《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (9): 1033-1040.doi: 10.3969/j.issn.1006-9771.2026.09.005

• 应用研究 • 上一篇    下一篇

规范化康复单元对脑外伤的效果

迟茜茜1,2, 张小年1,2(), 朱晓敏1,2, 孙琬玥1,2, 张欣1,2, 周进1,2, 卜宏伟1,2, 翟蕾1,2, 张新1,2, 凌子锐2, 陈泓宇2   

  1. 1 中国康复研究中心北京博爱医院神经康复亚中心, 北京市 100068
    2 首都医科大学康复医学院, 北京市 100068
  • 收稿日期:2026-02-09 修回日期:2026-05-31 接受日期:2026-06-09 出版日期:2026-09-25 发布日期:2026-09-20
  • 通讯作者: 张小年,男,博士,主任医师,副教授,硕士研究生导师。E-mail: youthzxn@163.com
  • 作者简介:迟茜茜(1984-),女,汉族,北京市人,硕士,副主任医师,主要研究方向:神经康复。
  • 基金资助:
    首都卫生科研发展专项项目(2022-2-6012)

Effect of standardized rehabilitation unit on traumatic brain injury

Chi Qianqian1,2, Zhang Xiaonian1,2(), Zhu Xiaomin1,2, Sun Wanyue1,2, Zhang Xin1,2, Zhou Jin1,2, Bu Hongwei1,2, Zhai Lei1,2, Zhang Xin1,2, Ling Zirui2, Chen Hongyu2   

  1. 1 Neurological Rehabilitation Sub-center, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
    2 School of Rehabilitation, Capital Medical University, Beijing 100068, China
  • Received:2026-02-09 Revised:2026-05-31 Accepted:2026-06-09 Published:2026-09-25 Online:2026-09-20
  • Contact: Zhang Xiaonian, E-mail: youthzxn@163.com
  • Supported by:
    Capital's Funds for Health Improvement and Research(2022-2-6012)

摘要:

目的 构建适配脑外伤全病程特点的急性期、重症期和综合恢复期三模式规范化康复单元,明确其多学科协作架构、标准化流程和信息化管理体系,并对比传统管理模式,验证该分型康复单元在改善脑外伤患者长期功能预后、降低住院并发症方面的临床有效性。

方法 分模式构建和疗效验证两阶段实施。第一阶段在神经外科、重症医学科、康复科分别建立急性期、重症期和恢复期脑外伤康复单元,统一多学科团队配置、评定与治疗方案、协同工作流程,并配套开发专用信息管理系统。第二阶段选取2023年7月至2025年7月入住新建康复单元的324例脑外伤患者为观察组,回顾性选取2018年1月至2022年12月接受传统管理模式的167例脑外伤患者为对照组。主要观察指标为伤后1年格拉斯哥预后量表、残疾等级量表评分;次要观察指标包括住院期间并发症发生率,气管插管、胃管、尿管平均保留时间。

结果 观察组伤后1年格拉斯哥预后量表评分显著高于对照组(t = -7.836, P < 0.001),残疾等级量表评分显著低于对照组(t = -6.742, P < 0.001)。观察组总体并发症发生率显著低于对照组(χ2 = 18.762, P < 0.001);肺部感染、尿路感染、下肢静脉血栓、压疮和关节挛缩畸形发生率均低于对照组(χ2 > 4.328, P < 0.05)。观察组气管插管、胃管和尿管保留时间均显著短于对照组(t > 10.276, P < 0.001)。

结论 急性-重症-综合三阶段分型脑外伤康复单元通过多学科协同、全程标准化管理和信息化质控,可显著改善脑外伤患者长期功能预后,降低并发症发生率,缩短有创管路留置时间。本模式贴合脑外伤疾病规律,可实现从急性期救治到恢复期康复的全程无缝衔接,具备良好临床可行性和推广价值,可为我国脑外伤康复的同质化、规范化建设提供循证依据和实践参考。

关键词: 脑外伤, 康复, 多学科团队, 预后

Abstract:

Objective To establish three standardized rehabilitation unit models covering acute, critical and comprehensive recovery stages for traumatic brain injury (TBI) that fit the whole-course characteristics, clarify their multidisciplinary collaborative framework, standardized procedures, and information management system, and verify the clinical effectiveness of this staged rehabilitation unit on long-term functional prognosis and in-hospital complications of TBI patients.

Methods This study was conducted at two stages: model construction and efficacy verification. At the first stage, TBI rehabilitation units for acute, critical and recovery stages were established in the Department of Neurosurgery, Intensive Care Unit and Department of Rehabilitation Medicine, respectively, with unified multidisciplinary team configuration, standardized assessment and treatment protocols, collaborative workflows, and a dedicated information management system. At the second stage, 324 TBI patients admitted to the newly built rehabilitation units from July, 2023 to July, 2025 were enrolled as the observation group, and 167 TBI patients receiving traditional management from January, 2018 to December, 2022 were retrospectively selected as the control group. The primary outcomes were 1-year post-injury Glasgow Outcome Scale (GOS) and Disability Rating Scale (DRS) scores. Secondary outcomes included the incidence of in-hospital complications and the mean indwelling time of tracheal intubation, gastric tube and urinary catheter.

Results The 1-year GOS score was significantly higher (t = -7.836, P < 0.001), and the DRS score was significantly lower (t = -6.742, P < 0.001) in the observation group than in the control group. The overall incidence of complications was significantly lower in the observation group than in the control group (χ2 =18.762, P < 0.001). The incidences of pulmonary infection, urinary tract infection, pressure ulcer, lower extremity venous thrombosis and joint contracture deformity were all significantly reduced (χ2 >4.328, P < 0.05). The indwelling time of tracheal intubation, gastric tube and urinary catheter was significantly shorter in the observation group than in the control group (t > 10.276, P< 0.001).

Conclusion The acute-critical-comprehensive three-stage standardized TBI rehabilitation unit could significantly improve the long-term functional outcomes of TBI patients, reduce the incidence of complications, and shorten the indwelling time of invasive tubes through multidisciplinary collaboration, whole-course standardized management and information-based quality control. This model conforms to the pathological and functional laws of TBI, realizes seamless whole-course connection from acute treatment to recovery rehabilitation, and has good clinical feasibility and promotion value. It can provide evidence-based evidence and practical reference for the homogenized and standardized development of TBI rehabilitation in China.

Key words: traumatic brain injury, rehabilitation, multidisciplinary team, prognosis

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