人体心肺功能康复状态的多维度非线性动态建模分析方法学研究

本研究着重从数理分析的方法学角度，探讨一种能多指标、多维度、动态反映心肺病人功能康复程度及机能变化规律的非线性建模分析新方法。尝试建立人体心肺功能应激运动负荷条件下的个体运动数学模型，为评价心肺病人机能康复状态，提供方法学上的参考。     

太极拳对恶性肿瘤病人生理机能影响的文献质量研究

[目的]分析太极拳对恶性肿瘤病人生理机能影响的文献现况,为太极拳的临床实践与研究提供参考。[方法]以太极拳、肿瘤为主题词搜索电子数据库(PubMed,Cochrane Library,Embase,CNKI,CBM),辅以手工、追溯检索,采用文献计量法、方法学评价工具和内容分析法对纳入文献进行分析。[结果]获得38篇文献,涉及随机对照试验研究10项,采用的太极拳招式与派别及其疗程各异,以杨氏太极拳为主;研究主要集中于上肢运动功能与循环功能、心肺功能、疲乏和睡眠方面。[结论]太极拳对恶性肿瘤病人生理机能的影响日益受到国内外研究者的关注,但研究领域较为局限且研究方法的质量还应进一步提高,建议适当扩大研究领域,规范太极拳干预措施,进行更科学、严谨的实验设计,为太极拳用于恶性肿瘤实践提供更强的护理循证证据。     

系统康复锻炼对睡眠呼吸暂停低通气综合征患者心肺功能及呼吸紊乱指数的影响

目的:探讨系统康复锻炼对睡眠呼吸暂停低通气综合征(OSAHS)患者心肺功能及呼吸紊乱指数的影响。方法:将2018年2月1日～2021年2月1日收治的106例OSAHS患者,根据入院先后顺序分为对照组和观察组各53例,对照组实施常规干预,观察组在对照组基础上实施系统康复锻炼;比较干预前后两组静动态心肺功能指标、呼吸紊乱指数(AHI)及血氧饱和度(SaO_2)水平。结果:干预后,两组静态心肺功能、动态心肺功能、AHI及SaO_2均优于干预前(P0.05),且观察组优于对照组(P0.05)。结论:系统康复锻炼有助于改善OSAHS患者静态及动态心肺功能指标,缓解其缺氧状态,降低呼吸紊乱指数。     

心肺复苏术后病人稳定期临床护理

[目的]探讨分析心肺复苏术后病人稳定期的临床护理措施,以促进病人脑功能的恢复和身体康复。[方法]回顾性分析2010年4月—2012年3月在我院治疗的64例心脏骤停后心肺复苏成功病人的临床记录资料。[结果]观察组的总有效率为84.38%,显著高于对照组的56.25%,具有统计学意义(P<0.05)。[结论]对心肺复苏术后稳定期病人给予细致、有效及全面的护理,可显著降低并发症发生率、促进病人脑功能的改善和机体功能的恢复。     

中医康复临床实践指南·心肺康复

心肺功能康复是现代康复医学的重要组成内容,心肺功能是人体生理功能的根基,心肺功能的高低直接影响着患者的生活质量和康复进程。循证医学显示,心肺康复是通过全面、规范的评定,采取药物、运动、营养、教育、心理等综合医疗干预手段进行心肺康复治疗,能有效提高患者循环系统和呼吸系统功能,改善患者生活质量,促进其回归家庭和社会生活。制定心肺中医康复临床实践指南的主要目的是规范临床心肺功能障碍评估及康复治疗方法,以提高康复疗效。本指南从范围、术语和定义、心肺系疾病的中医四诊(心系、肺系辨证分型)、心肺功能评估、心肺功能训练等方面对心肺康复流程进行梳理。其中心肺功能评估主要包括以下几个方面:病史、体格检查、辅助检查(心脏超声、心电图、动态心电图、心脏导管检查、肺容量测定、肺通气功能测试、气体代谢测试)、呼吸困难程度分级、功能性肺残疾分级、心功能分级、运动耐力的评估(6min步行试验、心肺运动试验)、体适能评估(肌力、徒手柔韧性、平衡能力评估);心肺功能训练主要包括:肺通气与肺容量改善训练、气道廓清技术、呼吸肌训练、运动训练、针刺疗法、推拿疗法、太极罐疗法、耳穴疗法、中医导引术等。本指南可为各级各类康复机构、中医医院或综合医院的康复从业人员进行心肺康复治疗提供指导,具有较好的临床适用性及有效性。     

