临床执业医师考试大纲复习预防医学名师辅导讲义

1、临床执业医师考试大纲复习预防医学名师辅导讲义第十篇 预防医学第1章 绪论考纲要求预防医学的概述：定义，内容，特点。健康及其影响因素：当代健康观，影响健康的主要因素，健康决定因素生态学模型。三级预防策略：疾病自然史与预防机会，三级预防策略（第一级预防、第二级预防、第三级预防）。复习要点1预防医学的概述 （1）定义预防医学是医学的一门应用学科，它以个体和确定的群体为对象，目的是保护、促进和维护健康，预防疾病、失能和早逝。其工作模式是“环境-人群-健康”。它强调环境与人群的相互依赖、相互作用和协调发展，并以人群健康为目的。（2）内容 预防医学的内容包括医学统计学、流行病学、环境医学、社会医学、行为科

2、学与健康促进、卫生管理学，以及在临床医学中运用三级预防措施。（3）特点 预防医学不同于临床医学，其特点为：预防医学的工作对象包括个体及确定的群体，主要着眼于健康和无症状患者。研究方法上注重微观和宏观相结合，但更侧重于影响健康的因素与人群健康的关系。 采取的对策更具积极的预防作用，具有较临床医学更大的人群健康效益。2健康及其影响因素 （1）当代健康观 1986年，who提出了健康的新定义：“健康是日常生活的资源，而不是生活的目标。健康是一个积极的概念，它不仅是个人素质的体现，也是社会和个人的资源”。“为达到身心健康和较好地适应社会的完美状态，每个人都必须有能力去认识和实现这些愿望，努力满足需求和

3、改善环境”。（2）影响健康的主要因素 有4大类：社会经济环境 包括个人收入和社会地位、文化背景和社会支持网络、教育、就业和工作条件。物质环境 包括生活和职业环境中的物理、化学、生物因素及建筑环境等，都是影响人们健康的重要因素。 个人因素 包括健康的婴幼儿发育状态、个人卫生习惯、个人的能力和技能，人类生物学特征和遗传因素。 卫生服务 对人群健康有重要促进作用。（3）健康决定因素生态学模型强调个体和人群健康是个体因素、卫生服务、物质和社会环境因素相互依赖、相互作用的结果。它是总结和指导预防医学和公共卫生实践的重要理论模型。该模型的结构从内至外分为5层： 第一层 即核心层，是先天的个体特质，如年龄、

4、性别、种族、其他生物学因素和疾病易感基因等。第二层 为个体行为特点。第三层 是社会、家庭和社区的人际网络。第四层 是生活和工作条件，包括心理社会因素、是否有工作及职业因素、社会经济地位、自然和人造环境、公共卫生服务、医疗保健服务等。第五层 即最外层（宏观层面），是全球水平、国家水平乃至当地的社会、经济、文化、卫生和环境条件，以及有关的政策等。3三级预防策略 （1）疾病自然史 疾病自然史 疾病从发生到结局（死亡或痊愈）的全过程称为疾病自然史。可分为病理发生期、症状发生前期、临床期、结局4个明确的阶段。健康疾病连续带（hdc） 是指一个人从“健康疾病健康（或死亡）”的连续过程。预防机会 根据疾病自

5、然史的几个阶段，以及健康疾病连续带理论，危险因素作用于机体到疾病临床症状的出现，有一个过程，从而为疾病的预防留出了时间。（2）预防机会 根据疾病自然史的阶段性和健康疾病连续带理论，危险因素作用于机体到疾病临床症状的出现，有一个时间的过程。这个过程根据危险因素的性质和接触的量，其导致疾病发生的时间有长有短，这样就为我们在疾病的预防上提供了机会，称为预防的机会窗。（3）三级预防策略 第一级预防 又称病因预防。是指针对病因所采取的预防措施。如果在疾病的因子还没有进入环境之前就采取预防性措施，称为根本性预防。第二级预防 在疾病的临床前期做好早期发现、早期诊断、早期治疗的三早预防工作。对于传染病，还需做

6、到疫情早报告及病人早隔离，即五早。第三级预防 对已患病的病人，采取及时、有效的治疗措施，防止病情恶化，预防并发症和伤残。任何疾病，无论其致病因子是否明确，都应强调第一级预防。如大骨节病、克山病等，其病因尚未确定，但综合性的第一级预防还是有效的。又如肿瘤，更需要第一级和第二级预防。有些疾病，病因明确而且是人为的，如职业病、医源性疾病，采取第一级预防，较易见效。常考点 三级预防策略。1a 2b 3参考答案a 4aqcwa3ptgz7r4i30ka1dkaghn3xtkknbycudxqa7fhyi2chhi92tgkqcwa3ptgshls50clmtwn60eo8wgqv7xav2ohum32w

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