消化专家负责的DIAMOND研究， 对GerdQ进行了严格的有效性验证
1. Jones R, et al, Aliment Pharmacol Ther. 2009 Nov 15; 30(10):1030-8. Epub 2009 Sep 8. 2. Halling K, et al. GUT 2007;56 (Suppl III):A209, abstract TUE-G-88 and poster presented at UEGW 2007, Paris.
GerdQ的诊断精确性达到消化专科医师 水平1
GerdQ比RDQ具有更高的精确性
敏感性 （100％敏感性指该试验能够分辨出所有患病者）
特异性 （100％特异性指该试验能够区分出所有未患病者） 1. Jones R, et al, Aliment Pharmacol Ther. 2009 Nov 15; 30(10):1030-8. Epub 2009 Sep 8.
确定GERD诊断 评估对生活质量影响
复诊患者
监测治疗效果
2
PPI 治疗患者
监测治疗效果
1. Jones R, et al, Aliment Pharmacol Ther. 2009 Nov 15; 30(10):1030-8. Epub 2009 Sep 8.
GerdQ－诊断GERD简单有效1
－初诊患者：A+B+C≥8分，提示GERD诊断
GerdQ
(胃食管反流病诊断问卷)
GerdQ是诊断及评估胃食管反流病最简单有效的工具
内容提要
GERD是以症状为诊断基础的疾病 GerdQ是诊断及评估胃食管反流病最简单有效 的工具
胃食管反流病(GERD)是以症状为 诊断基础的疾病
1. Vankil N,et al. Am J Gastroenterol.2006;101:1900-1920.
GerdQ－评估GERD患者生活质量1
－初诊患者：C≥3分，提示GERD影响生活质量
回忆，过去的7天当中
从无 A 烧心 反流 上腹部疼痛 B 0 0 3
1天 1 1 2
2-3天 2 2 1
4-7天 3 3 0
恶心
睡眠障碍
3
0 0
2
1 1
1
2 2
0
3 3
C
OTC用药
1. Jones R, et al, Aliment Pharmacol Ther. 2009 Nov 15; 30(10):1030-8. Epub 2009 Sep 8.
回忆，过去的7天当中
从无 烧心 A 反流 上腹部疼痛 B 恶心 睡眠障碍 C OTC用药 0 3 3 0 0 0
1天 1 1 2 2 1 1
2-3天 2 2 1 1 2 2
4-7天 3 3 0 0 3 3
1. Jones R, et al, Aliment Pharmacol Ther. 2009 Nov 15; 30(10):1030-8. Epub 2009 Sep 8.
以症状为基础的问卷诊断GERD更简单有效
GerdQ的诊断精确性达到消化专科医师水平
GerdQ全面管理GERD患者的工具
初诊病人：提高GERD诊断率及评估GERD 患者的生活质量 复诊PPI治疗患者:监测GERD治疗效果
耐信简明处方资料
【药品名称】
通用名称：埃索美拉唑镁肠溶片
【适应症/用法用量】
胃食管反流性疾病(GERD) —糜烂性反流性食管炎的治疗 40mg每日一次，连服四周。 对于食管炎未治愈或持续有症状的患者建议再服药治疗四周。 —已经治愈的食管炎患者防止复发的长期维持治疗 20mg每日一次。 —胃食管反流性疾病(GERD)的症状控制 没有食管炎的患者20mg每日一次。如果用药4周症状未获控制，应对患者作进一步的检查。 一旦症状消除，随后的症状控制可采用按需疗法，即需要时口服20mg，每日一次。 与适当的抗菌疗法联合用药根除幽门螺杆菌，并且 —愈合与幽门螺杆菌相关的十二指肠溃疡 —预防与幽门螺杆菌相关的消化性溃疡复发 埃索美拉唑镁肠溶片20mg+阿莫西林1g+克拉霉素500mg，每日二次，共7天。 药片应和液体一起整片吞服，而不应当咀嚼或压碎。
GerdQ评分越高 GERD诊断精确性越高1
100 90 患者百分数（％） 80 70 60 50 40 30 20 10 0
0 0 0 31.1 21.5
符合GERD诊断 符合病理性反酸
77.3
86.9
符合食管炎诊断
51.9 53.6 48.5
62.3
60.7
0-2分
3-7分 GerdQ评分
8-10分
胃食管反流病问卷GerdQ—— 全面管理GERD患者的工具1
1. Jones R,et al, Aliment Pharmacol Ther. 2009 Nov 15;30(10):1030-8. Epub 2009 Sep 8.
GerdQ的设计更简单更科学1
RDQ
总共6个问题 4级评分系统 从无 1天 2-3天 4-7天 总分：0分-18分 增加GERD诊断的准确性 阳性：烧心, 反流, 睡眠 障碍, OTC药物治疗 阴性：上腹部疼痛, 恶心
GerdQ－监测GERD治疗效果1
－复诊PPI治疗患者：A与C任何一项评分≤1，提示治疗有效 A与C任何一项评分≥2，提示治疗方案需调整
回忆，过去的7天当中
从无
1天
2-3天
4-7天
烧心
A 反流 上腹部疼痛 B 恶心 睡眠障碍 C OTC用药
0
0 3 3 0 0
1
1 2 2 1 1
2
2 1 1 2 2
3
3 0 0 3 3
1. Jones R, et al, Aliment Pharmacol Ther. 2009 Nov 15; 30(10):1030-8. Epub 2009 Sep 8.
结
论
GERD是一种以症状为基础诊断的疾病
典型的烧心和反流症状使患者感到不适就可以拟诊为胃食管反流病
GerdQ是诊断及评估胃食管反流病最简单有效的工具