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《广州医药》编辑部
因气候与生活习惯影响,广东地区老年性肩周炎临床特点及康复需求具有独特性,亟待制定规范、具有当地特色的康复方案。为制订适合地区差异化的康复方案,广东省中西医结合学会康复专业委员会联合广东省康复医学发展研究会疼痛康复发展研究分会牵头发起,省内多家机构专家学者共同制订《老年性肩周炎中医全周期康复广东专家共识(2026年版)》。该共识以ICF框架为基础,立足肩周炎康复循证医学证据,结合多学科专家产教研实践经验,对肩周炎 ICF评定、中医适宜技术及康复治疗技术运用、阶梯式干预性措施制定和中西医全周期康复协同等方面形成共识性意见。本共识的发布,将为老年性肩周炎中医全周期康复提供规范化、本土化的“广东方案”。
Due to climatic and lifestyle influences,the clinical characteristics and rehabilitation needs of senile periarthritis of the shoulder in Guangdong region exhibit unique features,necessitating the development of standardized and locally tailored rehabilitation protocols.To formulate regionally differentiated rehabilitation plans,the Rehabilitation Professional Committee of Guangdong Association of Integrative Medicine and the Pain Rehabilitation Development Research Branch of Guangdong Rehabilitation Medicine Development Research Association jointly initiated the development of the “Guangdong Expert Consensus on TCM Full-Cycle Rehabilitation for Senile Periarthritis of the Shoulder(2026 Edition)” through collaboration with multiple provincial institutions and experts.Based on the International Classification of Functioning,Disability and Health(ICF)framework and evidence-based rehabilitation medicine for periarthritis of the shoulder,this consensus integrates multidisciplinary expertise from industry,academia,and research to establish unified guidelines on ICF assessment,application of appropriate TCM techniques and rehabilitation therapies,implementation of stepwise intervention measures,and integrated TCM-Western medicine full-cycle rehabilitation approaches.The publication of this consensus will provide a standardized and localized “Guangdong Solution” for TCM-based full-cycle rehabilitation of senile periarthritis of the shoulder.
本文概述了传统日间腹腔镜胆囊切除术患者术后早期康复质量存在的问题,IMB模型通过向患者提供科学的疾病知识,改变其疾病认知与态度,最终促使其采纳并维持健康行为。本文还介绍了IMB模型在日间腹腔镜胆囊切除术后患者早期康复质量中应用涉及的相关概念、研究背景和国内外的研究现状以及未来发展趋势与挑战。研究结果显示,IMB模型可显著降低患者术后疼痛发生率,并提高患者参与治疗决策的程度,为后期关于IMB模型在日间腹腔镜胆囊切除术患者术后早期康复质量的相关研究提供借鉴与参考,以便后期实施相关个性化干预措施,并提供相关理论依据。
This paper summarizes the problems existing in the early postoperative rehabilitation quality of patients undergoing traditional ambulatory laparoscopic cholecystectomy.The IMB model changes patients’ disease cognition and attitude by providing them with scientific disease knowledge,and ultimately promotes their adoption and maintenance of healthy behaviors.It also introduces the relevant concepts involved in the application of the IMB model in the early postoperative rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy,the research background of this study,the current research status at home and abroad,as well as the future development trends and challenges.The research results show that the IMB model can significantly reduce the incidence of postoperative severe pain in patients and the degree of patient participation in treatment decision-making.This provides reference and guidance for subsequent studies on the early rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy using the IMB model,so as to implement relevant personalized intervention measures in the future and provide relevant theoretical basis.
