脊髓损伤中西医结合康复临床实践指南

Clinical Practice Guidelines of Integrated Chinese and Western Medicine Rehabilitation for Spinal Cord Injury

脊髓损伤(SCI)是指因脊髓损伤暂时或永久地导致脊髓功能异常的破坏性神经病理状态,可导致运动、感觉和自主神经功能障碍。基于循证医学原则制定SCI中西医结合康复临床实践指南可为临床医生提供一个全面、规范的治疗与康复框架。本指南从技术范围、规范性引用文件、术语及定义、SCI分类与临床诊断、康复评定、康复诊疗方案和常见并发症处理等方面进行规范制定,形成了科学、规范、统一的操作指南。其中康复评定主要包括感觉检查、运动检查、运动或感觉功能评级、生活质量评定、功能评定和心理功能评定(应激状态评估、认知功能评估、情绪状态评估);康复诊疗方案主要包括早期处理原则、药物治疗、物理治疗(肌力训练、平衡步态训练、有氧运动、电刺激和其他疗法)、作业治疗(关节活动度训练、日常生活活动训练、静息运动技能训练、上肢功能训练和轮椅技能训练等)、辅助器具、中药治疗[单药治疗(川芎嗪、丹参注射液、炙马钱子等)、复方治疗(丹参川芎嗪注射液、补阳还五汤、活血通督汤、二仙汤、益气活血汤和自拟汤药等)]、针灸治疗和其他治疗(新药治疗、细胞疗法、神经调节技术和脑脊接口技术);常见的并发症包括自主神经反射亢进、深静脉血栓、异位骨化、直立性低血压、压疮和尿路感染。本指南可为我国各级各类康复机构以及各级中医医院或综合医院的中医骨伤科、中西医结合骨科、针灸科、推拿科和康复医学科开展SCI临床诊断、康复评定、康复治疗和常见并发症处理提供指导,具有良好的临床适用性、安全性及有效性。

Spinal cord injury(SCI)is a destructive neuropathological condition characterized by the temporary or permanent impairment of spinal cord function,resulting in motor,sensory,and autonomic dysfunctions.Based on the principles of evidence-based medicine,the development of clinical practice guidelines of integrated Chinese and western medicine rehabilitation for SCI can provide clinicians with a comprehensive and standardized framework for SCI treatment and rehabilitation.This scientific,standardized and unified practice guideline covers the technical scope,normative references documents,terms and definitions,SCI classifications and clinical diagnosis,rehabilitation assessment,rehabilitation diagnosis and treatment program and treatment of common complications,etc.Rehabilitation assessment of SCI mainly includes sensory examination,motor examination,motor or sensory function rating,quality of life assessment,functional assessment and psychological function assessment(stress assessment,cognitive function assessment,and emotional state assessment).Rehabilitation diagnosis and treatment program of SCI mainly includes early treatment principles,drug therapy,physical therapy(muscle strength training,balance and gait training,aerobic exercise,electrical stimulation and other therapies),occupational therapy(joint range of motion training,activities of daily living training,resting motor skill training,upper limb function training and wheelchair skills training),assistive devices,traditional Chinese medicine therapy,including single drug therapy(ligustrazine,salvia miltiorrhiza injection,roasted nux vomica,etc.)and compound therapy(salvia miltiorrhiza ligustrazine injection,Buyang Huanwu decoction,Huoxue Tongdu decoction,erxian decoction,Yiqi Huoxue decoction and self-formulated decoction,etc.),acupuncture therapy and other therapies(new drug therapy,cell therapy,neuromodulation technology and brain-spine interface technology).Common complications of SCI include autonomic hyperreflexia,deep vein thrombosis,heterotopic ossification,orthostatic hypotension,pressure ulcers and urinary tract infection.This guideline can provide guidance for all kinds of rehabilitation institutions at all levels as well as the department of orthopedics and traumatology of traditional Chinese medicine,department of orthopedics of integrated traditional Chinese and western medicine,acupuncture and moxibustion department,Tuina department and rehabilitation medicine department in the hospitals of traditional Chinese medicine or general hospitals in China to perform SCI clinical diagnosis,rehabilitation assessment,rehabilitation treatment and treatment of common complications,with good clinical applicability,safety and effectiveness.