慢性意识障碍患者康复预后及照护研究进展  

Advances in Rehabilitation Outcomes and Care in Patients with Prolonged Disorders of Consciousness

作　　者：汤时蓝 谢可欣 刘玲谕 齐甜甜 杨燕绥 TANG Shilan;XIE Kexin;LIU Lingyu;QI Tiantian;YANG Yansui(Institute for Hospital Management of Tsinghua University,Shenzhen 518000,China)

机构地区：[1]清华大学医院管理研究院,广东省深圳市518000

出　　处：《中国全科医学》2023年第27期3342-3348,3354,共8页Chinese General Practice

基　　金：国家社会科学基金重大项目(17ZDA121)。

摘　　要：慢性意识障碍严重影响患者生存及生活质量,疾病负担极重。目前,多数资源和研究投入到了意识障碍患者的急性救治中,在评估检测、预测及促进意识恢复等方面取得了实质性进展,但对于急性期后的康复预后及照护了解有限。基于此,本文回顾了慢性意识障碍的定义、流行病学调查、临床特征及诊断标准,对慢性意识障碍康复预后的影响因素、干预措施及照护现状进行归纳总结,建议我国未来的相关研究和实践可从以下几个方面开展:(1)完善我国pDoC相关的流行病学数据,为相关决策提供数据基础;(2)研究、应用针对pDoC康复预后干预措施的新技术,将临床实践、康复预测与预后管理结合起来;(3)进一步确定pDoC康复的关键要素和轨迹,以降低因病程过长而导致预后结果的不确定性;(4)基于pDoC康复轨迹,建立包括急性期过渡在内的亚急性期至慢性恢复期的连续性照护体系,以提高照护质量和获得的机会,实现照护质量的持续改进;(5)对已有的照护体系进行系统改革,进一步完善有助于患者恢复的连续性照护体系,除了多学科团队,还应加强与患者家属、社区、残疾机构等利益相关组织的参与合作。期望本文可以为我国开展慢性意识障碍相关的研究及临床实践提供参考。Prolonged disorders of consciousness(pDoC)severely affects the patients'survival and quality of life,and causes an extremely heavy disease burden.At present,considerable resources and studies have focused on the acute care of patients with pDoC,and substantial progress has been made in detecting,predicting and promoting recovery of consciousness,but there is little research on post-acute rehabilitation outcomes and care.In views of this,we reviewed the definition,epidemiological surveys,clinical symptoms and diagnosis criteria of pDoC,summarized the associated factors,interventions and nursing regarding rehabilitation outcomes of pDoC.Then,we put forward the following recommendations relevant to future research and practice in China:(1)improving the epidemiological data related to pDoC to provide data for relevant decisionmaking;(2)studying and applying new technologies to interventions for pDoC rehabilitation,and integrating clinical practice,rehabilitation prediction and prognostic management;(3)further identifying key elements and trajectory for pDoC recovery to reduce the uncertainty of prognostic outcomes due to excessive disease duration;(4)establish a continuity of care system based on the pDoC rehabilitation trajectory from acute transition,sub-acute to chronic period to improve the quality of and access to care and achieve continuous improvement in the quality of care;(5)systematically reforming the current care system to further improve the continuity of care system that contributes to rehabilitation,and strengthening the participation of the patient's family,community,disability agencies and other stakeholders besides the multidisciplinary team and the cooperation between them.It is hoped that we can provide insights into the development of research and clinical practice of pDoC in China.

关 键 词：意识障碍 慢性意识障碍 康复 预后 照护 综述 

分 类 号：R749.93[医药卫生—神经病学与精神病学]