快跑快跑,后面有狗追

快跑快跑,后面有狗追 故事小说 今天在路上走，两个熊孩子牵着手一起走 其中一个回头看了看，对另一个说说:快跑快跑，后面有狗追。 小孩子就欢快的一起跑了。 我也回头看了看，他们后面貌似只有我。 为科学有效地进行危重病的临床和科研工作,必须有衡量危重患者病情严重程度,并被不同国家、不同医院普遍接受的标准,这种标准称为危重病预后评分系统。 1 危重病评分的临床应用现状 危重疾病评分方法的应用目的为定量评估疾病的严重程度和预测疾病或患者死亡的危险性。传统方法将疾病的严重程度分轻、中、重3级;而危重疾病评分法观察患者的急性生理改变、解剖学改变,甚至慢性疾病的病损因素等参数,通过赋值、加权以及逻辑推理和复杂的数学运算,从而客观地量化评价疾病的严重程度。这些量化评估结果对于医生和护士了解和掌握病情,动态观察病情变化非常重要。 探讨评估结果与并发症、病死率、住院时间、药物治疗和医疗护理等方面之间的关系,有利于、提高技术和学术水平,发现疾病发生和发展的客观规律,甚至总结经验教训;另一方面,在危重疾病研究中往往用评分分值作为分组依据;在许多研究中用评分来控制组间条件,从而增加组间的可比性。 危重疾病评分工具的另一作用是用来预测疾病预后或死亡的危险性(Ps)。这类评分工具通常以0.5作为Ps的界点,Ps>0.5为预测存活,Ps<0.5为预测死亡。对于某一群体来说,预测死亡(存活)与实际进行比较,二者越接近,预测效果越大。然而预测病死率主要进行流行病学研究,而为每个患者预测的Ps不能作为是否放 弃治疗的根据。 第二代的APACHE?是迄今为止影响最大的ICU预后评估系统。不论是外科创伤还是内科急症,APACHE?在应用中都得到很高的评价,既可根据评分的高低评价病情的严重程度,又可凭借得出的病死危险度判断患者的预后,是目前临床ICU中应用最广泛、最权威性的危重病情评价系统。虽然在APACHE?的运用中积累了很多成功的经验,但有些参数在我国大多数基层医院不易收集齐。若有些参数缺少,该系统即认为是正常,按此计分多有失误。况且收集各项资料,如某些生化指标,是需要一定测量时间的,往往延误危重患者的抢救。该评估系统目前还存在以下问题: (1)选择的评分指标有很大的主观性,缺乏有力的统计模型来支持。(2)在计算和推测死亡概率方面无能为力。(3)用于群体预测较准确,但用于个体死亡预测则有较大的偏差。 2 中医危重病评分的理论依据 中医学在危重病情的预测和评价方面积累了十分珍贵的经验,中医将疾病变化时出现的危险信号称为败兆,如中医典籍记载: “戴眼反折”为太阳经终信号, “耳聋,百节皆纵,目睘绝系”为少阳经绝死兆。(《素问〃诊要经终论》)五脏绝其败兆显现于五官开窍处,如 “鼻如烟煤,肺气已绝”,鼻火扇为肺竭凶兆,阴竭阳脱的败兆以汗、喘、躁为信号,烦躁为阳脱先兆,汗出不止为阴竭凶兆,息高喘冒为孤阳欲绝死兆。形神相离常常是败兆,如 “破 脱肉,目匡陷,真脏见,目不见人,立死”。(《素问〃玉机真脏论》)面色由晦暗突然转为两颊红赤,如妆如丹,是阴阳离绝,阳气虚脱,孤阳升越的回光返照现象。 “视其目色,以知病之存亡也”。《灵(枢〃四时气》)临床上目陷、目黑、目暴盲皆为三大凶兆。耳缩、耳黑、耳凉及暴聋为四大凶兆。指纹的浮沉长短和色泽变化可 作为内脏气血盛衰信号,如指纹由合谷达风关、气关、命关直射指尖称透关射甲,提示病情危重。总之, “切脉动静而视精明,察五色,观五脏有余不足,六腑强弱,形之盛衰,以此参伍,决死生之分”。(《素问〃脉要精微论》)中医疾病预测学建立在中医脏象理论和经络学说基础上。脏象即 “脏居于内,而形见于外”,内脏有病可见于外,因此通过外在器官变化便能预知内脏的病理情况。由于脏象学说突出了人体内外相应、表里相关、上下互通、背腹呼应的特点,所以疾病的存在和发展不是孤立的。 一个器官有病,其他器官必然会受到波及而有所暴露,因而危重病的一些征兆是可以预测的。经络是脏腑的延伸,经气源于脏气,脏气通过经气互相通应。十二经三百六十五络,内联脏腑外络肢节,网络周身,无所不通。由于经络有高度感应性和传导性,因此体内疾病可以由经络表现出来。而且经络作为疾病传变的桥梁,作为疾病预测手段,往往最早反映体内的病理状况。经络运行气血,构成了中医疾病预测学的物质基础。 中医疾病预测学虽然是以定性观察为主,主观因素影响较大,但其对病情的判断是直觉的、动态的、整体的、宏观的。中医疾病预测学有悠久的历史,广泛地用于医疗实践活动中,在危重病救治中能快速地做出判断,无需借助高精尖设备。中医以直观法收集四诊信息,运用模糊数学概念,对信息的量模拟分级,按量级来判断价值。 3 建立中西医结合的危重病评价体系 现代中医学临床上常以咳、喘、痰、肿、瘀等症状缓解或消失来判断病情的危重程度,部分参考了西医诊断学指标。 2002年版的《中药新药临床研究指导原则》中也可见一些危重病的诊断标准及疗效评价,主要考虑临床症状的变化,所以危重病的程度以患者的症状和体征为主进行客观评价是合理和可行 的。但上述症状和体征等的观察,仍然是医师的观察结果,因此判断内容尚不够全面,也缺乏良好的可操作性。 纵观中医药学发展历史,中医临床实践一直重视患者自身及其与环境、社会的关系,体现整体观念、辨证观念,中医危重病的病情观察也多注重患者感觉、症状变化和改善。但是,为了适应现代医学对于危重病的评价,现代中医领域逐步采用西医的危重病评分系统,可能并不能全面反映中医药的临床治疗效果,甚至无法从根本上阐明中医对危重病治疗的整体概貌。要客观、全面地评价病情,除了应用西医APACHE评分外,中医危重病的临床评价也应是临床预测的主要方面,两者共同构成了危重病的总体评价和预测。因此,需要一种能将两种方法有机结合,使之优势互补,适合我国国情和医疗机构的新的危重病病情评定方法。 因此,根据中医理论、病因病机和临床体征,构建中医危重病评分系统的理论框架,通过反复临床调查、测评,对评分系统的信度、效度和反应度等特性进行考评,最终形成既符合现代医学测量学的又具有中医临床特点的危重病评分量表,以对危重病的病情、预后和临床疗效进行客观评价是可行和必要的。 更多文章 www.msrtys.com 编辑,mswk 1、资料与方法 1.1临床资料 搜集因急性腹痛收治入院的3 268例患者,对其入院情况、诊断、治疗及预后情况进行回顾性分析。约占急诊就诊总人数的29.76%。共有1 747例非创伤性腹痛患者,诊断不明确者214例,1 533例诊断明确的腹痛住院患者纳入研究。其中男780例,女753例,年龄14~93岁,平均38.7岁。 1.2方法 采用回顾性研究的方法,观察2010-10-2013-10收治于我院住院的患者。检索词:根据主诉中“腹痛”的关键词,或入院诊断为“腹 痛待查”的患者。腹痛患者分为初诊即确诊的腹痛和初诊未被确诊的腹痛。初诊即确诊的腹痛定义为:患者以腹痛待查就诊,初次就诊时(包括在我院和在外院就诊)即明确诊断腹痛原因;初诊未被确诊的腹痛定义为:在初次就诊被误诊和(或)未被明确诊断,因治疗效果差而住院诊治的患者。根据既往研究,把腹痛病因分为腹腔脏器病变、腹腔外脏器病变和全身性疾病三种。记录各组病例的诱发因素症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况。 1.3统计学处理 采用SPSS16.0软件进行统计学分析,计数资料以率表示,行χ2检验;计量资料,以珚x±s表达,行方差分析。以P<0.05为差异有统计学意义。 2、结果 研究发现患者发病时间15min~15d,平均20h。引起腹痛的疾病原因有50种。初诊即确诊的腹痛共1 122例(占总例数73.19%),为:急性胰腺炎385例,急性肠梗阻200例,急性胆道病变137例,急性阑尾炎130例,急性胃肠炎110例,胃、十二指肠溃疡95例,均为腹腔脏器病变。 初诊未被确诊的腹痛共411例(占总例数26.81%)。其中腹腔脏器病变引起的腹痛共359例(占总例数23.42%),分别为急性胰腺炎143例,先天性结肠冗长症36例,肠易激综合征36例,肠系膜上动脉压迫综合征引发的十二指肠瘀滞21例,溃疡性结肠炎17例,肠系膜栓塞15例,肠结核13例,克隆病12例,脂肪肝肝病11例,泌尿系结石10例,急性阑尾炎10例,胃癌8例,妇科疾病肿瘤9例,泌尿系感染7例,食管裂孔疝3例,卵巢蒂扭转3例,急性胆道疾病2例,急性出血坏死性肠炎2例,间位结肠1例(见表1)。 这些初诊未确诊的腹痛患者中急性胰腺炎最多,表现存在一定 的不典型性。肠梗阻为表现70例,高血压24例,ARDS 20例,妊娠15例,MODS10例,抑郁症2例,胃癌1例,过敏性紫癜1例(见表2)。腹外脏器病变引起的腹痛共50例(占总例数4.24%)。分别为:急性心梗19例,主动脉夹层18例,胸腔积液6例,(其中结核性胸腔积液5例,炎症性胸腔积液1例),急性心衰2例,肺部感染3例,肺栓塞1例,胸膜炎1例(见表3)。 全身性疾病引起的腹痛共67例(占总例数4.37%)。分别为:过敏性紫癜(腹型)17例,神经官能症17例,重金属中毒23例(急性铊中毒8例,急性汞中毒8例,铅中毒7例),腹型癫痫6例,糖尿病引发的酮症酸中毒3例,尿毒症1例(见表4)。 本研究中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻,2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。 初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为 P<0.01,差异有统计学意义见表。 3、讨论 急性腹痛是急诊患者最常见的主诉之一,引起腹痛的原因复杂 。如何对急性腹痛进行全面准确的诊断,是急诊医生面临的重要课题。统计我院2010-10-2013-10急诊门诊患者的相关资料显示,本研究中全部腹痛患者占就诊人数的29.76%,非创伤性腹痛患者约占就诊腹痛患者的1/2,与国外报道一致。本研究显示急性非创伤性腹痛的患者中急性胰腺炎的发病率最高,其次为急性肠梗阻,与国内外文献报道略有不同。国内外文献报道非创伤性急性腹痛的疾病多以急性胃肠炎、急性阑尾炎、急性胆道疾病、泌尿系结石、急性胰腺炎、急性肠梗阻、溃疡病穿孔等最为常见。造成这种差别的原因之一可能为本研究的研究对象为急诊内科病房住院患者,而文献中的研究对象则包括所有急 诊就诊的患者,包括急诊门诊就诊的和住院的患者;造成这种差别的原因之二是本研究中急性胃肠炎大多在急诊留观得以诊治而无需住院治疗,急性阑尾炎、急性胆道疾病、泌尿系结石则大多于外科急诊就诊,并行手术治疗,也未在本研究的范围之内,这也是本研究腹痛患者以急性胰腺炎比例最高的原因;造成这种差别的原因之三考虑是我院作为三级甲等医院,一般多接诊下级医院因诊疗效果不佳转往上级医院的患者。 急性胰腺炎引起腹痛患者误诊分析。初诊未被确诊的腹痛也以急性胰腺炎比例最高,可见急诊医生应把急性胰腺炎作为急诊腹痛的常见病加以掌握。本研究发现符合中国胰腺炎诊治指 南推荐诊断标准的胰腺炎初诊较易确诊,有385例。 1、资料与方法 1.1临床资料 搜集因急性腹痛收治入院的3 268例患者,对其入院情况、诊断、治疗及预后情况进行回顾性分析。约占急诊就诊总人数的29.76%。共有1 747例非创伤性腹痛患者,诊断不明确者214例,1 533例诊断明确的腹痛住院患者纳入研究。其中男780例,女753例,年龄14~93岁,平均38.7岁。 1.2方法 采用回顾性研究的方法,观察2010-10-2013-10收治于我院住院的患者。检索词:根据主诉中“腹痛”的关键词,或入院诊断为“腹痛待查”的患者。腹痛患者分为初诊即确诊的腹痛和初诊未被确诊的腹痛。初诊即确诊的腹痛定义为:患者以腹痛待查就诊,初次就诊时(包括在我院和在外院就诊)即明确诊断腹痛原因;初诊未被确诊的腹痛定义为:在初次就诊被误诊和(或)未被明确诊断,因治疗效果差而住院诊治的患者。根据既往研究,把腹痛病因分为腹腔脏器病变、腹腔外脏器病变和全身性疾病三种。记录 各组病例的诱发因素症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况。 1.3统计学处理 采用SPSS16.0软件进行统计学分析,计数资料以率表示,行χ2检验;计量资料,以珚x±s表达,行方差分析。以P<0.05为差异有统计学意义。 2、结果 研究发现患者发病时间15min~15d,平均20h。引起腹痛的疾病原因有50种。初诊即确诊的腹痛共1 122例(占总例数73.19%),为:急性胰腺炎385例,急性肠梗阻200例,急性胆道病变137例,急性阑尾炎130例,急性胃肠炎110例,胃、十二指肠溃疡95例,均为腹腔脏器病变。 初诊未被确诊的腹痛共411例(占总例数26.81%)。其中腹腔脏器病变引起的腹痛共359例(占总例数23.42%),分别为急性胰腺炎143例,先天性结肠冗长症36例,肠易激综合征36例,肠系膜上动脉压迫综合征引发的十二指肠瘀滞21例,溃疡性结肠炎17例,肠系膜栓塞15例,肠结核13例,克隆病12例,脂肪肝肝病11例,泌尿系结石10例,急性阑尾炎10例,胃癌8例,妇科疾病肿瘤9例,泌尿系感染7例,食管裂孔疝3例,卵巢蒂扭转3例,急性胆道疾病2例,急性出血坏死性肠炎2例,间位结肠1例(见表1)。 这些初诊未确诊的腹痛患者中急性胰腺炎最多,表现存在一定的不典型性。肠梗阻为表现70例,高血压24例,ARDS 20例,妊娠15例,MODS10例,抑郁症2例,胃癌1例,过敏性紫癜1例(见表2)。腹外脏器病变引起的腹痛共50例(占总例数4.24%)。分别为:急性心梗19例,主动脉夹层18例,胸腔积液6例,(其中结核性胸腔积液5例,炎症性胸腔积液1例),急性心衰2例,肺部感染3例,肺栓塞1例,胸膜炎1例(见表3)。 全身性疾病引起的腹痛共67例(占总例数4.37%)。分别为:过敏性紫癜(腹型)17例,神经官能症17例,重金属中毒23例(急性铊中毒8例,急性汞中毒8例,铅中毒7例),腹型癫痫6例,糖尿病引发的酮症酸中毒3例,尿毒症1例(见表4)。 本研究中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻,2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为P<0.01,差异有统计学意义见表。 3、讨论 急性腹痛是急诊患者最常见的主诉之一,引起腹痛的原因复杂 。如何对急性腹痛进行全面准确的诊断,是急诊医生面临的重要课题。统计我院2010-10-2013-10急诊门诊患者的相关资料显示,本研究中全部腹痛患者占就诊人数的29.76%,非创伤性腹痛患者约占就诊腹痛患者的1/2,与国外报道一致。本研究显示急性非创伤性腹痛的患者中急性胰腺炎的发病率最高,其次为急性肠梗阻,与国内外文献报道略有不同。国内外文献报道非创伤性急性腹痛的疾病多以急性胃肠炎、急性阑尾炎、急性胆道疾病、泌尿系结石、急性胰腺炎、急性肠梗阻、溃疡病穿孔等最为常见。造成这种差别的原因之一可能为本研究的研究对象为急诊内科病房住院患者,而文献中的研究对象则包括所有急诊就诊的患者,包括急诊门诊就诊的和住院的患者;造成这种差别的原因之二是本研究中急性胃肠炎大多在急诊留观得以诊治而无需住院治疗,急性阑尾炎、急性胆道疾病、泌尿系结石则大多于外科急诊就诊,并行手术治疗,也未在本研究的范围之内,这也是本研究腹痛患者以急性胰腺炎比例最高的原因;造成这种差别的原因之三考虑是我院作为三级甲等医院,一般多接诊下 级医院因诊疗效果不佳转往上级医院的患者。 急性胰腺炎引起腹痛患者误诊分析。初诊未被确诊的腹痛也以急性胰腺炎比例最高,可见急诊医生应把急性胰腺炎作为急诊腹痛的常见病加以掌握。本研究发现符合中国胰腺炎诊治指 南推荐诊断标准的胰腺炎初诊较易确诊,有385例。 未被确诊的有143例,来诊时这些患者不符合上述标准。这些患者因持续性腹痛、腹胀、呕吐就诊,血清淀粉酶、脂肪酶早期无异常,CT等影像学发现肠梗阻及双肺底炎症等;入院后动态观察才发现血清淀粉酶、脂肪酶逐渐升高至正常参考值的3倍以上而得以确诊。其中以肠梗阻为表现的胰腺炎80例,占未被确诊胰腺炎患者的48.95%,因此急性肠梗阻的患者要注意鉴别急性胰腺炎。其它因AP腹痛而误诊的患者分别以高血压、ARDS或并发MODS,合并妊娠来诊,提示这些 病 症 可 以 掩 盖AP,临床上应深究其原因,考虑到胰腺炎的诊断,以防误诊。 死亡原因分析。本研究中共有10例患者死亡。3例胃癌晚期死亡。死亡率最高的是初诊未确诊组的腹痛患者,以腹腔外器官占比例最大。本研究中有2例死于主动脉夹层,其中1例26岁男性因腹痛伴腹泻就诊,就诊时测血压正常,入院后按胃肠炎治疗过程中突然死亡,死后尸检发现为主动脉夹层。全身性疾病致腹痛的前三位疾病:重金属中毒,腹型过敏性紫癜和神经官能症。本研究建议急诊医师在急性腹痛的诊疗中需要具备丰富的经验;要突破常规的思维模式,把握其主要的矛盾;对于危重的患者,确保患者生命体征的平稳,除外致命疾病所致的腹痛病因,如主动脉夹层、急性心肌梗塞等,然后再进行下一步明确诊断的治疗。 本研究中初诊即确诊的患者死亡率显著低于初诊未确诊的患者,P<0.01,有统计学差异,说明首诊若能及时确诊,及时找到病因,避免了延误病情,说明提高首诊准确性、降低死亡率和误诊率的 重要性。 腹腔脏器的病变,腹腔外脏器与全身性疾病这三大类疾病均可引起起腹痛,初诊被误诊的腹痛因临床少见常被误诊,要求急诊医师多总结经验教训,结合辅助检查又不能完全依赖辅助检查,既依据常规又突破常规的思维模式,诊断过程中综合考虑各种因素以免误诊、漏诊延误病情;本研究中确诊的患者死亡率显著低于初诊未确诊的患者,说明提高首诊准确性对降低死亡率至关重要。 1、资料与方法 1.1临床资料 搜集因急性腹痛收治入院的3 268例患者,对其入院情况、诊断、治疗及预后情况进行回顾性分析。约占急诊就诊总人数的29.76%。共有1 747例非创伤性腹痛患者,诊断不明确者214例,1 533例诊断明确的腹痛住院患者纳入研究。其中男780例,女753例,年龄14~93岁,平均38.7岁。 1.2方法 采用回顾性研究的方法,观察2010-10-2013-10收治于我院住院的患者。检索词:根据主诉中“腹痛”的关键词,或入院诊断为“腹痛待查”的患者。腹痛患者分为初诊即确诊的腹痛和初诊未被确诊的腹痛。初诊即确诊的腹痛定义为:患者以腹痛待查就诊,初次就诊时(包括在我院和在外院就诊)即明确诊断腹痛原因;初诊未被确诊的腹痛定义为:在初次就诊被误诊和(或)未被明确诊断,因治疗效果差而住院诊治的患者。根据既往研究,把腹痛病因分为腹腔脏器病变、腹腔外脏器病变和全身性疾病三种。记录各组病例的诱发因素症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况。 1.3统计学处理 采用SPSS16.0软件进行统计学分析,计数资料以率表示,行χ2检验;计量资料,以珚x±s表达,行方差分析。以P<0.05为差异有统计学意义。 2、结果 研究发现患者发病时间15min~15d,平均20h。引起腹痛的疾病原因有50种。初诊即确诊的腹痛共1 122例(占总例数73.19%),为:急性胰腺炎385例,急性肠梗阻200例,急性胆道病变137例,急性阑尾炎130例,急性胃肠炎110例,胃、十二指肠溃疡95例,均为腹腔脏器病变。 初诊未被确诊的腹痛共411例(占总例数26.81%)。其中腹腔脏器病变引起的腹痛共359例(占总例数23.42%),分别为急性胰腺炎143例,先天性结肠冗长症36例,肠易激综合征36例,肠系膜上动脉压迫综合征引发的十二指肠瘀滞21例,溃疡性结肠炎17例,肠系膜栓塞15例,肠结核13例,克隆病12例,脂肪肝肝病11例,泌尿系结石10例,急性阑尾炎10例,胃癌8例,妇科疾病肿瘤9例,泌尿系感染7例,食管裂孔疝3例,卵巢蒂扭转3例,急性胆道疾病2例,急性出血坏死性肠炎2例,间位结肠1例(见表1)。 这些初诊未确诊的腹痛患者中急性胰腺炎最多,表现存在一定的不典型性。肠梗阻为表现70例,高血压24例,ARDS 20例,妊娠15例,MODS10例,抑郁症2例,胃癌1例,过敏性紫癜1例(见表2)。腹外脏器病变引起的腹痛共50例(占总例数4.24%)。分别为:急性心梗19例,主动脉夹层18例,胸腔积液6例,(其中结核性胸腔积液5例,炎症性胸腔积液1例),急性心衰2例,肺部感染3例,肺栓塞1例,胸膜炎1例(见表3)。 全身性疾病引起的腹痛共67例(占总例数4.37%)。分别为:过敏性紫癜(腹型)17例,神经官能症17例,重金属中毒23例(急性铊中毒8例,急性汞中毒8例,铅中毒7例),腹型癫痫6例,糖尿病引发 的酮症酸中毒3例,尿毒症1例(见表4)。 本研究中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻,2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为P<0.01,差异有统计学意义见表。 3、讨论 急性腹痛是急诊患者最常见的主诉之一,引起腹痛的原因复杂 。如何对急性腹痛进行全面准确的诊断,是急诊医生面临的重要课题。统计我院2010-10-2013-10急诊门诊患者的相关资料显示,本研究中全部腹痛患者占就诊人数的29.76%,非创伤性腹痛患者约占就诊腹痛患者的1/2,与国外报道一致。本研究显示急性非创伤性腹痛的患者中急性胰腺炎的发病率最高,其次为急性肠梗阻,与国内外文献报道略有不同。国内外文献报道非创伤性急性腹痛的疾病多以急性胃肠炎、急性阑尾炎、急性胆道疾病、泌尿系结石、急性胰腺炎、急性肠梗阻、溃疡病穿孔等最为常见。造成这种差别的原因之一可能为本研究的研究对象为急诊内科病房住院患者,而文献中的研究对象则包括所有急诊就诊的患者,包括急诊门诊就诊的和住院的患者;造成这种差别的原因之二是本研究中急性胃肠炎大多在急诊留观得以诊治而无需住院治疗,急性阑尾炎、急性胆道疾病、泌尿系结石则大多于外科急诊就诊,并行手术治疗,也未在本研究的范围之内,这也是本研究腹痛患者以急性胰腺炎比例最高的原因;造成这种差别的原因之三考虑是我院作为三级甲等医院,一般多接诊下级医院因诊疗效果不佳转往上级医院的患者。 