轻度创伤性脑损伤后全科医学干预手段的应用

Progress in the application of general practice intervention after mild traumatic brain injury

全世界每年有超过5 000万人遭受创伤性脑损伤(TBI),约半数人口在其一生可能遭遇一次或以上的TBI。在TBI患者中,轻度创伤性脑损伤(m TBI)占主导,并且此类患者大多由专科医生诊治。有多数m TBI患者急性期后常常呈现出持续性、与伤害相关的日常生活能力困难及人际交往功能障碍,这说明m TBI患者的预后并非那么“轻微”。就这类症状的管理手段而言,由于存在生物心理社会因素的复杂相互作用,因此专科治疗手段对其的治疗作用有限。近年来,随着全科医学的飞速发展,利用家庭及社区等一切资源为m TBI患者提供长期的照顾以克服创伤后的低随访率和低康复率的全科医疗模式,渐渐成为国内外m TBI急性期后主要的干预手段。但对上述m TBI后的干预手段,目前最重要的决策因素是基于经验性的判断,尚未形成标准化的指南。现阶段可用于m TBI的全科干预手段有线上、线下两种模式,一般线上手段主要为以网络为基础的在线指导及程序性操作干预,线下手段主要为艺术疗法、作业疗法、音乐疗法及中医疗法。本文基于临床可用性对上述干预措施进行阐述,以期为今后“全专结合”模式的推进及普及提供借鉴。

More than 50 million people suffer from traumatic brain injury(TBI)every year in the world,and it is esti-maVed that about half of the population will have one or more TBIs over their lifetime.In all TBI patients,mild traumatic brain injury(mTBI)plays the dominant role,and most of them benefiting from the diagnosis and treatment of specialists.However,a majority of mTBI patients often present with a persistent and injury related activities of daily living difficulties and interpersonal dysfunction after the acute phase of injury,which indicates that the prognosis of those patients are not so"mikJ".In the term of the management of such symptom,the application of specialized treatment is limited due to most symptoms are result from a complex interplay of biopsychosocial factors.Recently,with the rapid development of general practice,family and community resources are gradually using to provide long-term care for patients with mTBI to overcome the low follow-up rate and recovery rate after injury.Unfortunately,there is no standardized general practice guideline for mTBI,and the most important decision-making factors are based on the clinical practice.At present,there are two modes of general practice intervention for mTBI:online and offline.The online mode means mainly include online guidance and procedural operation intervention based on network,and the offline mode means mainly include art therapy,occupational therapy,music therapy and traditional Chinese medicine therapy.With a view to pushing the development of the"combination of general practice and special treatment"mode in the future,this article reviewed the general intervention methods that can be used in mild traumatic brain injury.