刘海若重症复合性损伤的康复问题

按刘海若康复医疗小组制订的康复医疗计划进行的康复医疗活动，基本达到了预期的目的，可以预料刘海若的功能恢复将是比较理想的。从这个重症复合性损伤的个案治疗中体会到；在综合医院中，康复医疗的早期介入、与临床相关学科的密切配合、强调预防性康复和主动性康复、对多种损伤的全面康复考虑和对康复医疗功能后果的全面考虑等，是制订康复计划和实施康复医疗成功的前提条件。因此，作为综合医院临床科室的康复医学科的医生，必须具有扎实的临床基础。     

综合医院康复医学科脊髓损伤住院患者情况分析

摘要 目的：了解全国综合医院康复医学科脊髓损伤住院患者的诊疗现状,为国家康复医学专业质控中心开展脊髓损伤康复医疗质控工作奠定基础。 方法：在国家医疗质量管理与控制信息网（National Clinical Improvement System, NCIS）,用《2018年综合医院康复医学专业医疗质量管理控制情况调查表》采集全国抽样医院数据,进行统计分析。 结果：最终纳入全国1810家综合医院康复医学科脊髓损伤康复住院患者共计50411人次,男女比例为1.50∶1。年龄：31—45岁占26.30%;46—60岁占33.81%;61—75岁占20.15%。损伤原因：创伤性原因占比72.97%;非创伤性损伤占27.03%。损伤部位：颈椎占30.52%;胸椎占20.62%;腰椎占37.52%。损伤分级：A级占31.80%;B级占22.86%;C级占22.16%;D级占19.86%;E级占3.32%。地区分布：东部、中部、西部地区的脊髓损伤康复患者占康复医学科出院患者比例分别为：6.33%、6.14%、5.38%。三级综合医院收治的脊髓损伤康复患者中胸腰段脊髓损伤,损伤严重者（A级、B级）所占的比例均显著性高于二级综合医院（P＜0.001）。全国脊髓损伤住院患者的早期康复介入率为26.97%。综合医院康复医学科脊髓损伤神经源性膀胱住院患者中57.23%进行了间歇导尿,29.61%开展了尿动力学检查。 结论：我国不同地区、不同级别综合医院的脊髓损伤康复医疗服务能力尚不均衡,脊髓损伤早期康复介入有待加强,脊髓损伤后神经源性膀胱的处理尚待提高。     

综合性医院神经科早期介入康复技术

综合医院的神经科早期介入康复技术在国外康复界已取得共识，在我国亦已试行，使神经科医师充分认识并积极开展早期康复是促使康复医疗取得更大的社会效益的重要因素。但我们并不认为在综合医院中上述形式可取代相对独立的康复医学科，最近卫生部已发布文件明令，二级以上综合医院应根据当地的康复医学诊疗需求和条件，设置康复医学科。我们欢迎读者对上述问题及究竟如何协调临床神经科与康复医学科之间的关系发表自己的见解。     

影响骨关节损伤康复效果的因素

目的提高骨关节损伤康复效果,减少后遗症和并发症给患者带来不利影响。方法根据作者从事骨科工作和骨科康复工作中的体会,介绍骨折愈合因素、关节损伤因素、软组织损伤因素、疼痛因素、不合理固定、不合理活动对骨关节损伤患者功能受限的影响。结果骨科与康复科协作、康复早期介入、采用综合康复措施、避免过度治疗和治疗不足、结合医疗康复以外的其他康复措施等是提高骨关节损伤康复效果、减少后遗症和并发症的基本原则。结论骨关节损伤康复最佳效果为“患者损伤修复之时也是功能得到最好程度恢复之时”。     

综合医院康复医学科假肢矫形器工作运行机制的探讨

卫生部在《综合医院康复医学科建设与管理指南》第三条中提出：“综合医院康复医学科是在康复医学理论指导下,应用功能评定和物理治疗、作业治疗、言语治疗、心理康复、传统康复治疗、康复工程等康复医学诊断和治疗技术,为患者提供全面、系统的康复医学专业诊疗服务的临床科室”。对康复医学科的设置和功能有了明确的指导性意见,其中就包括康复工程的设置和技术的应用。假肢矫形器是康复工程中具有代表性或引领作用的专业技术,在假肢矫形器工作运行过程中需要建立科学的制度和切实可行的方法,     