急性胰腺炎引起腹痛患者误诊分析。初诊未被确诊的腹痛也以急性胰腺炎比例最高,可见急诊医生应把急性胰腺炎作为急诊 腹痛的常见病加以掌握。本研究发现符合中国胰腺炎诊治指 南推荐诊断标准的胰腺炎初诊较易确诊,有385例。 未被确诊的有143例,来诊时这些患者不符合上述标准。这些患者因持续性腹痛、腹胀、呕吐就诊,血清淀粉酶、脂肪酶早期无异常,CT等影像学发现肠梗阻及双肺底炎症等;入院后动态观察才发现血清淀粉酶、脂肪酶逐渐升高至正常参考值的3倍以上而得以确诊。其中以肠梗阻为表现的胰腺炎80例,占未被确诊胰腺炎患者的48.95%,因此急性肠梗阻的患者要注意鉴别急性胰腺炎。其它因AP腹痛而误诊的患者分别以高血压、ARDS或并发MODS,合并妊娠来诊,提示这些 病 症 可 以 掩 盖AP,临床上应深究其原因,考虑到胰腺炎的诊断,以防误诊。 死亡原因分析。本研究中共有10例患者死亡。3例胃癌晚期死亡。死亡率最高的是初诊未确诊组的腹痛患者,以腹腔外器官占比例最大。本研究中有2例死于主动脉夹层,其中1例26岁男性因腹痛伴腹泻就诊,就诊时测血压正常,入院后按胃肠炎治疗过程中突然死亡,死后尸检发现为主动脉夹层。全身性疾病致腹痛的前三位疾病:重金属中毒,腹型过敏性紫癜和神经官能症。本研究建议急诊医师在急性腹痛的诊疗中需要具备丰富的经验;要突破常规的思维模式,把握其主要的矛盾;对于危重的患者,确保患者生命体征的平稳,除外致命疾病所致的腹痛病因,如主动脉夹层、急性心肌梗塞等,然后再进行下一步明确诊断的治疗。 本研究中初诊即确诊的患者死亡率显著低于初诊未确诊的患者,P<0.01,有统计学差异,说明首诊若能及时确诊,及时找到病因,避免了延误病情,说明提高首诊准确性、降低死亡率和误诊率的重要性。 腹腔脏器的病变,腹腔外脏器与全身性疾病这三大类疾病均可引起起腹痛,初诊被误诊的腹痛因临床少见常被误诊,要求急诊 医师多总结经验教训,结合辅助检查又不能完全依赖辅助检查,既依据常规又突破常规的思维模式,诊断过程中综合考虑各种因素以免误诊、漏诊延误病情;本研究中确诊的患者死亡率显著低于初诊未确诊的患者,说明提高首诊准确性对降低死亡率至关重要。 1、资料与方法 1.1临床资料 搜集因急性腹痛收治入院的3 268例患者,对其入院情况、诊断、治疗及预后情况进行回顾性分析。约占急诊就诊总人数的29.76%。共有1 747例非创伤性腹痛患者,诊断不明确者214例,1 533例诊断明确的腹痛住院患者纳入研究。其中男780例,女753例,年龄14~93岁,平均38.7岁。 1.2方法 采用回顾性研究的方法,观察2010-10-2013-10收治于我院住院的患者。检索词:根据主诉中“腹痛”的关键词,或入院诊断为“腹痛待查”的患者。腹痛患者分为初诊即确诊的腹痛和初诊未被确诊的腹痛。初诊即确诊的腹痛定义为:患者以腹痛待查就诊,初次就诊时(包括在我院和在外院就诊)即明确诊断腹痛原因;初诊未被确诊的腹痛定义为:在初次就诊被误诊和(或)未被明确诊断,因治疗效果差而住院诊治的患者。根据既往研究,把腹痛病因分为腹腔脏器病变、腹腔外脏器病变和全身性疾病三种。记录各组病例的诱发因素症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况。 1.3统计学处理 采用SPSS16.0软件进行统计学分析,计数资料以率表示,行χ2检验;计量资料,以珚x±s表达,行方差分析。以P<0.05为差异有统计学意义。 2、结果 研究发现患者发病时间15min~15d,平均20h。引起腹痛的疾病原因有50种。初诊即确诊的腹痛共1 122例(占总例数73.19%),为:急性胰腺炎385例,急性肠梗阻200例,急性胆道病变137例,急性阑尾炎130例,急性胃肠炎110例,胃、十二指肠溃疡95例,均为腹腔脏器病变。 初诊未被确诊的腹痛共411例(占总例数26.81%)。其中腹腔脏器病变引起的腹痛共359例(占总例数23.42%),分别为急性胰腺炎143例,先天性结肠冗长症36例,肠易激综合征36例,肠系膜上动脉压迫综合征引发的十二指肠瘀滞21例,溃疡性结肠炎17例,肠系膜栓塞15例,肠结核13例,克隆病12例,脂肪肝肝病11例,泌尿系结石10例,急性阑尾炎10例,胃癌8例,妇科疾病肿瘤9例,泌尿系感染7例,食管裂孔疝3例,卵巢蒂扭转3例,急性胆道疾病2例,急性出血坏死性肠炎2例,间位结肠1例(见表1)。 这些初诊未确诊的腹痛患者中急性胰腺炎最多,表现存在一定的不典型性。肠梗阻为表现70例,高血压24例,ARDS 20例,妊娠15例,MODS10例,抑郁症2例,胃癌1例,过敏性紫癜1例(见表2)。腹外脏器病变引起的腹痛共50例(占总例数4.24%)。分别为:急性心梗19例,主动脉夹层18例,胸腔积液6例,(其中结核性胸腔积液5例,炎症性胸腔积液1例),急性心衰2例,肺部感染3例,肺栓塞1例,胸膜炎1例(见表3)。 全身性疾病引起的腹痛共67例(占总例数4.37%)。分别为:过敏性紫癜(腹型)17例,神经官能症17例,重金属中毒23例(急性铊中毒8例,急性汞中毒8例,铅中毒7例),腹型癫痫6例,糖尿病引发的酮症酸中毒3例,尿毒症1例(见表4)。 本研究中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻,2例死于胰腺炎合并 MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为P<0.01,差异有统计学意义见表。 3、讨论 急性腹痛是急诊患者最常见的主诉之一,引起腹痛的原因复杂 。如何对急性腹痛进行全面准确的诊断,是急诊医生面临的重要课题。统计我院2010-10-2013-10急诊门诊患者的相关资料显示,本研究中全部腹痛患者占就诊人数的29.76%,非创伤性腹痛患者约占就诊腹痛患者的1/2,与国外报道一致。本研究显示急性非创伤性腹痛的患者中急性胰腺炎的发病率最高,其次为急性肠梗阻,与国内外文献报道略有不同。国内外文献报道非创伤性急性腹痛的疾病多以急性胃肠炎、急性阑尾炎、急性胆道疾病、泌尿系结石、急性胰腺炎、急性肠梗阻、溃疡病穿孔等最为常见。造成这种差别的原因之一可能为本研究的研究对象为急诊内科病房住院患者,而文献中的研究对象则包括所有急诊就诊的患者,包括急诊门诊就诊的和住院的患者;造成这种差别的原因之二是本研究中急性胃肠炎大多在急诊留观得以诊治而无需住院治疗,急性阑尾炎、急性胆道疾病、泌尿系结石则大多于外科急诊就诊,并行手术治疗,也未在本研究的范围之内,这也是本研究腹痛患者以急性胰腺炎比例最高的原因;造成这种差别的原因之三考虑是我院作为三级甲等医院,一般多接诊下级医院因诊疗效果不佳转往上级医院的患者。 急性胰腺炎引起腹痛患者误诊分析。初诊未被确诊的腹痛也以急性胰腺炎比例最高,可见急诊医生应把急性胰腺炎作为急诊腹痛的常见病加以掌握。本研究发现符合中国胰腺炎诊治指 南推荐诊断标准的胰腺炎初诊较易确诊,有385例。 未被确诊的有143例,来诊时这些患者不符合上述标准。这些患 者因持续性腹痛、腹胀、呕吐就诊,血清淀粉酶、脂肪酶早期无异常,CT等影像学发现肠梗阻及双肺底炎症等;入院后动态观察才发现血清淀粉酶、脂肪酶逐渐升高至正常参考值的3倍以上而得以确诊。其中以肠梗阻为表现的胰腺炎80例,占未被确诊胰腺炎患者的48.95%,因此急性肠梗阻的患者要注意鉴别急性胰腺炎。其它因AP腹痛而误诊的患者分别以高血压、ARDS或并发MODS,合并妊娠来诊,提示这些 病 症 可 以 掩 盖AP,临床上应深究其原因,考虑到胰腺炎的诊断,以防误诊。 死亡原因分析。本研究中共有10例患者死亡。3例胃癌晚期死亡。死亡率最高的是初诊未确诊组的腹痛患者,以腹腔外器官占比例最大。本研究中有2例死于主动脉夹层,其中1例26岁男性因腹痛伴腹泻就诊,就诊时测血压正常,入院后按胃肠炎治疗过程中突然死亡,死后尸检发现为主动脉夹层。全身性疾病致腹痛的前三位疾病:重金属中毒,腹型过敏性紫癜和神经官能症。本研究建议急诊医师在急性腹痛的诊疗中需要具备丰富的经验;要突破常规的思维模式,把握其主要的矛盾;对于危重的患者,确保患者生命体征的平稳,除外致命疾病所致的腹痛病因,如主动脉夹层、急性心肌梗塞等,然后再进行下一步明确诊断的治疗。 本研究中初诊即确诊的患者死亡率显著低于初诊未确诊的患者,P<0.01,有统计学差异,说明首诊若能及时确诊,及时找到病因,避免了延误病情,说明提高首诊准确性、降低死亡率和误诊率的重要性。 腹腔脏器的病变,腹腔外脏器与全身性疾病这三大类疾病均可引起起腹痛,初诊被误诊的腹痛因临床少见常被误诊,要求急诊医师多总结经验教训,结合辅助检查又不能完全依赖辅助检查,既依据常规又突破常规的思维模式,诊断过程中综合考虑各种因素以免误诊、漏诊延误病情;本研究中确诊的患者死亡率显著 低于初诊未确诊的患者,说明提高首诊准确性对降低死亡率至关重要。 1、资料与方法 1.1临床资料 搜集因急性腹痛收治入院的3 268例患者,对其入院情况、诊断、治疗及预后情况进行回顾性分析。约占急诊就诊总人数的29.76%。共有1 747例非创伤性腹痛患者,诊断不明确者214例,1 533例诊断明确的腹痛住院患者纳入研究。其中男780例,女753例,年龄14~93岁,平均38.7岁。 1.2方法 采用回顾性研究的方法,观察2010-10-2013-10收治于我院住院的患者。检索词:根据主诉中“腹痛”的关键词,或入院诊断为“腹痛待查”的患者。腹痛患者分为初诊即确诊的腹痛和初诊未被确诊的腹痛。初诊即确诊的腹痛定义为:患者以腹痛待查就诊,初次就诊时(包括在我院和在外院就诊)即明确诊断腹痛原因;初诊未被确诊的腹痛定义为:在初次就诊被误诊和(或)未被明确诊断,因治疗效果差而住院诊治的患者。根据既往研究,把腹痛病因分为腹腔脏器病变、腹腔外脏器病变和全身性疾病三种。记录各组病例的诱发因素症状、体征、辅助检查、发病及诊疗经过和最终的诊断情况。 1.3统计学处理 采用SPSS16.0软件进行统计学分析,计数资料以率表示,行χ2检验;计量资料,以珚x±s表达,行方差分析。以P<0.05为差异有统计学意义。 2、结果 研究发现患者发病时间15min~15d,平均20h。引起腹痛的疾病原因有50种。初诊即确诊的腹痛共1 122例(占总例数73.19%), 为:急性胰腺炎385例,急性肠梗阻200例,急性胆道病变137例,急性阑尾炎130例,急性胃肠炎110例,胃、十二指肠溃疡95例,均为腹腔脏器病变。 初诊未被确诊的腹痛共411例(占总例数26.81%)。其中腹腔脏器病变引起的腹痛共359例(占总例数23.42%),分别为急性胰腺炎143例,先天性结肠冗长症36例,肠易激综合征36例,肠系膜上动脉压迫综合征引发的十二指肠瘀滞21例,溃疡性结肠炎17例,肠系膜栓塞15例,肠结核13例,克隆病12例,脂肪肝肝病11例,泌尿系结石10例,急性阑尾炎10例,胃癌8例,妇科疾病肿瘤9例,泌尿系感染7例,食管裂孔疝3例,卵巢蒂扭转3例,急性胆道疾病2例,急性出血坏死性肠炎2例,间位结肠1例(见表1)。 这些初诊未确诊的腹痛患者中急性胰腺炎最多,表现存在一定的不典型性。肠梗阻为表现70例,高血压24例,ARDS 20例,妊娠15例,MODS10例,抑郁症2例,胃癌1例,过敏性紫癜1例(见表2)。腹外脏器病变引起的腹痛共50例(占总例数4.24%)。分别为:急性心梗19例,主动脉夹层18例,胸腔积液6例,(其中结核性胸腔积液5例,炎症性胸腔积液1例),急性心衰2例,肺部感染3例,肺栓塞1例,胸膜炎1例(见表3)。 全身性疾病引起的腹痛共67例(占总例数4.37%)。分别为:过敏性紫癜(腹型)17例,神经官能症17例,重金属中毒23例(急性铊中毒8例,急性汞中毒8例,铅中毒7例),腹型癫痫6例,糖尿病引发的酮症酸中毒3例,尿毒症1例(见表4)。 本研究中2例死于主动脉夹层,1例死于铊中毒,1例死于胆道疾病,1例死于胃癌合并胰腺炎、肠梗阻,2例死于胰腺炎合并MODS,3例死于胃癌晚期,均发生在初诊未被确诊的腹痛患者。初诊即确诊的患者死亡率显著低于初诊未确诊的患者,为P<0.01,差异有统计学意义见表。 3、讨论 急性腹痛是急诊患者最常见的主诉之一,引起腹痛的原因复杂 。如何对急性腹痛进行全面准确的诊断,是急诊医生面临的重要课题。统计我院2010-10-2013-10急诊门诊患者的相关资料显示,本研究中全部腹痛患者占就诊人数的29.76%,非创伤性腹痛患者约占就诊腹痛患者的1/2,与国外报道一致。本研究显示急性非创伤性腹痛的患者中急性胰腺炎的发病率最高,其次为急性肠梗阻,与国内外文献报道略有不同。国内外文献报道非创伤性急性腹痛的疾病多以急性胃肠炎、急性阑尾炎、急性胆道疾病、泌尿系结石、急性胰腺炎、急性肠梗阻、溃疡病穿孔等最为常见。造成这种差别的原因之一可能为本研究的研究对象为急诊内科病房住院患者,而文献中的研究对象则包括所有急诊就诊的患者,包括急诊门诊就诊的和住院的患者;造成这种差别的原因之二是本研究中急性胃肠炎大多在急诊留观得以诊治而无需住院治疗,急性阑尾炎、急性胆道疾病、泌尿系结石则大多于外科急诊就诊,并行手术治疗,也未在本研究的范围之内,这也是本研究腹痛患者以急性胰腺炎比例最高的原因;造成这种差别的原因之三考虑是我院作为三级甲等医院,一般多接诊下级医院因诊疗效果不佳转往上级医院的患者。 急性胰腺炎引起腹痛患者误诊分析。初诊未被确诊的腹痛也以急性胰腺炎比例最高,可见急诊医生应把急性胰腺炎作为急诊腹痛的常见病加以掌握。本研究发现符合中国胰腺炎诊治指 南推荐诊断标准的胰腺炎初诊较易确诊,有385例。 未被确诊的有143例,来诊时这些患者不符合上述标准。这些患者因持续性腹痛、腹胀、呕吐就诊,血清淀粉酶、脂肪酶早期无异常,CT等影像学发现肠梗阻及双肺底炎症等;入院后动态观察才发现血清淀粉酶、脂肪酶逐渐升高至正常参考值的3倍以上 而得以确诊。其中以肠梗阻为表现的胰腺炎80例,占未被确诊胰腺炎患者的48.95%,因此急性肠梗阻的患者要注意鉴别急性胰腺炎。其它因AP腹痛而误诊的患者分别以高血压、ARDS或并发MODS,合并妊娠来诊,提示这些 病 症 可 以 掩 盖AP,临床上应深究其原因,考虑到胰腺炎的诊断,以防误诊。 死亡原因分析。本研究中共有10例患者死亡。3例胃癌晚期死亡。死亡率最高的是初诊未确诊组的腹痛患者,以腹腔外器官占比例最大。本研究中有2例死于主动脉夹层,其中1例26岁男性因腹痛伴腹泻就诊,就诊时测血压正常,入院后按胃肠炎治疗过程中突然死亡,死后尸检发现为主动脉夹层。全身性疾病致腹痛的前三位疾病:重金属中毒,腹型过敏性紫癜和神经官能症。本研究建议急诊医师在急性腹痛的诊疗中需要具备丰富的经验;要突破常规的思维模式,把握其主要的矛盾;对于危重的患者,确保患者生命体征的平稳,除外致命疾病所致的腹痛病因,如主动脉夹层、急性心肌梗塞等,然后再进行下一步明确诊断的治疗。 本研究中初诊即确诊的患者死亡率显著低于初诊未确诊的患者,P<0.01,有统计学差异,说明首诊若能及时确诊,及时找到病因,避免了延误病情,说明提高首诊准确性、降低死亡率和误诊率的重要性。 腹腔脏器的病变,腹腔外脏器与全身性疾病这三大类疾病均可引起起腹痛,初诊被误诊的腹痛因临床少见常被误诊,要求急诊医师多总结经验教训,结合辅助检查又不能完全依赖辅助检查,既依据常规又突破常规的思维模式,诊断过程中综合考虑各种因素以免误诊、漏诊延误病情;本研究中确诊的患者死亡率显著低于初诊未确诊的患者,说明提高首诊准确性对降低死亡率至关重要。 症。本研究建议急诊医师在急性腹痛的诊疗中需要具备丰富的 经验;要突破常规的思维模式,把握其主要的矛盾;对于危重的患者,确保患者生命体征的平稳,除外致命疾病所致的腹痛病因,如主动脉夹层、急性心肌梗塞等,然后再进行下一步明确诊断的治疗。 本研究中初诊即确诊的患者死亡率显著低于初诊未确诊的患者,P<0.01,有统计学差异,说明首诊若能及时确诊,及时找到病因,避免了延误病情,说明提高首诊准确性、降低死亡率和误诊率的重要性。 腹腔脏器的病变,腹腔外脏器与全身性疾病这三大类疾病均可引起起腹痛,初诊被误诊的腹痛因临床少见常被误诊,要求急诊医师多总结经验教训,结合辅助检查又不能完全依赖辅助检查,既依据常规又突破常规的思维模式,诊断过程中综合考虑各种因素以免误诊、漏诊延误病情;本研究中确诊的患者死亡率显著低于初诊未确诊的患者,说明提高首诊准确性对降低死亡率至关重要。 (英文版 ) Two regulations promulgated for implementation is in the party in power for a long time and the rule of law conditions, the implementation of comprehensive strictly strategic plan, implementation in accordance with the rules and discipline to manage the party, strengthen inner-party supervision of major initiatives. The two regulations supporting each other, the < code > adhere to a positive advocate, focusing on morality is of Party members and Party leading cadres can see, enough to get a high standard; < rule > around the party discipline, disciplinary ruler requirements, listed as "negative list, focusing on vertical gauge, draw the party organizations and Party members do not touch the" bottom line ". Here, the main from four square face two party rules of interpretation: the first part introduces two party Revised regulations the necessity and the revision process; the second part is the interpretation of the two fundamental principles of the revision of laws and regulations in the party; the third part introduces two party regulations modified the main changes and needs to grasp several key problems; the fourth part on how to grasp the implementation of the two regulations of the party. < code > and < Regulations > revised the necessity and revised history of the CPC Central Committee the amendment to the Chinese Communist Party members and leading cadres honest politics several guidelines > and < Chinese Communist Party discipline and Punishment Regulations > column 1 by 2015 to strengthen party laws and regulations focus. Two party regulations revision work lasted a Years, pooling the wisdom of the whole party, ideological consensus, draw historical experience, respect for the wisdom of our predecessors, which reflects the unity of inheritance and innovation; follow the correct direction, grasp the limited goals, adhere to the party's leadership, to solve the masses of the people reflect a focus on the problem. The new revision of the < code > and < rule >, reflects the party's 18 and the eighth session of the third, the spirit of the fourth plenary session, reflecting the experience of studying and implementing the General Secretary Xi Jinping series of important speech, reflects the party's eighteen years comprehensive strictly