目的 探讨基于肺康复的阻抗训练联合营养支持对老年慢性阻塞性肺疾病(COPD)衰弱患者肌少症及运动耐量的影响。方法 将2024年1月—2025年5月收治的80例老年COPD衰弱合并肌少症患者,分为对照组、观察组,各40例。所有患者均采取常规药物治疗,对照组予以营养支持,观察组在对照组基础上增加基于肺康复的阻抗训练。比较两组治疗前、治疗3个月后肌少症改善情况,运动耐量,肺功能指标,衰弱状态及生活质量。结果 治疗3个月后,观察组骨骼肌指数、握力、股四头肌肌厚度均较治疗前提高,且与对照组相比,观察组更高(P<0.05);治疗3个月后,两组6 min步行距离、日常活动代谢当量均较治疗前提高,Borg量表评分降低,且与对照组相比,观察组改善幅度更大(P<0.05);治疗3个月后,两组第一秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)、最大通气量(MVV)均较治疗前改善,且与对照组相比,观察组更优(P<0.05);治疗3个月后,两组Fried衰弱表型评分、COPD评估测试(CAT)总分、圣乔治呼吸问卷(SGRQ)总分均较治疗前降低,且与对照组相比,观察组更低(P<0.05)。结论 老年COPD衰弱合并肌少症患者采取基于肺康复的阻抗训练联合营养支持可改善其肌少症情况,提升运动耐量,并且提升患者肺功能水平,改善衰弱状态,提升生活质量。
Objective To explore the effects of impedance training based on pulmonary rehabilitation combined with nutritional support on sarcopenia and exercise tolerance in elderly patients with chronic obstructive pulmonary disease(COPD)and frailty.Methods Eighty elderly patients with COPD and frailty complicated by sarcopenia,admitted from January 2024 to May 2025,were selected as the study subjects and divided into a control group and an observation group,with 40 patients in each group.All patients received conventional drug therapy.The control group received nutritional support,while the observation group received additional impedance training based on pulmonary rehabilitation on top of the matched group’s treatment.The improvement of sarcopenia,exercise tolerance,pulmonary function index,weakness status and quality of life before and 3 months after treatment were compared between the two groups.Results After 3 months of treatment,the skeletal muscle index,grip strength and quadriceps thickness of the observation group increased compared with that before treatment,and compared with the control group,the observation group was higher(P<0.05).After 3 months of treatment,the 6 min walking distance and daily activity metabolic equivalent of both groups increased compared with that before treatment,and the Borg Scale score decreased.Compared with the control group,the improvement of the observation group was better(P<0.05).After 3 months of treatment,Forced Expiratory Volume in one second(FEV1),FEV1/Forced Vital Capacity(FVC)and Maximal Voluntary Ventilation(MVV)of both groups improved compared with that before treatment,and the observation group was better than that of the control group(P<0.05).After 3 months of treatment,the Fried weakness phenotype score,COPD Assessment Test(CAT)total score and St. George’s Respiratory Questionnaire(SGRQ)total score of both groups were lower than that before treatment,and the observation group was lower than that of the control group(P<0.05).Conclusions Impedance training based on pulmonary rehabilitation combined with nutritional support can improve sarcopenia,enhance exercise tolerance,and improve pulmonary function levels,frailty status,and quality of life in elderly patients with COPD and frailty complicated by sarcopenia.
目的 探讨肺癌根治术后患者康复期的症状体验与心理感受, 为完善症状管理和制定个性化康复干预方案提供依据。方法 采用现象学研究法,对15例肺癌根治术后康复期患者进行半结构式访谈, 运用Colaizzi 7步分析法进行归纳和提炼主题。结果 归纳出5个主题, 12个亚主题:多重躯体症状负担持续存在(术后疼痛综合征、顽固性刺激性咳嗽、劳力性呼吸困难、持续性疲劳感); 负性心理情绪困扰(病耻感、疾病不确定感与复发恐惧); 心理调适过程(诊断冲击与认知失调、角色适应与主动应对); 创伤后成长与健康行为转变(生命意义感提升、健康促进行为强化); 强烈的康复信息支持需求(自我保健知识需求、结构化康复锻炼指导需求)。结论 医护人员应关注肺癌根治术后患者康复期的症状体验, 动态评估患者的身心状况, 制定精准、有效的个性化干预方案, 帮助患者树立康复信心, 改善术后康复体验和提高生活质量。
Objective To explore the symptom experience and psychological feelings of patients during the rehabilitation period after radical resection of lung cancer, aiming to provide a basis for improving symptom management and formulating personalized rehabilitation interventions.Methods The phenomenological research method was used to conduct semi-structured interviews with 15 patients in the rehabilitation period after radical surgery for lung cancer.Colaizzi's 7-step analysis method was used to summarize and extract themes.Results Five themes and 12 sub-themes were summarized:Persistent burden of multiple physical symptoms(postoperative pain syndrome, refractory irritative cough, exertional dyspnea, persistent fatigue); negative emotional experiences(stigma of illness, illness uncertainty and fear of recurrence); psychological adjustment processes(diagnostic shock and denial, role acceptance and active coping); post-traumatic growth and health behavior transformation(enhanced sense of meaning in life, strengthened health-promoting behaviors); strong demand for rehabilitation information support(self-care knowledge, rehabilitation exercise knowledge).Conclusions Medical staff should pay attention to the symptom experience of patients during the recovery period after radical lung cancer surgery, dynamically assess their physical and mental conditions, develop precise and effective personalized intervention plans, help patients build confidence in recovery, and thereby improve their postoperative rehabilitation experience and quality of life.