肺康复对特发性肺纤维化病人心肺功能及生活质量影响的Meta分析

目的:系统评价肺康复对特发性肺纤维化病人心肺功能和生活质量的影响。方法:计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、中国期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据知识服务平台(WanFang Data)和中国生物医学文献数据库(CBM)中肺康复治疗特发性肺纤维化临床试验研究的相关文献,检索日期为建库至2021年6月10日。运用RevMan 5.4软件进行Meta分析。结果:共纳入9篇文献,涉及373例病人。Meta结果显示,心肺康复干预后,病人6 min步行距离明显提高(MD=30.48)、用力肺活量(MD=5.60)和圣乔治呼吸问卷(SGRQ)评分(MD=-9.16)改善。结论:现有证据表明,肺康复能够提高特发性肺纤维化病人的运动能力,改善心肺功能和生活质量。     

康复医学护理

920640康复护理/马荫楠//护士进修杂志一1991,6(9)一6~7 康复的任务是对身心健康发生障碍的人,最大限度地恢复其残留功能,使其重返社会,达到身心全面康复的目的。在康复小组中护士起着独特的作 ·102·用。通过康复护理,能使病人接受康复计划,鼓励病人保持积极康复的要求,帮助病人在生活自理后在社会上自立。在身体机能上,主要是帮助病人训练日常生活动作、肢体功能、言语机能以及精神障碍病人的康复等。(马荫楠)9206妇类风泥性关节炎的康复护理/李爱琴//实用护理杂志一1991,7(10)一36 对病人要耐心、细心,及时地把握病人的心理状态,进行心…     

股骨颈骨折病人规范化康复指导

从 1999年 1月～ 2000年 12月，对 75例股骨颈骨折病人进行规范化康复指导，促进肢体的功能恢复，减少并发症，提高病人的生存质量。现报道如下。 1 对象与方法 1.1 对象 75例股骨颈骨折病人均为住院病人，男 36例，女 39例，年龄 45～ 88岁，平均 67岁，手术治疗 40例，非手术治疗 35例。 1.2 方法 (1)心理指导：把心理康复作为机能康复的枢纽，以心理康复促进和推动机能康复。病人入院后首先向他们宣传功能锻炼的意义，使其充分认识功能锻炼的重要性，消除思想顾虑，主动进行锻炼。 (2)体位指导：告知病人患肢置于外展 10°～ 15°中立位…     

心脏康复模式在冠心病病人中的应用效果

[目的]探讨心脏康复模式对冠心病病人心肺储备功能及生活质量的影响。[方法]将60例冠心病病人随机分为观察组和对照组各30例。对照组病人给予冠心病常规治疗和护理,观察组在此基础上给予心脏康复模式干预。记录两组病人住院时间和住院费用,并于入院后第1天和干预3个月后,评估病人对冠心病相关知识的掌握情况及自我效能、生活质量,检测病人心肺运动试验1 min后心率恢复(HRR1)、摄氧量峰值(VO2max)、无氧阈值(AT)、无氧阀下氧气通气量(VE/VO2)和每搏氧耗量(O2pulse)。[结果]观察组冠心病病人住院时间、住院费用均低于对照组(P0.05);干预后观察组冠心病病人HRR1、VO2max、AT、O2pulse及冠心病相关知识、自我效能、生活质量得分均高于对照组(P0.05)。[结论]心脏康复模式可以改善冠心病病人的心肺储备功能,提高生活质量。     