practice. (a) revised two regulations of the party need of < the ICAC guidelines > in < in 1997 Leaders as members of the Communist Party of China clean politics certain criteria (Trial) > based on revised, the promulgation and implementation of January 2010, to strengthen the construction of the contingent of leading cadres play an important role. But with the party to manage the party strictly administering the deepening, has not been able to fully meet the actual needs. Content is too complicated, "eight prohibition, 52 are not allowed to" hard to remember, and also difficult to put into practice; the second is concisely positive advocated by the lack of prohibited provisions excessive, no autonomy requirements; the third is banned terms and discipline law, both with the party discipline, disciplinary regulations repeat and Criminal law and other laws and regulations repeat; the fourth is to "clean" the theme is not prominent, not for the existing problems, and is narrow, only needle of county-level leading cadres above. < rule > is in 1997 < Chinese Communist Party disciplinary cases (Trial) > based on revision, in December 2003 the promulgation and implementation, to strengthen the construction of the party play very important role. Along with the development of the situation, which many provisions have been unable to fully meet the comprehensive strictly administering the practice needs. One is Ji law, more than half of the provisions and criminal law and other countries laws and regulations Repetition; two is the political discipline regulations is not prominent, not specific, for violation of the party constitution, damage the authority of Party Constitution of misconduct lack necessary and serious responsibility to pursue; third is the main discipline for the leading cadres, does not cover all Party members. Based on the above situation, need to < the criterion of a clean and honest administration > and < rule > the two is likely to be more relevant regulations first amendment. By revising, really put the authority of Party discipline, the seriousness in the party tree and call up the majority of Party members and cadres of the party constitution of party compasses party consciousness. (II) two party regulations revision process the Central Committee of the Communist Party of China attaches great importance to two regulations revision . Xi Jinping, general books recorded in the Fifth Plenary Session of the eighth session of the Central Commission for Discipline Inspection, on the revised regulations < > made clear instructions. According to the central deployment, the Central Commission for Discipline Inspection from 2014 under six months begin study two regulations revision. The Standing Committee of the Central Commission for Discipline Inspection 4 review revised. Comrade Wang Qishan 14 times held a special meeting to study two regulations revision, amendment clarifies the direction, major issues of principle, path and target, respectively held a forum will listen to part of the province (area) secretary of the Party committee, Secretary of the Discipline Inspection Commission, part of the central ministries and state organs Department The first party committee is mainly responsible for people, views of experts and scholars and grassroots party organizations and Party members. Approved by the Central Committee of the Communist Party of China, on 7 September 2015, the general office of the Central Committee of the Party issued a notice to solicit the provinces (autonomous regions, municipalities) Party, the central ministries and commissions, state ministries and commissions of the Party (party), the General Political Department of the military, every 3 people organization of Party of two regulations revision opinion. Central Commission for Discipline Inspection of extensive solicitation of opinions, careful study, attracting, formed a revised sent reviewers. In October 8 and October 12, Central Committee Political Bureau Standing Committee and the Political Bureau of the Central Committee After consideration of the two regulations revised draft. On October 18, the Central Committee of the Communist Party of China formally issued two regulations. Can say, two laws amendment concentrated the wisdom of the whole party, embodies the party. Second, < code > and < Regulations > revision of the basic principles of two party regulations revision work and implement the party's eighteen, ten eight plenary, the spirit of the Fourth Plenary Session of the Eleventh Central Committee and General Secretary Xi Jinping important instructions on the revised < low political criterion > and < Regulations >, highlighting the ruling party characteristics, serious discipline, the discipline quite in front of the law, based on the current, a long-term, advance as a whole, with Bu Xiuding independent < rule > and < rule >. Main principle is: first, adhere to the party constitution to follow. The constitution about discipline and self-discipline required specific, awaken the party constitution of party compasses party consciousness, maintaining the authority of the constitution. General Secretary Xi Jinping pointed out that "no rules, no side round. Party constitution is the fundamental law, the party must follow the general rules. In early 2015 held the eighth session of the Central Commission for Discipline Inspection Fifth Plenary Session of the 16th Central Committee, Xi Jinping again pointed out that constitution is the party must follow the general rules, but also the general rules." the revision of the < code > and < rule > is Method in adhere to the regulations established for the purpose of combining rule of virtue is to adhere to the party constitution as a fundamental to follow, the constitution authority set up, wake up the party constitution and party rules the sense of discipline, the party constitution about discipline and self-discipline specific requirements. 4 second is to adhere to in accordance with the regulations governing the party and the party. The Party of rule of virtue "de", mainly refers to the party's ideals and beliefs, excellent traditional style. The revised the < code > closely linked to the "self-discipline", insisting on the positive initiative, for all members, highlight the "vital few", emphasized self-discipline, focusing on the morality, and the majority of Party members and the ideological and moral standards. The revised < > Ji method separately, Ji, Ji Yan to Method, as a "negative list", emphasizing the heteronomy, focusing on vertical gauge. Is this one high and one low, a positive reaction, the strict party discipline and practice results transformation for the integration of the whole party to observe moral and discipline requirements, for the majority of Party members and cadres provides benchmarking and ruler. Third, insist on to. In view of the problems existing in the party at the present stage, the main problems of Party members and cadres in the aspect of self-discipline and abide by the discipline to make clearly defined, especially the party's eighteen years strict political discipline and political rules, organization and discipline and to implement the central eight provisions of the spirit against the four winds and other requirements into Disciplinary provisions. Not one pace reachs the designated position, focusing on in line with reality, pragmatic and effective. After the revision of major changes, major changes in the < code > and < rule > modified and needs to grasp several key problems (a) < code > < code > adhere to according to regulations governing the party and party with morals in combination, for at the present stage, the leadership of the party members and cadres and Party members in existing main problems of self-discipline, put forward principles, requirements and specifications, showing Communists noble moral pursuit, reflected at all times and in all over the world ethics from high from low 5 common requirements. One is closely linked to the "self-discipline", removal and no direct relation to the provisions of . the second is adhere to a positive advocate, "eight prohibition" 52 are not allowed to "about the content of the" negative list moved into synchronization amendment < cases >. Three is for all the party members, will apply object from the leadership of the party members and cadres to expand to all Party members, fully embodies the comprehensive strictly required. The fourth is prominent key minority, seize the leadership of the party members and cadres is the key, and put forward higher requirements than the ordinary Party members. Five is to simplify, and strive to achieve concise, easy to understand, easy to remember. The revised < code > is the ruling Party since the first insists on a positive advocate forAll Party members and the self-discipline norms, moral declaration issued to all members of the party and the National People's solemn commitment. > < criterion of a clean and honest administration consists of 4 parts, 18, more than 3600 words. After the revision of the < code >, a total of eight, 281 words, including lead, specification and Party member cadre clean fingered self-discipline norms, etc. Part 3 members low-cost clean and self-discipline, the