脑卒中偏瘫患者康复管理现状

doi:10.3969/j.issn.1674-490X.2019.05.005

摘要/Abstract

摘要： 高致残率是脑卒中的特点之一,有效的康复治疗能明显改善卒中后偏瘫患者的日常生活能力。康复治疗具有专业性强、周期长的特点,有些患者甚至需要终生康复,而脑卒中偏瘫患者对康复治疗缺乏正确的认识,大部分患者回归社区后采取了错误的甚至是有害的锻炼方式,因此脑卒中偏瘫患者康复的管理至关重要。通过借鉴发达国家的管理经验,结合中国康复患者管理现状,可为中国脑卒中偏瘫患者康复管理提出新的思路。

关键词: 脑卒中, 康复, 管理体系, 三级医疗, 医联体, 远程康复

Abstract: High disability rate is one of the characteristics of stroke. Effective rehabilitation therapy can significantly improve the daily living ability of hemiplegic patients after stroke. Rehabilitation treatment has the characteristics of strong professionalism and long cycle. Some patients even need lifelong rehabilitation. However, stroke patients with hemiplegia lack correct understanding of rehabilitation treatment. Most of them take wrong or even harmful exercise after returning to the community. Therefore, the management of rehabilitation for stroke patients with hemiplegia is very important. Based on the management experience of developed countries and the current management situation of rehabilitation patients in China, this paper puts forward some suggestions for rehabilitation management of stroke patients with hemiplegia.

Key words: stroke, rehabilitation, management system, tertiary care, medical alliance, tele-management

中图分类号:

隗麒轩,杨信才. 脑卒中偏瘫患者康复管理现状[J]. 医学研究与教育, 2019, 36(5): 24-29.