互联网+预康复在食管鳞癌病人新辅助化疗空窗期的应用

目的:探讨互联网+预康复在食管鳞癌病人新辅助化疗空窗期的应用效果。方法:便利抽取2021年3月—2022年3月在南昌某三级甲等医院肿瘤科住院的79例进展期食管鳞癌病人作为研究对象。采用抽签法随机分为观察组40例和对照组39例,在食管鳞癌病人新辅助化疗空窗期,观察组应用互联网+预康复方案,对照组应用常规护理方案,比较两组病人营养状况、心肺功能、心理状态、并发症发生情况、住院时长等。结果:两组干预后体质指数、营养风险筛查工具2002评分、焦虑抑郁评分、6 min步行距离(6MWD)、第1秒呼气容积(FEV1%)、住院时间比较差异均有统计学意义(P<0.05)。结论:互联网+预康复在食管鳞癌病人新辅助化疗空窗期的应用有助于提高病人营养状况、心肺功能,改善心理状态,缩短住院时间。     

Cardiorespiratory strain during stroke rehabilitation: Are patients trained enough? A systematic review

BackgroundRehabilitation is a mandatory component of stroke management, aiming to recover functional capacity and independence. To that end, physical therapy sessions must involve adequate intensity in terms of cardiopulmonary stress to meet the physiological demands of independent living.ObjectiveThe aim of this systematic review was to determine the current level of cardiopulmonary strain during rehabilitation sessions in stroke patients.MethodsThree electronic databases (PubMed, CINAHL and Embase. com) were searched to identify observational studies that documented cardiopulmonary strain during rehabilitation sessions in post-stroke patients (last search performed in February 2019). A manual cross-referencing search was also performed. To be included, articles needed to report data related to both cardiopulmonary strain (heart rate, oxygen consumption or energy expenditure) and active therapy time. The methodological quality of each study was assessed with the Evidence-Based Librarianship Critical Appraisal Tool. Data related to both cardiorespiratory strain and active therapy time were extracted from selected articles.ResultsFour of 43 full-text articles assessed for eligibility met the inclusion criteria. Results extracted from these articles suggested that the intensity of rehabilitation sessions was insufficient to induce a cardiopulmonary training effect in a post-stroke context as measured by metabolic stress. Patients were inactive from 21% to 80% of the therapy time. The Evidence-Based Librarianship tool scores ranged from 65% (15/23) to 91% (21/23), which indicates questionable to good quality.ConclusionThe current literature on cardiopulmonary solicitation during stroke rehabilitation sessions is poor in terms of both the number of studies available and their methodological quality. Summarized results tend to support previous claims that rehabilitation sessions offered to stroke patients are of suboptimal cardiopulmonary strain, which can interfere with their capacity to regain functional independence.     

心肺运动康复对居家老年冠心病伴衰弱患者心肺功能、睡眠及生命质量的影响

目的:探究心肺运动康复对居家老年冠心病伴衰弱患者心肺功能、睡眠及生命质量影响.方法:选取2019年10月至2020年10月于联勤保障部队第九医院确诊的95例老年冠心病伴衰弱患者,随机分为对照组和观察组,对照组接受心肺康复健康教育,并自行运动,观察组在对照组基础上予心肺运动康复.比较2组患者的心肺功能、睡眠质量与生命...     

居家老年冠心病伴衰弱患者心肺运动康复效果评价

目的:观察心肺运动康复对居家老年冠心病伴衰弱患者心肺功能和生活质量的影响。方法:便利选取郑州市航海东路社区卫生服务中心的98例患者为研究对象,按照居住地分成两组,干预组与对照组各49例患者。对照组接受心肺康复健康教育,干预组接受心肺康复健康教育+心肺运动康复。比较干预前后两组患者衰弱得分、心肺功能和生活质量变化情况。结果:干预后,干预组患者衰弱总分及各维度得分低于对照组,差异具有统计学意义(P<0.05);干预组患者心率、收缩压、舒张压及心脏负荷量好于对照组,差异具有统计学意义(P<0.05);干预组患者用力肺活量、第一秒用力肺活量和一秒率水平好于对照组,差异具有统计学意义(P<0.05);干预组患者生活质量总分及各维度得分高于对照组,差异有统计学意义(P<0.05)。结论:心肺运动康复可以改善居家老年冠心病患者心肺功能及衰弱情况,提高患者生活质量。     