main contents can be summarized as "four must" "eight code". Lead part, reiterated on ideal and faith, fundamental purpose, the fine traditions and work style, noble sentiments, such as "four must" the principle of requirements, strong tone of self-discipline, The higher request for 6 and supervised tenet, the foothold in permanent Bao the party's advanced nature and purity, to reflect the revised standards requirements. Members of self-discipline norms around the party members how to correctly treat and deal with the "public and private", "cheap and rot" thrifty and extravagance "bitter music", put forward the "four norms". Party leader cadre clean fingered self-discipline norms for the leadership of the party members and cadres of the "vital few", around the "clean politics", from civil servant of the color, the exercise of power, moral integrity, a good family tradition and other aspects of the leadership of the party members and cadres of the "four norms" < > < norm norm. "The Party member's self-discipline norms" and "party members and leading cadre clean fingered self-discipline norms," a total of eight, collectively referred to as the "eight". "Four must" and "eight" of the content from the party constitution and Party's several generation of leaders, especially Xi Jinping, general secretary of the important discussion, refer to the "three discipline and eight points for attention" statements, and reference some embody the Chinese nation excellent traditional culture essence of epigrams. (2) the revised regulations, the main changes in the revised Regulations > to fully adapt to the strictly requirements, reflects the according to the regulations governing the law of recognition of deepening, the realization of the discipline construction and Jin Ju. < rule > is party a ruler, members of the basic line and follow. And the majority of Party members and cadres of Party organizations at all levels should adhere to the bottom line of thinking, fear discipline, hold the bottom line, as a preventive measure, to keep the party's advanced nature and purity. 1, respect for the constitution, refinement and discipline. Revised < rule > from comprehensive comb physical constitution began, the party constitution and other regulations of the Party of Party organizations and Party discipline requirements refinement, clearly defined in violation of the party constitution will be in accordance with regulations to give the corresponding disciplinary action. The original 10 categories of misconduct, integration specification for political discipline, discipline, honesty and discipline masses Ji Law and discipline and discipline and other six categories, the content of < rule > real return to Party discipline, for the majority of Party members and listed a "negative list. 7 2, highlighting the political discipline and political rules. > < Regulations according to the stage of the discipline of outstanding performance, emphasizing political discipline and political rules, organization and discipline, in opposition to the party's leadership and the party's basic theory, basic line, basic program and basic experience, the basic requirement of behavior made prescribed punishment, increase the cliques, against the organization such as violation of the provisions, to ensure that the central government decrees and the Party of centralized and unified. 3, adhere to strict discipline in the law and discipline In front, Ji separated. Revised < Regulations > adhere to the problem oriented, do Ji separated. Any national law existing content, will not repeat the provisions, the total removal of 79 and criminal law, repeat the content of the public security management punishment law, and other laws and regulations. In the general reiterated that party organizations and Party members must conscientiously accept the party's discipline, die van comply with national laws and regulations; at the same time, to investigate violations of Party members and even criminal behavior of Party discipline and responsibility, > < Regulations distinguish five different conditions, with special provisions were made provisions, so as to realize the connection of Party discipline and state law. 4, reflect Wind building and anti-corruption struggle of the latest achievements. < rule > the party's eighteen years implement the spirit of the central provisions of the eight, against the requirements of the "four winds" and transformation for disciplinary provisions, reflecting the style construction is always on the road, not a gust of wind. In the fight against corruption out of new problems, increase the trading rights, the use of authority relatives profit and other disciplinary terms. Prominent discipline of the masses, the new against the interests of the masses and ignore the demands of the masses and other disciplinary terms and make provisions of the disposition and the destruction of the party's close ties with the masses. Discipline to protect the party's purpose. 8 of these regulations, a total of three series, Chapter 15, 178, more than 24000 words, after the revision of the regulations a total of 3 series, Chapter 11, 133, 17000 words, divided into "general" and "special provisions" and "Supplementary Provisions" Part 3. Among them, add, delete, modify the provisions of the proportion of up to nearly 90%. 1, the general general is divided into five chapters. The first chapter to the regulations of the guiding ideology, principles and scope of application of the provisions, highlight the strengthening of the party constitution consciousness, maintenance the authority of Party Constitution, increase the party organizations and Party members must abide by the party constitution, Yan Centralized centralized, would examine at all levels of the amended provisions implementing and maintaining Party discipline, and consciously accept the party discipline, exemplary compliance with national laws and regulations. The second chapter of discipline concept, disciplinary action types and effects of the regulations, will be a serious warning from the original a year for a year and a half; increase the Party Congress representative, by leaving the party above (including leave probation) punishment, the party organization should be terminated its representative qualification provisions. The third chapter of the disciplinary rules of use prescribed in the discipline rectifying process, non convergence, not close hand classified as severely or heavier punishment. "Discipline straighten "At least eighteen years of five years, these five years is to pay close attention to the provisions of the central eight implementation and anti -" four winds ". The fourth chapter on suspicion of illegal party disciplinary distinguish five different conditions, with special provisions were made provisions, to achieve effective convergence of Party and country 9 method. < rule > the provisions of Article 27, Party organizations in the disciplinary review found that party members have committed embezzlement, bribery, dereliction of duty dereliction of duty and other criminal law act is suspected of committing a crime shall give cancel party posts, probation or expelled from the party. The second is < Regulations > Article 28 the provisions of Party organizations in the disciplinary review But found that party members are stipulated in the criminal law, although not involved in a crime shall be investigated for Party discipline and responsibility should be depending on the specific circumstances shall be given a warning until expelled punishment. This situation and a difference is that the former regulation behavior has been suspected of a crime, the feeling is quite strict, and the latter for the behavior not involving crime, only the objective performance of the provisions of the criminal code of behavior, but the plot is a crime to slightly. < Regulations > the 29 provisions, Party organizations in the discipline review found that party members and other illegal behavior, affect the party's image, the damage to the party, the state and the people's interests, we should depend on the situation Seriousness given disciplinary action. The loss of Party members, seriously damaging the party's image of behavior, should be given expelled from the party. At this article is party member is in violation of the criminal law outside the other illegal acts, such as violates the public security administration punishment law, customs law, financial laws and regulations behavior. The fourth is < cases > Article 32 stipulates, minor party members and the circumstances of the crime, the people's Procuratorate shall make a decision not to initiate a prosecution, or the people's court shall make a conviction and exempted from criminal punishment shall be given within the party is removed from his post, probation or expelled from the party. Party members and crime, sheets were fined in accordance with For acts; the principal Ordinance amended the provisions of the preceding paragraph. This is the new content, in order to achieve Ji method effective convergence. Five is < > the thirty third article 10 of the provisions, the Party member due to an intentional crime is sentenced to criminal law (including