脊柱脊髓损伤临床及康复治疗路径实施方案

目的制订脊柱脊髓损伤临床及康复治疗路径。方法总结中国康复研究中心在脊柱脊髓损伤临床及康复治疗领域的经验、患者住院流程及住院费用情况,同时参考ICF Core sets相关内容。结果脊柱脊髓损伤临床及康复治疗路径适用于胸、腰、骶椎损伤并发脊髓神经损伤患者。内容包括急性期的外科治疗(伤后2周内)和亚急性期及后期的脊髓损伤临床及康复治疗(伤后2周～6个月)。急性期的外科治疗路径体现了重建脊柱稳定性及神经减压等核心治疗内容;亚急性及后期脊髓损伤治疗路径体现以康复为主的综合治疗特点。结论本路径的制订及实施基于疾病发展时间进程及脊髓损伤后神经恢复和治疗的阶段性特点,目的是提高医疗服务质量、降低医疗消耗。     

对综合性医院康复医学科的几点建议

虽然卫生部已经颁发《综合医院康复医学科管理规范》 ,但是从对我省多家医院的考察中看 ,综合医院康复医学科现状并不令人满意。1临床医生对康复普遍不重视社会对康复的需求越来越大 ,综合医院医护人员康复意识淡薄 ,严重地影响康复医学的发展。综合医院是目前实施康复计划的最佳场所 ,是取得康复成功的关键。现代临床康复理论的精华在于临床与康复并重。这是减少或消除病 (伤 )者身心社会功能障碍 ,最终重返社会的重要保证 ,然而某些医院领导和临床科室医生 ,对康复医学的理解模糊 ,将康复等同于疗养、理疗、针灸或按摩等 ,无形中阻碍了现…     

加强专业合作,发展脑外伤的临床康复

在各类外伤中,颅脑损伤,无论平时或战时,皆占全身各部位损伤的20%,发生率仅次于四肢伤,占第二位,而死亡率居首位(见:DelisaJA.ed.RehabilitationMedicinPrinciplesandPractice.Philadelphia.NewYork:Lippincott-Raven,1998.1193)。重型损伤幸存者往往留有不同程度的功能障碍,这是康复医疗需解决的问题。因此脑外伤康复的重要性不言而喻。现代康复医学的理论认为,康复医疗不是临床医疗的延续或重复而是贯穿始终,康复干预应当贯穿于损伤开始至恢复期全过程。目前国内对颅脑损伤康复的实践和研究主要集中在恢复期的功能训练上,而国外受到…     

职业康复简介

全面康复有两个极其重要的因素,就是医学康复和职业康复。这是两个具有不同特点的专业领域,但又互相依存不可分割。医学康复是通过医疗手段达到残疾人身体功能的康复。而职业康复的目的是为了帮助残疾人重新就业。国际劳工组织(The Internationallabour organization)对职业康复提出了精确的定义:“职业康复是连续的、统一的全面康复的一部分,是为残疾人谋求并维持适当职业而进行计划、设想及给予职业指导、     

综合医院康复医疗的特点和设想

目前康复医学在世界各国不断发展。各国都在努力探索符合本国国情的康复医学的模式，在人类健康医学体系中，保健、预防、医疗和康复医学，四者紧密结合，互相渗透，为人类提供全面的服务，由于早期康复越来越受到人们的重视，综合医院建立康复科已是一种趋势。综合医院的康复病房与普通病房有许多不同之处，它不仅要对病人进行继续治疗，而且要给病人早期康复介入。     

CURRENT CONCEPTS IN MUSCLE STRETCHING FOR EXERCISE AND REHABILITATION

Stretching is a common activity used by athletes, older adults, rehabilitation patients, and anyone participating in a fitness program. While the benefits of stretching are known, controversy remains about the best type of stretching for a particular goal or outcome. The purpose of this clinical commentary is to discuss the current concepts of muscle stretching interventions and summarize the evidence related to stretching as used in both exercise and rehabilitation.     

脑卒中恢复期康复程序的设计和实施

运用自行设计、编排的康复治疗程序,以提高生活技能为中心的康复方案,对脑卒中偏瘫恢复期的患者实施全面、系统的康复治疗,使康复措施贯穿在患者日常生活中去,成为生活中不可分割的组成部份。对提高康复医疗效果有一定的实用价值。     

儿童重症监护室患儿早期康复的现状及前景

危重症患儿进行早期康复可促进躯体功能的恢复,改善临床结局。本文主要阐述危重患儿早期康复护理现状,为今后儿童重症监护室(PICU)实施早期康复提供对策。     

Perceived value of stroke outcome measures across the post-acute care continuum: A qualitative case study

Connecting the continuum of post-acute care stroke services may be important for easing patients' transition between settings and facilitating recovery and community reintegration. The use of outcome measures is suggested as one means of connecting the continuum. The purpose of this qualitative case study is to describe administrators' and physiotherapists' perceived value of an outcomes program across the post-acute care stroke continuum at a rehabilitation hospital. Data were collected through individual interviews and focus groups with 18 participants. Three themes emerged on the value of the outcomes program: 1) enhanced communication; 2) supports clinical decision-making; and 3) value of objective data. These findings lend support for the use of standardized outcome measures by physiotherapists in stroke rehabilitation. Findings from this study may be useful for organizations and physiotherapists who wish to integrate outcome measures into practice.     

Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction

We have designed a new 4-week hospitalized phase II cardiac rehabilitation program. The purpose of the present study is to clarify whether the physical and psychological status of patients with myocardial infarction (MI) improves after participation in our program. Twenty-nine patients (27 males, two females) with acute MI who enrolled in the 4-week hospitalized phase II rehabilitation program were assessed. All patients enrolled in this study had received coronary interventions. The rehabilitation consisted of exercise training, education and counseling. We evaluated the physical and psychological status of the patients before and just after the program, and at a 6-month follow up. The physical status was assessed by exercise tolerance measured by the peak oxygen consumption and anaerobic threshold, frequency of exercise, and serum concentrations of triglyceride, total cholesterol, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol. The psychological status was assessed by the Spielberger state-trait anxiety inventory questionnaire (STAI) and the self-rating questionnaire for depression (SRQ-D). Thirty-four patients (27 men, seven women) with MI who did not participate in our rehabilitation program served as a control group. After participation in our rehabilitation program, exercise tolerance and the serum lipid profiles of the patients were improved compared with those before rehabilitation. These parameters had improved significantly 6 months after rehabilitation. The STAI anxiety score was improved significantly and the SRQ-D depression score tended to be improved just after the rehabilitation program. Regular physical activity was continued even 6 months after the completion of the program. Our hospitalized phase II cardiac rehabilitation program improved the management of cardiac risk factors and the psychological status in patients with MI. This comprehensive program may contribute to the secondary prevention of MI as well as the recovery of physical and psychological activities.     

影响脑卒中偏瘫患者日常生活能力恢复的因素分析

目的:分析脑卒中偏瘫患者治疗前后影响日常生活活动能力(activitiesofdailyliving,ADL)的相关因素。方法:对53例脑卒中偏瘫患者治疗前后进行上下肢功能、ADL等相关因素评定。结果:影响入院前ADL(ADL0)的正性因素包括肌张力、治疗前下肢运动能力,负性因素为年龄、尿便失禁、入院前居住地及发病次数。治疗后ADL(ADL1)的正性因素有ADL0和病变性质,而患肢腱反射的亢进或减弱和发病后住院时间则是ADL1预后的负性因素。家庭人数与ADL1恢复程度呈负相关(r=-0.527,n=53)。结论:肌张力和患肢腱反射是影响患者ADL恢复的有利因素;家庭人数多是ADL恢复的阻碍因素,提示对家属进行康复意识的教育非常必要。     

Systematic review of measures and their concepts used in published studies focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities

Purpose: To identify outcome measures cited in published studies focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities, and to identify and quantify the concepts contained in these measures using the ICF as a reference.

Methods: Electronic searches of Medline, Embase, CINAHL, Pedro and the Cochrane Library from 1997 to March 2002 were carried out. In a first step, abstracts of the retrieved studies were checked and data on the outcome measures and certain characteristics of the included studies were extracted. In a second step, the items of the questionnaires and their underlying concepts were specified. These concepts were then linked to ICF categories using standardized linkage rules.

Results: From the 1,657 abstracts retrieved, 259 studies met the inclusion criteria. In a second step, 277 formal assessment instruments and 351 single clinical measures were retrieved. A total of 1,353 concepts were extracted from the clinical and technical measures. Ninety-six percent of these concepts could be linked to ICF categories. Fifty-six second-level ICF categories representing the concepts contained in the measures. Twenty-six (46%) of the 56 categories belong to the component Body Functions, five (9%) to the component Body Structures, and 25 (45%) to the component Activities and Participation.

Conclusions: The ICF provides a valuable reference to identify and quantify the concepts of outcome measures focusing on rehabilitation in the acute hospital and in early post-acute rehabilitation facilities. Our findings indicate a need to define and to agree on ‘what should be measured’ in rehabilitation care to allow for a comparison of patient populations.     

早期康复对脊髓损伤患者步行功能恢复的临床观察

目的探讨早期康复对脊髓损伤患者步行能力的影响及运动和感觉功能与步行能力之间的相关性。方法对 47例脊髓损伤患者给予综合康复治疗 ,在入院时和治疗过程中根据美国脊髓损伤学会 (ASIA) 1992年的标准评定患者的运动与感觉功能 ,采用Hoffer步行能力分级评定步行能力。结果伤后 12个月时患者的运动功能和感觉功能比入院时显著增加 (P <0 0 5 ) ,入院时的运动功能与患者最终获得的步行能力相关 (P <0 0 5 )。结论早期康复能改善脊髓损伤患者的运动功能和感觉功能 ,入院时的运动功能与患者最终获得的步行能力相关