心肺康复对冠脉搭桥术后患者肺功能及运动耐力的影响

摘要 目的：探究早期院内心肺康复治疗对于冠脉搭桥术（CABG）后患者肺功能及运动耐力恢复的影响。 方法：选择冠脉搭桥术后住院患者40例,按手术日期分为康复组20例及对照组20例。对康复组患者予以术后第1天至第14天的早期心肺康复治疗,内容包括：运动疗法、呼吸训练、心脏危险因素控制、疾病相关教育及心理咨询对于对照组患者除常规护理外无特殊干预。两组患者均于手术后第15天以床头肺功能检查评价患者肺功能情况,以6min步行试验（6MWT）评估患者运动耐力,并以SF-36量表评价患者生存质量情况。 结果：肺功能检查结果显示康复组患者第1秒钟用力呼气量（FEV1）占预计值百分比（FEV1占预计值%）数值显著高于对照组（P<0.01）,用力肺活量（FVC）占预计值百分比（FVC占预计值%）数值明显高于对照组（P<0.05）,同样康复组6min步行实验及SF-36量表(P<0.05)评价结果亦优于对照组。 结论：对于CABG术后患者而言,早期适当的心肺康复训练有助于肺功能、运动耐力的恢复,是改善其术后恢复情况,提高生存质量并最终影响疾病结局的重要治疗手段之一。     

康复锻炼对慢性阻塞性肺疾病患者心肺运动能力的影响

目的对慢性阻塞性肺疾病(COPD)患者进行康复锻炼,旨在检验康复锻炼能能够提高患者心肺运动能力的假设。方法患者接受为期12周的康复锻炼,每周训练4次,共48次。锻炼结束前进行15min的放松训练。每次锻炼时间约为1.5h。锻炼安排在晨练时间进行。锻炼计划实施前组织患者参加呼吸疾病健康教育,内容包括呼吸技术训练和呼吸肌锻炼。锻炼开始前和结束后分别对患者进行心肺运动能力评定。指标包括最大运动能力、无氧阈、最大摄氧量和6min步行试验(6MD)。结果康复锻炼后与锻炼前比较,患者最大运动能力(t=2.820,P=0.009)、无氧阈(t=2.278,P=0.038)、最大摄氧量(t=2.189,P=0.041)和6min步行试验(t=2.834,P=0.009)差异有显著性或非常显著性意义(P<0.05或P<0.01),心肺运动能力百分数变化差异也有显著意义(P<0.05或P<0.01)。结论康复锻炼可显著提高COPD患者心肺运动能力。     

Physical fitness in persons with hemiparetic stroke: its structure and longitudinal changes during an inpatient rehabilitation programme

OBJECTIVE: To test the hypothesis that the structure of fitness in patients with hemiparetic stroke can be categorized into impairment/disability, cardiopulmonary, muscular and metabolic domains, and to study longitudinal changes in their fitness during an inpatient rehabilitation programme. DESIGN: Structure analysis of multiple fitness parameters with principal component analysis (PCA), and a before and after trial. SETTING: Tertiary rehabilitation centre in Japan. PATIENTS: One hundred and seven consecutive inpatients with hemiparetic stroke. INTERVENTION: A conventional stroke rehabilitation programme consisting of 80 minutes of physical therapy and occupational therapy sessions five days a week, and daily rehabilitation nursing for a median duration of 105.5 days. MAIN OUTCOME MEASURES: Principal component scores extracted from measurement of paresis/daily living (the Stroke Impairment Assessment Set (SIAS) and the Functional Independence Measure (FIM)); muscular (grip strength (GS), knee extensor torque, and cross-sectional areas of thigh muscles); metabolic (body mass index (BMI) and fat accumulation on CT); cardiopulmonary (heart rate oxygen coefficient (HR-O2-Coeff) obtained with a graded bridging activity and a 12-minute propulsion distance). RESULTS: PCA categorized the original 15 variables into four factors corresponding to paresis/activities of daily living, muscular, metabolic and cardiopulmonary domains, and explained 78.1% of the total variance at admission and 69.6% at discharge. Except the metabolic domain, PCA scores for the other three domains improved significantly at discharge (paired t-test, p < 0.05). CONCLUSION: The hypothetical structure of fitness was confirmed, and the PCA scores were useful in following longitudinal changes of fitness during inpatient rehabilitation.     