probation) sheets or additional deprivation of political rights; due to negligence crime and was sentenced to three years or more (excluding three years) a penalty, shall give expelled punishment. Due to negligence crime is convicted and sentenced to three years (including three years) in prison or be sentenced to public surveillance, detention, shall in general be expelled from the party. For the individual may not be expelled from the party, should control Approval. This is followed and retained the original > < Regulations the provisions of punishment party authorization rules and report to a level party organizations. For is "party members with criminal acts, and by the criminal punishment, generally should be expelled from the party". The fifth chapter of probationary Party member of the discipline and discipline after missing members of the treatment and punishment decisions, such as the implementation of the provisions, clear the related party discipline and punishment decision made after, for duties, wages and other relevant alteration formalities for the longest time. 2, sub sub section will the original regulations of 10 categories of acts of violation of discipline integration revised into 6 categories, respectively, in violation of the punishments for acts of political discipline "in violation of discipline behavior of punishment" in violation of integrity of disciplinary action points "of violation punishments for acts of mass discipline" "the violation of work discipline, punishment" in violation of discipline of life behavior punishment "6 chapters. 3, annex" Supplementary Provisions "clear authority making supplementary provisions of, cases of interpretative organ, as well as regulations implementation time and retroactivity etc.. 11 (3) learning understanding > < regulations needs to grasp several key problems The first problem -- about the violation of political discipline behavior > < new ordinance chapter 6 the political discipline column for the six disciplines, that is the main opposition to Party leadership and the opposition of the basic theory, basic line, basic program and basic experience, basic requirements of misconduct made provisions of the disposition, especially the eighteen since the CPC Central Committee put forward the Yan Mingzheng treatment of discipline and political rules requirements and practical achievements transformation for Discipline article, increase the false debate central policies, cliques, against the organization review, make no discipline of the principle of harmony terms. These are the party's eighteen years in comprehensive strictly Process combined with the practice of rich content. (1) false debate the central policies and undermine the Party of centralized and unified the problem is made in accordance with the provisions of the party constitution. Constitution in general programme requirements adhere to democratic centralism is one of the requirements of the construction of the party must adhere to the four cardinal. Application of this principle is not only the party the basic organization principle and is also the mass line in party life, it requires that we must fully develop inner-party democracy, respect for the dominant position of Party members, safeguarding the Party member democratic rights, give full play to the enthusiasm and creativity of the party organizations at all levels and Party members, at the same time, also must implement the right concentration, ensure the party's mission < the chaos in unity and concerted action to ensure that the party's decision to get quickly and effectively implementing. The Party Central Committee formulated the major principles and policies, through different channels and ways, fully listen to the party organizations and Party members of the opinions and suggestions, but 12 is some people face to face not to say back blather "" will not say, after the meeting said, "" Taiwan does not say, and nonsense ", in fact, not only disrupt the people thought, some causing serious consequences, the damage to the Party of the centralized and unified, hinder the central policy implementation, but also a serious violation of the democratic system of principles. There is no doubt that shall, in accordance with the Regulations > 4 Specified in Article 6 to give the appropriate punishment. For did not cause serious consequences, to give criticism and education or the corresponding tissue processing. (2) about the destruction of the party's unity < New Regulations > the forty eighth to fifty second article, to damage Party's unity unified and violation of political discipline, punishment situation made explicit provisions. Article 52 of the new "in the party get round group, gangs seek private gain, cliques, cultivate private forces or through the exchange of interests, for their own to create momentum and other activities to gain political capital, given a serious warning or withdraw from their party posts disposition; if the circumstances are serious, to give Leave a party to observation or expelled from the party. (3) on against the organization review of the provisions of the constitution, party loyalty honesty is party members must comply with the obligations. Members must obey the organization decision, shall not violate the organization decided encounters by asking questions to find organization, rely on the organization, shall not deceive the organization, against the organization. For example, after the investigation does not take the initiative to explain the situation, but to engage in offensive and defensive alliance, hiding the stolen money is against survey organization, is a violation of the behavior of political discipline. Article 24 of the original > < Regulations, although the provisions of the interference, hinder group review the behavior of the fabric can be severely or 13 Aggravated punishment, but did not put this kind of behavior alone as a discipline for qualitative amount of discipline. > < new regulations increase the Article 57, "anti organization review, one of the following acts, given a warning or serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, give expelled from the party: (a) on supply or forged, destroyed, transfer, conceal evidence; (II) to prevent others expose, providing evidence Material; (III) harboring co personnel; (4) to the organization to provide false information, to hide the fact; (5) the him against the acts of the organization review. "< rule > add this clause to the Constitution requires more specific, the previous no punishment in accordance with the definite list and put forward clear punishment in accordance with. (4) about organizing or participating in superstitious activities as < Regulations > about engage in activities of feudal superstition obstruction of social management order" violations of Article 164 the provisions, but according to the original < rule > only in disrupting production, work, social life order The case to be disciplinary treatment, in other words, alone make the feudal superstition, organize or participate in the activities of feudal superstition of, does not constitute a violation. Which is not consistent with the requirements of our party's political party. > < new regulations in this change is, superstitious activities on the political discipline, increase the Article 58, is the organization of Party members, in superstitious activities included in violation of the negative list of political discipline deserves punishment, which and Party members should adhere to the correct political principle, political standpoint and viewpoint is consistent. 14 the second question about organization and discipline violation behavior of democratic centralism is our The party's fundamental organizational system. < New Regulations > Chapter 7 "in violation of the behavior of organizational discipline punishment" mainly for violation of democratic centralism, contrary to the "four obey the discipline behavior for source classification rules. Increased not in accordance with the relevant provisions or requirements to the organization for instructions to report on major issues; do not report truthfully report about personal matters; falsify personal archives; hide before joining the party serious mistakes; leading cadres in violation of the relevant provisions of the organization, will participate in the spontaneous formation of the old Xiang, Alumni Association, comrades in arms; to obtain illegal country residence abroad or foreign nationality, illegal for private frontier Documents such as discipline terms. (1) on the report truthfully report personal matters in 2010 the Central Committee of the Communist Party of China office, office of the State Council introduced < provisions on issues related to the leading cadres to report personal >, is clear about the request, deputy division level and above leading cadres should truthfully report changes in my marriage and spouse, children, moved to the country (territory), practitioners, income, real estate, investment and other matters, for failing to report, do not report, concealed and unreported, according to the seriousness of the case, giving criticism and education, and to make a correction within a time limit, shall