文章围绕康复治疗学专业创新创业人才培养模式展开研究,讨论了国内外高校创新创业人才培养现状。从教育理念、课程体系、师资力量、资源配套等方面探讨了人才培养所面临的问题。结合广东药科大学康复治疗学专业培养现状,从管理、教学、平台、服务四大体系明确了具体要求,有望为其他高校康复治疗学专业培养模式改革提供思路。
The article focuses on innovative and entrepreneurial talent-cultivation models in the Rehabilitation Therapy specialty,discussing the current status of such cultivation in domestic and international universities.It explores challenges in talent development from perspectives including educational philosophy,curriculum system,faculty resources,and resource allocation.Based on the current training status of Guangdong Pharmaceutical University’s Rehabilitation Therapy Program,the study specifies detailed requirements through four major systems:management,teaching,platform,and service.This research is expected to provide valuable insights for the reform of talent cultivation models in rehabilitation therapy programs at other higher educationinstitutions.
目的 探讨肌骨超声(MSUS)在慢性肌肉骨骼疼痛(CMP)康复精准化教学中的应用效果。方法 选取在广州市第一人民医院南沙医院康复医学科实习的43名大专及本科学生,对照组进行常规CMP康复精准化教学,MSUS组在常规教学基础上增加MSUS辅助教学。实习结束后,通过专业理论考试和实践考核观察教学效果,并以问卷调查学生对教学形式和效果的满意度。结果 MSUS组的理论考核成绩为(84.62±5.14)分,对照组为(81.45±6.21)分,两组间差异无统计学意义(P>0.05)。MSUS组的实践考核成绩(4.71±1.06)分高于对照组(3.64±1.14)分(P<0.05)。问卷调查显示,MSUS组学生的总体满意度(35.24±3.43)高于对照组(32.64±3.98),P<0.05。其中,对于教学方法的满意度,MSUS组(9.81±0.60)高于对照组(8.82±1.18)(P<0.05);对于综合分析与实践能力的满意度,MSUS组(7.43±1.91)高于对照组(6.18±1.62)(P<0.05)。结论 MSUS教学在夯实学生专业基础知识、深化临床实践、提高综合分析能力和学习积极性方面具有显著优势,为精准化康复教学提供了有效手段。
Objective To explore the application effect of musculoskeletal ultrasound(MSUS)in the precise teaching of chronic musculoskeletal pain(CMP)rehabilitation.Methods Forty-three college and undergraduate students interning in Rehabilitation Medicine Department of Nansha Hospital,Guangzhou First People’s Hospital were selected,control group conducted conventional CMP rehabilitation teaching,and the MSUS group received additional MSUS-assisted teaching on the basis of the conventional teaching.After the internship,the teaching effectiveness was observed through professional theoretical examinations and practical assessments,and a questionnaire survey was conducted to evaluate students’satisfaction with the teaching methods and outcomes.Results The theoretical assessment score of the MSUS group were(84.62±5.14)and(81.45±6.21)of the control group,there was no difference between the two groups(P>0.05).The practical assessment scores of the MSUS group(4.71±1.06)were higher than those of the control group(3.64±1.14),and a significant difference was found between the two groups(P<0.05).The questionnaire survey showed that the overall satisfaction of the MSUS group students(35.24±3.43)was higher than that of the control group(32.64±3.97)(P<0.05).Among them,satisfaction with the teaching method was higher in the MSUS group(9.81±0.60)than in the control group(8.82±1.18)(P<0.05),satisfaction with comprehensive analysis and practical ability was also higher in the MSUS group(7.43±1.91)than in the control group(6.18±1.62)(P<0.05).Conclusions MSUS teaching has significant advantages in consolidating students’basic professional knowledge,deepening clinical practice,improving comprehensive analysis ability and learning enthusiasm.It provides an effective means for precise rehabilitation teaching.
