创伤性脑损伤的康复目标、时限与管理

目的创伤性脑损伤(traumatic braininjury,TBI)多由交通事故、体育活动、工伤或暴力袭击等引起.患者主要为青年男性,多数出现明显残障.研究欧美国家有关TBI的康复管理模式有助于提高TBI患者的康复治疗水平.资料来源应用计算机检索Medline1990-01/2004-06与TBI相关的文章,检索词"traumatic brain injury;rehabilitation",并限定文章语言种类为English.共检索到15篇.同时手工检索<中国临床康复>杂志2003-01/2004-06期间的相关文章,限定文章语言种类为中文,检索词"创伤性脑损伤;康复",检索到3篇.资料选择选择有关TBI康复管理的文献,包括著作、论著等.数据提炼共收集到18篇近5～10年有关TBI的预后评价与影响因素、康复目标、康复时限、昏迷阶段的治疗、康复阶段管理和有关并发症的处理等方面的文献.资料综合TBI康复阶段管理贯穿TBI康复全过程,了解每个阶段康复管理要点,尤其对患者残障情况做出正确评价并制定康复方案,是保证康复预后的关键.康复工作者对患者认知障碍以及伤前状况、损伤程度和康复方式对康复目标的影响,必须有足够的认识.结论从已检索的文献报告表明,康复管理水平是影响TBI康复效果的关键.

Rehabilitative objective,time limit and management of traumatic brain injury

BACKGROUND: Most of the traumatic brain injuries(TBI) are caused by traffic accident, sports, occupational injuries or violent attacks. Most of TBI patients are young males. And most of the TBI leaves obvious physical disabilities. To review the literatures regarding the rehabilitative management mode for TBI in Western Countries to help the improvement of rehabilitative therapy for TBI patients in our country.DATA SOURCE: TBI-related literatures in Medline during January 1990 to June 2004 were searched with the searching words of "traumatic brain injury, rehabilitation". The language of objective articles was limited in English. A total of 15 articles were obtained. At the same time, TBI-related articles were manually searched in Chinese Clinical Rehabilitation during January 2003 to June 2004 with the searching words of "traumatic brain injury, rehabilitation" . The language of the objective articles was limited in Chinese. A total of 3 articles were obtained.DATA SELECTION: Articles related to TBI rehabilitative management including literatures and treatise were selected.DATA EXTRACTION: A total of 18 articles in the recent 5 to 10 years were collected, which were regarding the prognostic evaluation, influencing factors, rehabilitative objective, rehabilitative time limit, the treatment in coma stage, the management in rehabilitative stage and the management of corresponding complications in TBI.DATA SYNTHESIS: TBI rehabilitative management impenetrated in the whole process of TBI rehabilitation. Tocomprehend the key points of each stage in the rehabilitative management, especially the establishment of rehabilitative program based on the accurate evaluation of the disability of the patients, is the key to ensure the rehabilitation and prognosis. The impacts of cognitive disability, pre-tranmatic conditions, traumatic degrees, and the restorative methods on the rehabilitative objectives should be recognized adequately.CONCLUSION: It is indicated by the reviewed literatures that the level of rehabilitative management is the key factor affecting FBI rehabilitation.