be ordered to make a check, the commandment Jiemian conversation, informed criticism or jobs, free Post processing, constitute violations, in accordance with the relevant provisions shall be given a disciplinary sanction. But since the original < Regulations > and there is no corresponding specific terms, the violation of the regulations, do not report, as a false report about personal matters, there is no corresponding disciplinary action terms, in practice it is difficult to operate. In this regard, in order to solve is not reported, as a false report about personal matters 15 asked censure, the new < Regulations > add the Article 67 of violation of personal matters related to reporting requirements, report truthfully report the clear punishment basis, making this kind of violation behavior is no longer free drilling for Exhibition on matters of personal checks to verify and supervision of cadres, discipline review provides a powerful discipline guarantee. (2) about the illegal organization, to fellow, alumni, friends of the war will < regulations stipulated in Article 68 of >, leading cadres of the party in violation of relevant provisions of the organization, will participate in the spontaneous formation of fellow, Alumni Association, comrade in arms to give the punishment according to the seriousness of the case. Here special needs note is three points: this provision for only the leading cadres ", reflecting the high requirements of leading cadres; second violation in 2002, the Central Commission for Discipline Inspection, the central Organization Department and the The relevant provisions of the General Political Department jointly issued the < off in leading cadres not to participate in the initiative to set up "the villagers would be" alumni "" comrades in arms organization notice >. That is to say, to the spontaneous formation of fellow, Alumni Association, comrades in arms will constitute the premise of discipline is a violation of the provisions of this. The notification specified, leading cadres are not allowed to participate in the spontaneous incorporation of fellow, alumni, between comrades association would like the organization and shall not bear the sorority Human and the organizer shall not hold the corresponding position in the sorority; shall not borrow machine woven "network" and engage in kiss sparsely, round and round the gangs, but not "align" "Jieyi Gold Orchid" behavior. The third is to emphasize here that shall be organized to participate in the initiative to set up the villager, Alumni Association, comrades in arms. The so-called 16 spontaneous was established mainly means without registration. Therefore, Party members include leading cadres in the normal range of fellow, alumni, comrades in the party is not a violation of the rules of Party discipline. The three problem about integrity violations discipline Lian Jie discipline has been eighteen years clean government and anti The focus of the work of corruption. This Ordinance to amend, honesty and discipline this biggest adjustment, the new content, most of which prescribed by the original < criterion of a clean and honest administration > 8 ban and 52 are not allowed into the basic this part. (1) the central eight provisions of the spirit and requirements into < New > in the regulations of the party's eighteen years, central resolutely implement the provisions of the eight and pay close attention to the node and intensive briefing, on public funds, private bus, public funds tourism, gifts of public funds, the big parade and lavish weddings and festive, illegal payment allowances and subsidies, illegal construction of buildings such as the original masses reflects the relatively strong, "four winds" problem of the Resolute rectification. But original < Regulations > to eat and drink, super standard reception and no clear and specific expression, new < rule > will implement eight Central provisions of the spirit of the problem increased to "clean cheap self-discipline" chapter, clear to exceed the standard, beyond the scope of the reception or borrow machine eating and drinking etc. some in violation of the provisions of the spirit of the eight central relevant persons responsible for punishment, once the violation will be according to the < rule > severely punished, binding, enhanced significantly. One is to add Article 87, about to obtain illegal, hold, and the actual use of the sports card, golf ball cards and other consumer card. Illegal access to private clubs made the punishment provisions. The second is increase the Article 97, has made provisions of the disposition of illegal self pay or 17 spamming allowances, subsidies and bonuses. The third is added to the Article 99, on violation of super standard, beyond the scope of the reception or borrow machine eat and drink to make the provisions of punishment. The fourth is to increase the Article 101, on the management of conference activities in violation of the provisions made sanctions regulations. The fifth is the increased Article 102, for violation of office space management provisions made the punishment provisions. Six is to split the original < rule > Article 78, formed article 98, Article 100 of public Models of tourism, violate the provisions on the administration of the use of discipline of the bus through the list of made a more detailed provisions, apply more operational. Seven is increased the article 96, in violation of the relevant provisions of the, to participate in public funds to pay for dinner, high consumption of entertainment, fitness activities and public funds to buy gift, send gifts to make the provisions of the disposition. On the violation of the central provisions of the spirit of the eight, in addition to > < new regulations into "violation of honesty and self-discipline" misconduct outside, is different with the original < Regulations >, revised < rule > clearly defined not only to disposition of the directly responsible persons, but also dispose of collar Guide responsibilities. (2) increased trading rights, use of authority or position influence as relatives and close to profit violation of the terms of the < New Regulations > absorption < clean politics several guidelines > the relevant provisions spirit, increase the "negative list, including trading rights, the functions and powers or duties of influence as relatives and staff around profit. Increase Article 81" mutual use of office or authority ring for each other and their spouses, children and their spouses and other relatives, around 18 personnel and other specific relationship between the people to seek benefits engage in trading rights, given a warning or serious warning Sanctions; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, shall be expelled from the party. Increase Article 82 "connivance, acquiescence to the spouse, children and spouse etc. relatives and staff around the effect of Party members and cadres personal authority or position for personal gain, if the circumstances are relatively minor, given a warning or a serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, the given Expelled from the party. Party members and cadres of the spouses, children and their spouses does the actual work and get salary or although the actual work but to receive significantly beyond the same rank salary standard, Party members and cadres informed fails to correct, in accordance with the provisions of the preceding paragraph. "(3) about the gifts, gifts misconduct from handling practices in recent years, engaged in official cadres received gifts, gifts problems more prominent. This has seriously affected the image of Party members and cadres, damaged the relations between the party and the masses, and is a hotbed of corruption, is really necessary for this kind of behavior to be disciplined. < rule > no on accepting gifts, gifts, Card consumption behavior to engage in simple "one size fits all", but the difference between the different separately. One is in accordance with the provisions of Article 83, accepting may affect the impartial enforcement of the official gifts, gifts, consumer cards to depending on the seriousness of the case shall be given disciplinary sanctions. That is to say, for may affect the fair execution of business gifts, gifts, consumer cards are not allowed to accept. 