目的 探讨断指再植患者采用微波理疗联合康复训练的影响。方法 回顾性选取2022年1月—2023年12月于福州市第二总医院进行断指再植的患者,采用康复训练的50例患者纳入对照组,采用微波理疗联合康复训练的51例患者纳入观察组,对比两组干预1个月后的毛细血管反应情况、感知恢复情况、疼痛评分、手指功能及日常生活能力情况。结果 干预1个月后, 观察组患指的温度[(28.43±5.86)℃ vs (26.15±5.39)℃,t=2.025,P<0.001]、毛细血管反应[(9.76±2.63)cm/s vs(7.36±2.23)cm/s,t=4.922,P=0.046,]高于对照组(P<0.05);观察组的英国医学研究委员会感觉评分[(15.79±3.75)分 vs(11.88±3.13)分,t=5.660,P<0.001]高于对照组;观察组第2周[(3.72±0.88)分 vs(4.39±0.92)分,t=3.721,P<0.001]、4周后[(2.67±0.32)分 vs(3.03±0.52)分,t=4.169,P=0.001]的视觉模拟量表(VAS)评分低于对照组(P<0.05);观察组的密歇根手功能量表(MHQ)评分[(61.05±10.68)分 vs(52.58±10.21)分,t=4.054,P<0.001]高于对照组(P<0.05);观察组的生活质量综合评定表(GQLI-74)评分[(320.16±55.25)分 vs(270.85±50.06)分,t=4.677,P<0.001]高于对照组(P<0.05);观察组的Barthel指数[(75.71±12.84)分 vs(68.58±12.23)分,t=2.843,P=0.005]高于对照组(P<0.05)。结论 微波理疗联合康复训练能够提高断指再植患者的手指功能,减轻患者疼痛,改善日常生活质量。
Objective To explore the effect of microwave physiotherapy combined with rehabilitation training on finger function and daily living ability of patients with severed finger replantation.Methods Patients who underwent replantation of severed fingers in our hospital from January 2022 to December 2023 were selected retrospectively.Fifty patients who received rehabilitation training were included in the control group,51 patients who were intervened by microwave physiotherapy combined with rehabilitation training were included in the observation group.The blood circulation,sensory recovery,pain score,finger function and daily living ability of the two groups were compared.Results The temperature([28.43±5.86]℃ vs [26.15±5.39]℃,t=2.025,P<0.001) and capillary reaction([9.76±2.63]cm/s vs [7.36±2.23]cm/s,t=4.922,P=0.046) of the affected fingers in the observation group were higher(P<0.05).The sensory score([15.79±3.75] vs [11.88±3.13],t=5.660,P<0.001)of the observation group was higher than that of the control group(P<0.05).The visual analogue scale(VAS)scores of the observation group at the second week([3.72±0.88] vs [4.39±0.92],t=3.721,P<0.001) and four weeks later([2.67±0.32]vs [3.03±0.52],t=4.169,P=0.001)were lower than those of the control group(P<0.05).The score of Michigan Hand Outcome Questionnair(MHQ)([61.05±10.68] vs [52.58±10.21],t=4.054,P<0.001) in the observation group was higher(P<0.05).The GQLI-74 score([320.16±55.25] vs [270.85±50.06]) and Barthel index([75.71±12.84] vs[68.58±12.23],t=2.843,P=0.005)in the observation group were higher(P<0.05).Conclusions Microwave physiotherapy combined with rehabilitation training can improve the finger function,relieve the pain and improve the quality of daily life of patients with severed fingers.
