早期康复的治疗技术、期限及机构准入条件研究报告

Research report on treatment techniques, deadlines and institutional access conditions for early rehabilitation

目的基于成都市早期康复大数据、部分国内康复机构调研及专家咨询意见,探讨早期康复涉及的常用康复技术、期限及实施早期康复的医疗机构准入条件,为相关医疗机构实施早期康复提供科学依据。方法提取2014年1月1日—12月31日成都市内130家医疗保险定点机构数据,采用调查法研究8类临床康复常见病种疾病(脑卒中除外);出外调研康复开展较好的5家医院的8类疾病(烧伤除外)数据;采用专家咨询法征集15位专家关于临床康复常见病种早期治疗介入时间、康复费用等意见。结果早期康复治疗的常用技术有康复评定、针灸/电针治疗、低中频脉冲电治疗、气压式四肢血液循环促进治疗、关节松动训练及其他推拿训练、有氧训练和运动疗法、作业疗法等;此外,各病种还对应专项的康复技术。早期康复治疗期限:持续性植物状态(缺氧缺血性脑病)为13～14 d,骨折为11～18 d,关节及软组织损伤为12～14 d,脊柱脊髓损伤为31～47 d,颅脑损伤为11～18 d,烧伤(化学性、电击伤)为14～19 d,手外伤为10～12 d,周围神经损伤为9～20 d,脑卒中为13～21 d。实施早期康复的准入条件:二级以上的综合医院,具备独立的康复治疗室及康复病房,具备早期康复设备,具备有资质的专职康复医师与治疗师。结论早期康复治疗的常用技术方面,各病种有共有技术,还对应专项的康复技术。大部分病种的早期康复治疗期限为2～3周。为了确保早期康复的质量与安全,建议把医院级别及专业康复人才资质等纳入实施早期康复的准入条件中。

Objective To explore the common rehabilitation techniques involved in early rehabilitation, early rehabilitation period, and the access conditions of medical institutions for early rehabilitation on the basis of the early rehabilitation data of Chengdu, investigation on some domestic rehabilitation institutions, and expert consultation opinions, to provide a scientific basis for the early rehabilitation of relevant medical institutions. Methods We extracted the data of 130 medical insurance designated institutions in Chengdu for the whole year of 2014 （from January 1st to December 31st）, and used the investigation method to study eight common types of clinical rehabilitation diseases （except stroke）; went out to investigate the data of eight common types of clinical rehabilitation diseases （except burns） of five hospitals; using expert consultation method, collected 15 experts’ opinions on the early treatment of common clinical rehabilitation, intervention time, rehabilitation costs and so on. Results Common techniques for early rehabilitation included： rehabilitation assessment, acupuncture/electroacupuncture treatment, low-intermediate frequency pulse electrotherapy, pneumatic limb blood circulation promotion treatment, joint loosening training, other massage training, aerobic training, exercise therapy, and occupational therapy. In addition, each disease type also corresponded to special rehabilitation techniques. The early rehabilitation period was 13–14 days for persistent vegetative state （hypoxic ischemic encephalopathy）, 11–18 days for fractures, 12–14 days for joint and soft tissue injury, 31–47 days for spinal cord injury, 11–18 days for brain injury, 14–19 days for burn （chemical, electric shock）, 10–12 days for hand injury, 9–20 days for peripheral nerve injury, and 13–21 days for stroke. The access conditions for early rehabilitation included： general hospitals above the second level, with independent rehabilitation treatment rooms and rehabilitation wards, with early rehabilitation equipment, qualified full-time rehabilitation physicians and therapists. Conclusions In the common technical aspects of early rehabilitation, each disease has a common technology and also corresponds to special rehabilitation techniques. The early rehabilitation period for most diseases is 2–3 weeks. In order to ensure the quality and safety of early rehabilitation, it is recommended to include the hospital level and professional rehabilitation talent qualifications into the access conditions for early rehabilitation.