19 is in accordance with the provisions of Article 83, accepting was significantly higher than normal ceremony is still exchanges of gifts, gifts, consumer card to disciplinary action. This is new regulations that daily life is purely reciprocity, accepting the same thing, boys , fellow friends gifts, gifts, shopping cards, although and fair execution of business has nothing to do, also want to as the case shall be dealt with, the situation is obviously beyond normal reciprocity ". The so-called" reciprocity ", one is emphasizes the reciprocal in protocol. In other words is you to me how, I to you how, not only does not go. The second is to significantly exceeded the normal local economy level, customs and habits, economic capacity of individual gifts, gift value. Specific sanctions to according to the processing of a variety of factors to consider, as appropriate. The third is the root according to the provisions of Article 84," to Engaged in public service personnel and their spouses and children, children's spouses and other relatives and other specific relationship presented Ming Xianchao normal reciprocity of gifts, gifts, consumer card, if the circumstances are relatively serious, given a warning until probation. "In accordance with the above provisions, gift giving significantly beyond the normal reciprocity, giver constitute the discipline. (4) on illegal trading of stocks or of other regulations of securities investment < > Article 88 is engaged in punishment regulation of camp and activity in violation of the relevant provisions on. Among them, 3 will" buying and selling stocks or in other securities investment "column as one of disciplinary cases Out. First need to be clear, > < regulations did not change the provisions of the Ordinance. The ordinance of the provisions of the second paragraph of Article 77 provisions "who, in violation of the provisions of the sale of stocks" is one of the violation, and at the beginning of the first paragraph of this article "violation of 20 against the relevant provisions of the" textual representation of the repeat revision. In, just from the legislative technique removed the "personal" in violation of the provisions, content and not to change the original provisions. Need to clear is, "buy or sell a stock or of other securities investment" refers to violation of the relevant provisions refers to in April 2001, the Party Central Committee, the State Council promulgated the On the work of the party and government organs staff's personal investment in securities if dry provisions >. According to the provisions of Article 3, use of work time, office facilities, the sale of stocks and securities investment fund belongs to illegal behavior. The fourth question, about the violation of the masses of the disciplinary actions < new regulations > would violate public discipline behavior of a single set of a class of restored "three rules of discipline and eight note" in the discipline of the masses of excellent traditional. < New Regulations > Chapter 9 "to violate the masses of disciplinary action", mainly the destruction of the party's close ties with the masses of misconduct made provisions on disciplinary; enrich and perfect the super standard, beyond the scope of Xiang Qun < All to raise fund and labor, in for involving the public affairs deliberately, chinakayao, in social security, policy support, disaster relief funds and materials and other matters assigned any kind and affectionate friends, obviously unfair acts against the interests of the masses of the disciplinary terms; increase the terms not in accordance with the provisions of the public party provided, government, factory and village (neighborhood) provided etc. violation of the people's right to know the behavior of the discipline. The fifth issue, on the violation of work discipline violation of work discipline added "negative list, including Party organizations carry out strictly Main responsibility for poor discipline terms. (1) the new party organization comprehensive strictly the main responsibility of the party does not fulfill the 21 or perform poor disciplinary terms < New Regulations > has a lead people to pay attention to the new terms, that is, in chapter ten "on the violation of work discipline behavior punishment" increase in the one hundred and fourteenth "party fail to perform comprehensive strictly the main responsibility of the party or to perform comprehensive strictly the main responsibility for administering the ineffective, resulting in serious damage or serious adverse effects, to the person directly responsible and the responsibility of leadership and give a warning or serious warning. The situation is serious, giving removed from their party posts or on probation Punishment. "Here the changes. For the first time, the main responsibility write < rule >. (2) new shall report does not report or false reporting discipline shall increase the 117 bar" in the higher level units to check to inspect the work or report to the parent unit, work report of shall report the matters do not report or do not report, cause serious damage or serious adverse effects of, to the person directly responsible and the responsibility of leadership, to give warning or a serious warning; if the circumstances are serious, giving removed from their party posts or placed on probation. "For example, during the tour visits to the region, the unit Members the obligation to the inspection teams to reflect the true situation, to conceal not reported or intentionally to the inspection teams to provide false information, causing serious damage or serious adverse effects of, the person directly responsible and the responsibility of leadership should be in accordance with the provisions of < rule > Article 117 to give the appropriate punishment. (3) the new not granted in accordance with the provisions of punishment, not according to the provisions of the implementation of disciplinary measures 22 violation of the provisions of Article 115 "Party organizations have one of the following circumstances, the direct leadership responsibility. Probation: members were sentenced punished, in accordance with the provisions give disciplinary action or in violation of state law Rules of behavior should be given disciplinary punishment and dispose of; disciplinary punishment by decision or complaint review the decision made, not in accordance with the provisions of the implementation decisions on punishment of the party, position, rank, and the treatment of the matters; Party members subject to disciplinary action, not in accordance with the cadre management authority and organizational relationships of by dispose of Party members to carry out education and supervision of daily management. "What needs to be pointed out is," cliff "demoted with cars, housing, secretary problem, implementation is not a discipline and party posts and ranks treatment by the organization department is responsible for the implementation, with cars, housing by the logistics department is responsible for the implementation of, Ji Commission responsible oversight responsibilities. The six questions, about the acts violating the discipline of life "in violation of discipline of life behavior punishment", mainly to "four winds" problems and a serious violation of social morality, family virtue acts of misconduct made provisions on disciplinary, an increase of extravagant life, contrary to the social public order and good customs disciplinary terms. Worth mentioning is, > < Regulations in Article 150 about "adultery" "mistress (Cardiff) formulation in the new < rule > is removed, to expand the scope of Article 127 provisions" and others hair improper sexual relations, let face disciplinary action Wider more strict. Four, and earnestly do a good job in the < code > and < rule > implement system of life lies in execution. < code > and < Regulations > is 23 Party organizations at all levels of a strong constraint and all Party members follow. Learning and implementing the < code > and < rule > is party committees (party), commission for discipline, discipline inspection group), the majority of Party members and cadres of the common responsibility, must party caught together, the party one execution. () Party committees (party) and play and implement comprehensive strictly the main responsibility, pays special attention to the two party regulations learning cross penetration. One is to Adhere to the party constitution is fundamental to follow, and resolutely safeguard the authority of the Party Chapter. The second is to adhere to the problem oriented, to strictly political discipline and political rule moments in the first place. The third is to adhere to the discipline and rules quite in front must not allow the bottom line to break the discipline. The fourth is to seriously organize the study of propaganda and education, in the city party members to create a disciplined, about the rules of the strong atmosphere. (II) Commission for Discipline Inspection at all levels (Discipline Inspection Group) to an important basis for the revised two party regulations as, adhere to easily blame, strengthen supervision and enforcement And early method in combining Ji, increase accountability efforts. One is to two regulations within the party important basis, adhere to the party constitution duties, with strict discipline to maintain the constitution authority. The second is to adhere to high standards and keep the bottom line, adhere to Ji Yan in law and discipline, the discipline and rules quite in front, grasping grasping small, easily blame, comprehensive use of supervision and discipline of "four kinds of form" in the discipline embodies the strict requirements and care for the discipline, tighten up, Yan. According to discipline in accordance with regulations to carry out disciplinary review. Increase the violations punishment, clues can initiate an investigation on the trial of cases According to the discipline on the provisions of the proportion of processing and control manager maintains discipline. To focus on investigating non convergence, don't accept hand serious disciplinary