目的 探究本体感觉神经肌肉促进疗法(PNF)技术与居家远程康复治疗对缺血性脑卒中患者凝血功能、平衡状态的影响。方法 选择2023年1月—2024年1月在宁乡市中医医院择期治疗的60例缺血性脑卒中患者为研究对象。按照患者选择的治疗方案进行分组, 观察组接受PNF技术联合居家远程康复指导治疗, 对照组接受常规居家远程康复指导治疗。记录疗效、凝血功能、神经功能缺损症状。结果 凝血功能方面,观察组治疗后活化部分凝血酶时间(APTT)、凝血酶原时间(PT)高于治疗前, 二聚体(D-D)、纤维蛋白原(FIB)低于治疗前,组间比较差异有统计学意义(P<0.05)。与对照组相比, 观察组的APTT、PT、D-D、FIB指标相近,组间比较差异无统计意义(P>0.05)。治疗后, 观察组平衡功能(BBS)评分比治疗前高, 组间比较差异有统计学意义(P<0.05)。观察组BBS评分、FMA评分、肌力等级更高, 组间比较差异有统计学意义(P<0.05)。结论 PNF技术+居家远程康复指导治疗可作为缺血性脑卒中患者治疗的有效手段。联合治疗后凝血功能、平衡状态、肢体功能状况、肌力明显改善, 可见联合治疗对于减轻患者病情尤为明显。
Objective To explore the effects of proprioceptive neuromuscular facilitation(PNF)and home-based remote rehabilitation on coagulation function and balance function in patients with ischemic stroke.Methods From January 2023 to January 2024, 60 patients with ischemic stroke were selected from our hospital.The patients were divided into two groups according to the treatment plan chosen by themselves.The patients in the observation group received PNF technology combined with home-based remote rehabilitation guidance, while the patients in the control group received routine home-based remote rehabilitation guidance.The curative effect, coagulation function and neurological deficit were recorded.Results After treatment, activated partial thrombin time(APTT)and prothrombin time(PT)were significantly higher, D-dimer(D-D)and fibrinogen(FIB)were significantly lower in the observation group than those before treatment(P<0.05).Compared with the control group, the APTT, PT, D-D and FIB of the observation group were similar, and there was no significant difference between the two groups(P>0.05).After treatment, the Berg Balance Scale score of the observation group was higher than that before treatment, and there was significant difference between the two groups(P<0.05).The Berg Balance Scale score, Fugl-Meyer Assessment score and muscle strength grade of observation group were higher than those of control group(P<0.05).Conclusions PNF combined with home-based remote rehabilitation can be used as an effective method for the treatment of patients with ischemic stroke.The coagulation function, balance, extremity function and muscle strength were significantly improved after combined treatment, which indicated that the combined treatment was especially effective in relieving the patients’ symptoms.