Outcomes following cardiopulmonary resuscitation in an acute rehabilitation hospital. Clinical and ethical implications.

This retrospective study examines cases of cardiac arrest requiring cardiopulmonary resuscitation (CPR) in an acute rehabilitation hospital. All admissions to the Center for Rehabilitation Medicine at Emory University, a 56-bed facility, are reviewed. Seventeen cases of true cardiac arrest are identified for analysis of ultimate disposition over a 10-yr period. Only one patient (5.9%) survived CPR to discharge from the rehabilitation hospital, but he died subsequent to his transfer to the acute hospital. Though the sample size is small, it reflects the total population of patients eligible for CPR who suffered a cardiac arrest. We conclude that CPR is generally not successful in the elderly inpatient rehabilitation population. The growing clinical complexity of the rehabilitation patient demands that health-care providers and their patients more regularly address decision-making issues pertinent to CPR.     

系统心肺康复训练对冠心病病人运动耐力和生活质量的影响

[目的]探讨系统心肺康复训练对冠心病(CHD)病人运动耐力和生活质量的影响。[方法]按随机数字法将100例康复期CHD病人分为对照组和实验组各50例。对照组按照CHD治疗指南进行常规药物治疗及常规干预,而实验组在对照组基础上进行系统心肺康复训练。于干预前及干预后检测两组病人心功能各项指标,采用6min步行距离测试(6MWD)评价运动耐力,并采用健康调查量表(SF-36)评价病人生活质量。[结果]实验组病人干预后心功能各项指标及6MWD结果较干预前均有明显改善,且优于对照组,差异有统计学意义(P0.05);实验组干预后SF-36量表中各维度评分均高于对照组(P0.05)。[结论]系统心脏康复训练能明显改善康复期CHD病人心功能,提高病人的运动耐力,改善病人的生活质量。     

急诊心肺复苏预后的相关因素分析

目的分析急诊心肺复苏预后的相关因素。方法回顾性分析2019年1月至2020年1月本院的120例心跳呼吸骤停患者的临床资料,分析急诊心肺复苏预后的相关因素。结果120例患者中,预后良好16例,预后不良104例,占比分别为13.3%、86.7%。急诊心肺复苏预后良好与预后不良患者的发病时间、发病地点、发病病因、发病前状态、首次监测心律、心肺复苏起始时间、心肺复苏连续时间、肾上腺素总量比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,首次监测心律、心肺复苏起始时间、心肺复苏连续时间是影响急诊心肺复苏预后的独立危险因素(P<0.05)。结论首次监测心律、心肺复苏起始时间、心肺复苏连续时间是影响急诊心肺复苏预后的独立危险因素,值得临床充分重视。     

What is the role of the physical medicine and rehabilitation unit after total knee arthroplasty? Clinical practice recommendations.

OBJECTIVES: To develop clinical practice guidelines concerning the interest of post-operative rehabilitation in physical medicine and functional rehabilitation (PMR) ward after total knee arthroplasty (TKA). METHOD: The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. Main outcomes were impairment, disability, medico-economic implications and postoperative complications. RESULTS: Post-operative rehabilitation in a PMR ward after TKA is recommended for patients because of preoperative joint stiffness, and/or associated co-morbidities. The other parameters used by French physician for post-operative rehabilitation in a PMR ward after TKA are: the self-governing of the patient at home, the wishes of the patient and the opinion of the surgeon on the post-operative functional evolution of the patients. For patients in whom sustained rehabilitation is not necessary but who cannot return home, a stay in a non-specific (non-PMR) post-operative centre could be recommended. Post-operative rehabilitation in a PMR ward after TKA could reduce the length of stay in a surgical ward and increase the functional status of patients with co-morbidities. Studies with good methodological quality are needed to evaluate the cost/benefit ratio in the French health care system. CONCLUSION: This study suggests a value of rehabilitation in a PMR ward after TKA, but good methodological quality studies are needed to evaluate the cost/benefit ratio of rehabilitation in a PMR ward after TKA in the French health care system.