violations at the same time, pay more attention to the general review of discipline 24 behavior, and gradually increase the lighter punishment. Four is to illuminate two party regulations, combined with the local district of the Department of party conduct Lianzheng to relevant laws and regulations system clean, timely research proposes to establish, change, waste release opinion, avoid conflict, and the fasten system of cage, and gradually formed not rot, not rot, not want to rot system and working mechanism. (3) the leadership of the party members and cadres should play an exemplary role. The rate of higher consciousness of the front of the Ordinance to lead practice self-discipline norms, leading to maintain discipline of seriousness and authority. One is the above rate, demonstration and guidance, take the lead in learning and mastering the < code > and < > the requirements and regulations, do the deep understanding, learning to use. The second is to play an exemplary role in abiding by discipline rate, take the lead in practicing self-discipline norms, firmly establish before the discipline are equal, the system has no privilege, discipline is no exception, and consciously do standards, require more strict measures more practical. Third is to consciously accept supervision, conscientiously participate in the democratic life and debriefing honesty responsibility, such as Real to the party organization to report personal matters, and to accept the supervision of the work and life of the normal, habits under the supervision of the exercise of power, to carry out the work. The fourth is to set an example for the strict enforcement of discipline. Leading cadres should take the lead in the maintenance of discipline of seriousness and authority, to dare to seriously, dare to struggle, dare to offend people, for misconduct not laissez faire, but do not indulge, not tolerate to ensure the party constitution of party compasses party put in place. (4) the majority of Party members and cadres to set high standards and hold the bottom line, consciously abide by the < code > and < rule >. One is to control the < standard > and < 25 cases >, tight Close connection with their own thoughts, practical work and life, efforts to solve the problems, to enhance the study and implement of the effectiveness and pertinence. The second is to establish a high standard and hold the bottom line, consciously in the self-discipline pursuit of high standards, strictly in the party away from the red line discipline, discipline, about the rules and know fear, distrust, the formation of the honor system, comply with the system, safeguard system of good habits. Regulations and discipline regulations of < < New Revision of the Communist Party of China clean fingered self-discipline criterion > and < Chinese Communist Party Disciplinary Regulations > is the Party Central Committee in the new situation to promote the comprehensive strictly root of the lift, the regulations of the party construction of keeping pace with the times. We should study and implement the Standards > and < > as the primary political task, adhere to the party constitution duties, adhere to the discipline of, Ji Yan in law, the full implementation of supervision and discipline accountability responsibilities for coordination and promotion "four overall" strategic layout in XX District vivid practice to provide a strong guarantee. - Si Jian Wu, and effectively enhance the implementation of the implementation of the < code > < > The consciousness of General Secretary Xi pointed out that the party is in charge of the party, to manage the party; strictly, it can cure good party. Criterion > and < rule > keep pace with the times is our party to form a new potential strictly rules, to deepen understanding of the ruling law, is a comprehensive strictly, and strengthen the supervision within the party important grasper. Criterion > closely linked to the theme of self-discipline, self-discipline intensity-modulated, focusing on morality, for the majority of Party members and cadres set to see, feel the high standard, show the Communists noble moral sentiment; District Ordinance < < rule > the constitution of discipline integration into a political discipline, organization and discipline, honesty and discipline, discipline of the masses, work discipline, discipline, emphasize discipline, focusing on established rules, to draw the party organizations and Party members do not touch the bottom line. Party committees (party) to effectively strengthen the study and publicize the implementation of the < code > and < rule > the organization and leadership of criterion > and < > a full range, multi angle, deep publicity, the formation of study and publicize and implement the boom, in order to consolidate the development of good political environment to create a positive environment and atmosphere. The majority of Party members and cadres to strict requirements, the < rule > and < Ordinance cases > as a guide to action and behavior criterion, adhere to the moral standards and discipline of the bottom line, to maintain the discipline of worship and awe, learning, compliance, and maintain party discipline and rules of the model. The discipline inspection and supervision organs and cadres to the < code > and < > as the deepening of the "three", and strengthen supervision and discipline of accountability is important to follow correctly grasp the use of supervision and discipline of "four types", promote the comprehensive strictly in new roots. Strict discipline, adhere to the discipline and rules quite in front of the enterprise in the implementation of expensive to implement to execute. The discipline inspection and supervision organs to implement the < code > and < Efforts to investigate cases > as an opportunity, adhere to the party should manage the party strictly, serious performance of their duties to promote two regulations implementation. Change discipline concept. From the simple "investigation of illegal" to a comprehensive "stare at violate discipline"; from the business case to prosecute the big cases and timely solve the signs of tilt to. From the orientation to the normal supervision; from the tube "minority" to resist the "most". Guide Party members and cadres to seriously implement the < code > and < rule >, consciously abide by the political, organizational, honest people, work, life six discipline. Urge the leadership cadres sent to play an exemplary role, take the lead in strictly enforced. Relaxation and rest Strong wind is Su Ji, closely linked to the "four winds" prone to multiple, the masses reflect the strong important nodes and, glued to the four winds "new form, new trends, seriously investigate and deal with violations of the central eight provisions of the spirit, to increase the bulletin exposure intensity, the formation of Chajiu" four winds "loudly, continue to release and discipline must be strict signal. At the same time, extended supervision tentacles, through the development of the rural and fishery party conduct Lianzheng construction inspection, issued in a timely manner, Chajiu occurred in grassroots side of corruption and unhealthy, and earnestly safeguard the interests of the masses and social stability. The creativity and discipline. Grasp and make good use of the supervision and discipline of" four types ", to ensure the Promoting clues to lots of discipline and the law of the vacuum tube, strict together. Not only to the "less" and "very few" thorough investigation severely punished, but also the "most" to maintain zero tolerance trend through layers of conductive pressure, let the discipline about the rules for each party members and cadres consciously follow. At present, it is necessary to implement the "list" management, strictly follow the clues to the disposal of five standards, make the classification of disposal, dynamic cleanup. Zadok Party committees at all levels to implement the main responsibility, comprehensive use of disciplinary action and tissue processing and other means to effectively curb the commonplace, used to see do not blame the "small problem", not because of "practice" and "exception". Prominent Discipline characteristics, the problems of violation of discipline and rules into the focus of supervision and discipline and disciplinary review. At the same time, increase case double check the intensity, the serious problems of discipline violations or "four winds" ban but not absolutely, not only to be held directly responsible, but also held leadership responsibility; not only to pursue studies the main responsibility of the Party committee, and to pursue Commission for Discipline Inspection and supervision responsibilities and promote accountability to become the new norm. The implementation of supervisory responsibility. Maintain < code > and < rule > the seriousness and authority of the discipline and rules and truly become the party's ruler. Discipline as supervision within the party the specialized agency, we must strengthen the responsibility to act, adhere to the Impartial discipline accountability, earnestly will be strict discipline, discipline must be punished, and severely punish the acts in violation of rules and regulations.