目的 探讨与分析全面护理联合细节干预在创伤骨科手术质量及康复中应用价值。方法 选择2022年1月—2023年1月在福建省立医院骨科进行创伤骨科手术患者120例为研究对象,用随机数字表法分组,分为常规组、联合组,各纳入60例患者。前者进行常规护理,后者在前者基础上开展全面护理联合细节干预,对两组患者术后恢复情况进行观察比较。结果 在围术期指标方面,联合组手术时间、术中出血量、术后首次下床活动时间、术后住院时间与常规组相比减少(P<0.05)。联合组术后1 d、术后3 d、术后7 d、术后14 d的疼痛VAS评分与常规组相比减少(P<0.05)。联合组术后14 d的护理总满意度为100.00%,常规组为83.33%,联合组与常规组相比明显提高(P<0.05)。联合组术后14 d的社会关系、心理关系、生理关系等生活质量评分均高于常规组(P<0.05)。结论 全面护理联合细节干预在创伤骨科手术患者的应用促进患者康复,能持续缓解患者的疼痛状况,提高患者的护理满意度与生活质量。
Objective To explore and analyze the application value of comprehensive nursing combined with detailed intervention in the quality and rehabilitation of orthopedic trauma surgery.Methods From January 2022 to January 2023,120 cases of patients who underwent trauma orthopedic surgery in the Department of Orthopedic Surgery of Fujian Provincial Hospital were selected as the research subjects.And the randomized numerical table method was taken to operate in groups,which were divided into the conventional group and the combined group,and 60 patients were included in each group.The former group recieved conventional nursing care,and the latter group recieved comprehensive nursing care combined with detail intervention on its basis to observe and compare the postoperative recovery of patients in the two groups.Results In terms of perioperative indicators,the operation time,intraoperative bleeding,time to first postoperative bed movement and postoperative hospitalization time were significantly reduced in the combined group compared with the conventional group(P<0.05).The pain VAS scores of the combination group were significantly reduced compared to the conventional group at 1 day,3 days,7 days and 14 days after surgery(P<0.05).The total satisfaction rate of postoperative care in the combination group at 14 days was 100.00%,while in the conventional group it was 83.33%.The combination group showed there were significant improvements compared to the conventional group(P<0.05).The social,psychological and physiological quality of life scores of the combination group were significantly higher than those of the conventional group 14 days after surgery(P<0.05).Conclusions The application of comprehensive nursing combined with detailed intervention in orthopedic trauma surgery patients can promote their recovery,continuously alleviate their pain status and improve their nursing satisfaction and quality of life.
目的 探讨导航护士主导的三级质控在胸腔镜肺癌切除术患者加速康复中的应用效果。方法 选取2020年6月—2023年6月周口市中心医院收治的106例肺癌患者,应用随机数字表法分为观察组(n=53)与对照组(n=53)。患者均采取胸腔镜肺癌切除术治疗,对照组实施常规的术前、术中及术后相关围术期护理,观察组在常规围术期护理基础上增加导航护士主导的三级质控护理。对比两组住院时间、术后并发症和护理前后世界卫生组织生活质量-100量表(WHOQOL-100)及癌因性疲乏程度(PFS),最后对比两组的护理满意度。结果 观察组首次排气时间、首次下床时间、术后疼痛视觉模拟量表(VAS)评分、术后住院时间均优于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05);干预后两组WHOQOL-100评分升高、PFS评分降低,观察组均优于对照组(P<0.05);观察组护理满意度高于对照组(P<0.05)。结论 对胸腔镜肺癌切除术患者,采取导航护士主导的三级质控管理的加速康复护理,可促进患者术后肠胃功能恢复,缩短住院时间,减轻术后疼痛感与减少并发症,在改善患者癌因性症状的同时,提升其生活质量,提高患者护理满意度。
Objective To explore the application effect of three-level quality control led by navigation nurses in accelerating rehabilitation of patients undergoing thoracoscopic lung cancer resection.Methods A total of 106 lung cancer patients admitted to our hospital from June 2020 to June 2023 were selected and randomly divided into an observation group(n=53)and a control group(n=53)using a random number table method.All patients were treated with thoracoscopic lung cancer resection,while the control group received routine preoperative,intraoperative and postoperative perioperative care,the observation group received a three-level quality control nursing led by navigation nurses in addition to routine perioperative care.The length of hospitalization,postoperative complications,WHOQOL-100 and PFS before and after care,and the nursing satisfaction of the two groups were compared.Results The observation group had significantly shorter first exhaust time,first time out of bed,postoperative visual analogue scale(VAS)score and postoperative hospital stay compared to the control group(P<0.05).The incidence of complications in the observation group was lower than that in the control group(P<0.05).After intervention,the WHOQOL-100 scores of both groups increased,and the observation group was higher than the control group.The PFS score decreased,and the observation group was lower than the control group(P<0.05).The nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusions Adopting a three-level quality control management led by navigation nurses to accelerate rehabilitation care for patients undergoing thoracoscopic lung cancer resection can promote postoperative recovery of gastrointestinal function,reduce hospitalization time,reduce postoperative pain and complications,improve cancer related symptoms,improve their quality of life and increase patients nursing satisfaction.