遠(yuǎn)程機(jī)器人床邊會(huì)診在基層醫(yī)院兒童重癥醫(yī)學(xué)科（PICU）中的應(yīng)用

應(yīng)勤來(lái)　　張旭　　滕懿群　　朱雯

[關(guān)鍵詞] 遠(yuǎn)程醫(yī)學(xué);機(jī)器人;床邊會(huì)診;PICU

[中圖分類(lèi)號(hào)] R197.324? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1673-9701（2021）20-0017-04

Application of remote robotic bedside consultation in the pediatric intensive care unit （PICU） in primary hospitals

YING Qinlai? ?ZHANG Xu? ?TENG Yiqun? ?ZHU? Wen

The Second Hospital of Jiaxing，Jiaxing? 314000，China

[Abstract] Objective To explore the application value of remote robotic bedside consultation in pediatric intensive care unit （PICU） in primary hospitals. Methods 22 cases of remote robotic bedside consultation were collected in our hospital from July 2018 to December 2019.The case data were retrospectively analyzed and were statistical analyzed.Results The demand rate of consultation was high （condition need： 86.4%）;the cure rate after the consultation was 86.4%，and the consultation satisfaction was 90.9%.The family members of the children patients were in agreement with this type of consultation and the results of consultation. Conclusion The remote robotic bedside consultation in PICU in primary hospitals can enable consultation experts to better understand the condition of critically ill children. Through consultation，the consultation can be carried out in a timely and effective manner，which is conducive to improving the cure and improvement rate of children;at the same time，it can also improve the level of diagnosis and treatment of difficult and critical conditions by PICU physicians in primary hospitals，and accelerate the development of PICU in primary hospitals.

[Key words] Remote medicine;Robots;Bedside consultation;PICU

遠(yuǎn)程醫(yī)學(xué)通常是指通過(guò)計(jì)算機(jī)電子通訊技術(shù)、遠(yuǎn)程遙控技術(shù)，充分發(fā)揮大型醫(yī)學(xué)單位的醫(yī)療技術(shù)和醫(yī)療設(shè)備優(yōu)勢(shì)，對(duì)醫(yī)療衛(wèi)生條件相對(duì)不足的地區(qū)或醫(yī)療單位進(jìn)行遠(yuǎn)距離診斷、治療和咨詢(xún)。

遠(yuǎn)程醫(yī)學(xué)發(fā)展歷史久遠(yuǎn)，從上世紀(jì)50年代末開(kāi)始，美國(guó)學(xué)者Taylor Luisa[1]首先將雙向電視系統(tǒng)用于醫(yī)療，此后，美國(guó)相繼不斷有人利用通訊和電子技術(shù)進(jìn)行醫(yī)學(xué)活動(dòng)。我國(guó)的遠(yuǎn)程醫(yī)療技術(shù)起步偏晚，但發(fā)展迅速。在20世紀(jì)90年代，我國(guó)的通信和電子信息網(wǎng)絡(luò)開(kāi)始發(fā)展，為遠(yuǎn)程醫(yī)學(xué)創(chuàng)造了條件。1993年，“金字工程”被提出，結(jié)合我國(guó)當(dāng)時(shí)國(guó)情，1995年前衛(wèi)生部建立“金衛(wèi)工程”，至今已建立國(guó)家醫(yī)療衛(wèi)生高速信息網(wǎng)絡(luò)，通過(guò)衛(wèi)星、電子通訊、網(wǎng)絡(luò)和多媒體技術(shù)實(shí)現(xiàn)全國(guó)衛(wèi)生機(jī)構(gòu)間的聯(lián)網(wǎng)，建立了多個(gè)遠(yuǎn)程醫(yī)療服務(wù)[2]，為偏遠(yuǎn)地區(qū)和醫(yī)療條件有限的單位的疑難急重癥患者進(jìn)行遠(yuǎn)程會(huì)診，也可以進(jìn)行遠(yuǎn)程的學(xué)術(shù)講座及臨床教學(xué)，推動(dòng)我國(guó)遠(yuǎn)程醫(yī)學(xué)事業(yè)的發(fā)展。

遠(yuǎn)程會(huì)診是遠(yuǎn)程醫(yī)學(xué)中的一種方式，其中遠(yuǎn)程機(jī)器人床邊會(huì)診是一種特殊的遠(yuǎn)程會(huì)診方式。嘉興位于浙江東北部，是上海大都市圈的重要城市，可以間接分享到上海地區(qū)先進(jìn)的醫(yī)療資源。我院兒童重癥醫(yī)學(xué)科（PICU）從2015年設(shè)立，起步較晚，較上海大型專(zhuān)科醫(yī)療單位PICU的醫(yī)療技術(shù)、醫(yī)療設(shè)備、醫(yī)療經(jīng)驗(yàn)有差距。許多危重患兒因?yàn)榻?jīng)濟(jì)問(wèn)題、轉(zhuǎn)運(yùn)條件的限制無(wú)法至上海享受更好的醫(yī)療服務(wù)，PICU患兒多數(shù)伴有意識(shí)障礙，不易移動(dòng)，如需遠(yuǎn)程會(huì)診，優(yōu)先選擇遠(yuǎn)程床邊會(huì)診模式。2018年7月我院兒科與上海市某兒童專(zhuān)科醫(yī)院建立協(xié)作關(guān)系，從2018年7月至2019年12月，共開(kāi)展遠(yuǎn)程會(huì)診107例，其中傳統(tǒng)遠(yuǎn)程視頻會(huì)診85例（圖1），遠(yuǎn)程機(jī)器人床邊會(huì)診22例（圖2）?，F(xiàn)對(duì)22例遠(yuǎn)程機(jī)器人床邊會(huì)診的情況進(jìn)行回顧性調(diào)查，以探討遠(yuǎn)程機(jī)器人床邊會(huì)診在兒童重癥醫(yī)學(xué)科的應(yīng)用價(jià)值。