参考文献

[1] 王陇德,刘建民,杨弋,等.中国脑卒中防治仍面临巨大挑战——《中国脑卒中防治报告2018》概要[J].中国循环杂志,2019,34(2):105-119.DOI: 10.3969/j.issn.1000-3614.2019.02.001.
[2] ZHOU M,WANG H,ZHU J,et al. Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013[J]. Lancet,2015,387(10015):251-272. DOI: 10.1016/S0140-6736(15)00551-6.
[3] DOU Z,CHENG S,CHENG S,et al.Thigh muscle function in stroke patients revealed by velocity-encoded cine phase-contrast magnetic resonance imaging[J].Muscle Nerve,2008,37(6):736-744.DOI: 10.1002/mus.20986.
[4] LI J,WANG L,CHAO B,et al. Prevalence of stroke in China: an epidemiological study based on the National Stroke Screening Survey[J]. Lancet,2015,386:S49.DOI: 10.1016/S0140-6736(15)00630-3.
[5] 周雪梅,唐福顺,徐勇,等.脑卒中社区康复医疗干预技术的应用模式探索[J].中国康复,2015(3):238-239.DOI: 10.3870/zgkf.2015.03.026.
[6] 赵宁,张宗久,陶红兵,等.基本医疗服务的内涵及其外延的界定探讨[J].中华医院管理杂志,2014,30(4):241-244.DOI: 10.3760/cma.j.issn.1000-6672.2014.04.001.
[7] 谢苏杭,杨霖,杨永红,等.康复医联体——学科建设新战略[J].华西医学,2019,34(5):503-508.DOI: 10.7507/1002-0179.201904094.
[8] 肖月,赵琨.关于建立三级康复医疗体系的思考——基于北京、云南、黑龙江的试点实践[J].卫生经济研究,2012(11):10-12. DOI: 10.3969/j.issn.1004-7778.2012.11.004.
[9] 丁玲,黄肖群,王博,等.关于三级康复医疗体系建设的思考——以神经康复为例[J].按摩与康复医学,2018,9(10):12-14.DOI: 10.3969/j.issn.1008-1879.2018.10.006.
[10] 巫蓉,朱亚,屠小明,等.国内外促进分级诊疗的实践经验及启示[J].南京医科大学学报(社会科学版),2018,18(3):172-175. DOI: 10.7655/NYDXBSS20180302.
[11] 姚银蓥,熊季霞,周亮亮,等.“互联网+健康”背景下区域医联体信息化建设探析[J].中国医院,2019,23(2): 4-6.DOI: 10.19660/j.issn.1671-0592.2019.02.02.
[12] 钱珍光,王艳翚,朱艳娇.医联体制度下患者就医模式转变的困境与应对策略[J].中国医院,2019,23(2):20-22.DOI: 10.19660/j.issn.1671-0592.2019.02.08.
[13] 黄美玲,王玉龙,王尧.康复医学专科医疗联合体中脑卒中患者康复疗效的同质化研究[J].中国康复医学杂志,2017,32(6):618-623. DOI: 10.3969/j.issn.1001-1242.2017.06.003.
[14] 陈红斌.北海市居民脑卒中家庭病床一体化康复治疗管理模式的研究[J].中西医结合心脑血管病杂志,2015(14): 1685-1687.DOI: 10.3969/j.issn.1672-1349.2015.14.039.
[15] 郑国俊,梁晓艳,兰丽梅.“三位一体”脑卒中社区康复模式及其效果的研究[J].吉林医学,2013,34(23):4652-4653.DOI: 10.3969/j.issn.1004-0412.2013.23.006.
[16] 许彬,杨阳,陈卫海,等.脑卒中远程康复与传统专业康复效果比较的循证分析[J].中国康复医学杂志,2017,32(12):1394-1398. DOI: 10.3969/j.issn.1001-1242.2017.12.015.
[17] 高修明,夏媛,郭琳,等.基于视频互动的远程康复模式对脑卒中偏瘫患者疗效的研究[J].中国继续医学教育,2017,9(22):211-213.DOI: 10.3969/j.issn.1674-9308.2017.22.112.
[18] 贾书磊,方小群,冯琼,等.线上线下互动平台在社区脑卒中康复中的应用[J].中国康复医学杂志,2017,32(3): 340-343.DOI: 10.3969/j.issn.1001-1242.2017.03.021.
[19] 唐红,陈菊娣.德国康复医疗的现况与思考[J].护理与康复,2014,13(1):98-99.DOI: 10.3969/j.issn.1671-9875.2014.01.041.
[20] 岳增文.德国康复医学的发展现况及启示[J].解放军医院管理杂志,2013(11):1096-1098.DOI: 10.16770/j.cnki.1008-9985.2013.11.028.
[21] 李巍.德国数字化康复平台的发展和应用[J].中国卫生人才,2017(7):26-28. DOI: 10.3969/j.issn.1008-7370.2017.07.011.
[22] CORTESE D,SMOLDT R.Taking steps toward integration[J]. Health Aff,2007,26(1):w68-w71.DOI: 10.1377/hlthaff.26.1.w68.
[23] ESCARCE J J,BUNTIN M B,COLLA C H.Effects of payment changes on trends in post-acute care[J].Health Serv Res:HSR,2009,44(4):1188-1210.DOI: 10.1111/j.1475-6773.2009.00968.x.
[24] 姜从玉.美国康复医疗制度的演进对中国的启示[J].中国康复医学杂志,2010,25(12):1188-1190. DOI: 10.3969/j.issn.1001-1242.2010.12.016.
[25] 臧芝红,廉爽.谈基于国际视角下的中国医联体发展[J].解放军医院管理杂志,2014,21(2):117-119.DOI:10.16770/j.cnki.1008-9985.2014.02.004.
[26] TURNER-STOKES L,WILLIAMS H,ABRAHAM R,et al. Clinical standards for inpatient specialist rehabilitation services in the UK[J]. Clin Rehabil,2000,14(5):468-480.DOI: 10.1191/0269215500cr349oa.
[27] 刘菲,密忠祥,崔志茹,等.英国医疗康复机构设置特点及参考意义[J].中国医院,2012,16(6):21-23. DOI:10.3969/j.issn.1671-0592.2012.06.008.
[28] CHUMBLER N R,QUIGLEY P,LI X,et al. Effects of telerehabilitation on physical function and disability for stroke patients: a randomized,controlled trial[J]. Stroke,2012,43(8):2168-2174.DOI: 10.1161/STROKEAHA.111.646943.
[29] SMITH G C,EGBERT N,DELLMANJENKINS M,et al. Reducing depression in stroke survivors and their informal caregivers: A randomized clinical trial of a web-based intervention[J]. Rehabil Psychol,2012,57(3):196-206.DOI: 10.1037/a0029587.
[30] LIN K H,CHEN C H,CHEN Y Y,et al.Bidirectional and multi-user telerehabilitation system: clinical effect on balance,functional activity,and satisfaction in patients with chronic stroke living in long-term care facilities[J]. Sensors,2014,14(7): 12451-12466.DOI: 10.3390/s140712451.
[31] CHUMBLER N R,LI X,QUIGLEY P,et al. A randomized controlled trial on stroke telerehabilitation: The effects on falls self-efficacy and satisfaction with care[J]. J Telemed Telecare,2015,21(3):139-143.DOI:10.1177/1357633X15571995.
[32] HUNG M C,HSIEH C L,HWANG J S,et al. Estimation of the long-term care needs of stroke patients by integrating functional disability and survival[J].PLoS One,2013,8(10):760-765.DOI: 10.1371/journal.pone.0075605.
[33] KATALINIC O,YOUNG A,DOOLAN D.Case study: the interact home telehealth project[J]. J Telemed Telecare,2013,19(7):418-424.DOI: 10.1177/1357633X13506513.
[34] 丁永超,田文华,许苹,等.发达国家及地区康复医疗服务体系的特点及启示[J].中国卫生质量管理,2013,20(5):125-128. DOI: 10.3969/j.issn.1006-7515.2013.05.042.