重症作业治疗中国专家共识(2026年版)

doi:10.3969/j.issn.1006-9771.2026.10.001

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (10): 1117-1132.doi: 10.3969/j.issn.1006-9771.2026.10.001

重症作业治疗中国专家共识(2026年版)

中国康复医学会重症康复专业委员会, 昆明医科大学第二附属医院康复医学部

收稿日期:2026-02-28 修回日期:2026-07-20 接受日期:2026-07-21 出版日期:2026-10-25 发布日期:2026-10-23
基金资助:
昆明医科大学一流学科团队建设项目(2024XKTDTS18);云南高原温泉医康养重点实验室项目(20254916CE340046);云南省科技厅重大科技专项(202502AS100004);国家自然科学基金地区基金项目(82460453);云南省重大疑难疾病慢性意识障碍中西医临床协作试点项目;云南省康复临床医学中心项目(ZX2019-04-02)

Chinese expert consensus on occupational therapy in critical care (2026)

Committee of Critical Care Rehabilitation, Chinese Association of Rehabilitation Medicine, Department of Rehabilitation Medicine, the Second Affiliated Hospital of Kunming Medical University

Received:2026-02-28 Revised:2026-07-20 Accepted:2026-07-21 Published:2026-10-25 Online:2026-10-23
Supported by:
Kunming Medical University First-Class Discipline Team Development Program(2024XKTDTS18);Yunnan Key Laboratory of Plateau Thermal Medical Rehabilitation and Wellness Project(20254916CE340046);Major Science and Technology Special Project of Yunnan Provincial Department of Science and Technology(202502AS100004);Regional Science Fund Project of National Natural Science Foundation of China(82460453);Yunnan Provincial Pilot Program on Integrated Chinese and Western Medicine Clinical Collaboration for Major and Refractory Diseases: Chronic Disorders of Consciousness;Yunnan Provincial Clinical Medical Center for Rehabilitation(ZX2019-04-02)

摘要/Abstract

摘要：

目的为中国重症监护室(ICU)中作业治疗(OT)的规范化实施提供循证依据与实践指导，明确重症OT的安全介入时机、干预领域、特殊人群管理及辅助技术应用，推动重症康复的多学科协作和临床实践标准化。

方法由中国康复医学会重症康复专业委员会发起，组建多学科专家组，系统检索中英文数据库(建库至2025年9月)，纳入符合标准的研究及指南，结合国内临床实践，采用GRADE、ROBINS-I和PEDro等工具评价证据质量，通过专家共识会议形成推荐意见。

结果共形成16条推荐意见和1条良好实践声明。安全介入标准：明确生命体征(心率、血压、血氧饱和度等)及血红蛋白(> 70 g/L)、血小板计数(> 20×10⁹ /L)等实验室指标的阈值。干预领域：涵盖情境调整、表现模式重建、感官刺激、谵妄筛查与管理、早期活动与参与等，强调以患者为中心、家庭参与的个性化干预。辅助技术：包括眼动追踪等智能干预手段，用于沟通支持与心理康复。特殊人群：针对重症烧伤患者与新生儿重症监护病房(NICU)早产儿，提出早期干预、疼痛管理、袋鼠护理等专项建议。团队协作与培训：强调OT需与重症医学、护理、外科等多学科紧密协作，并需完成结构化培训和督导。

结论重症OT是改善ICU患者功能结局、降低ICU获得性并发症的关键组成部分。本共识为临床提供了可操作且循证的工作框架，有助于推动中国重症OT的规范化发展和普及，提升重症患者的康复质量和生活参与度。

关键词: 重症, 康复, 作业治疗, 专家共识

Abstract:

Objective To provide evidence-based guidance for the standardized implementation of occupational therapy (OT) in intensive care unit (ICU) in China, and clarify safe intervention timing, intervention domains, management of special populations and the application of assistive technologies, in order to promote multidisciplinary collaboration and clinical practice standardization in critical care rehabilitation.

Methods Led by the Committee of Critical Care Rehabilitation of Chinese Association of Rehabilitation Medicine, a multidisciplinary expert panel was formed. A systematic literature search was conducted in Chinese and English databases (up to September, 2025), incorporating relevant studies and guidelines. Evidence was evaluated using the tools such as GRADE, ROBINS-I and PEDro, and recommendations were developed through expert consensus meetings, integrating domestic clinical practice.

Results A total of 16 recommendations and a good practice statement were summarized. Safety criteria for intervention: thresholds for vital signs (heart rate, blood pressure, SpO₂, etc.) and laboratory values (hemoglobin > 70 g/L, platelet count > 20×10⁹/L). Core intervention domains: context modification, performance patterns reconstruction, sensory stimulation, delirium screening and management, early mobilization and engagement, emphasizing patient-centered and family-involved approaches. Assistive technologies: including eye-tracking for communication support and psychological rehabilitation. Special populations: specific recommendations for critically ill burn patients and neonates in the neonatal intensive care unit, covering early intervention, pain management, kangaroo mother care and positioning support. Team collaboration and training emphasizes close collaboration with intensive care medicine, nursing and surgical disciplines, along with structured training and supervision for OT practitioners.

Conclusion OT plays a crucial role in improving functional outcomes and reducing ICU-acquired complications in critically ill patients. This consensus provides a practical, evidence-based framework to promote the standardization and dissemination of critical care OT in China, enhancing rehabilitation quality and life participation for ICU survivors.

Key words: critical care, rehabilitation, occupational therapy, expert consensus

中图分类号:

R493

中国康复医学会重症康复专业委员会, 昆明医科大学第二附属医院康复医学部. 重症作业治疗中国专家共识(2026年版)[J]. 《中国康复理论与实践》, 2026, 32(10): 1117-1132.

Committee of Critical Care Rehabilitation, Chinese Association of Rehabilitation Medicine, Department of Rehabilitation Medicine, the Second Affiliated Hospital of Kunming Medical University. Chinese expert consensus on occupational therapy in critical care (2026)[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(10): 1117-1132.

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疾病种类	HR	BP	RR	备注
急性冠脉综合征/心肌梗死	静息HR < 120次/min	收缩压< 110 mmHg，MAP > 60 mmHg	RR< 30次/min，能轻松交流	停止OT介入：HR下降> 10次/min；收缩压下降> 10 mmHg，MAP升高> 10 mmHg；不能轻松交流，RR> 40次/min
心衰	静息HR < 120次/min	MAP > 60 mmHg	RR< 30次/min，能轻松交流
急性缺血性脑卒中(使用溶栓)		允许BP高达180/105 mmHg
脑外伤	静息HR< 100次/min	患者年龄50~69岁：收缩压≥ 100 mmHg 患者年龄15~49岁或> 70岁：收缩压≥ 110 mmHg		HR> 100次/min且无明显刺激因素出现，应重新检查BP、HR和体温如不具备侵入性监测能力，建议将收缩压控制在120 mmHg以下
颅内出血		收缩压< 140 mmHg
蛛网膜下腔出血		收缩压< 160 mmHg		例外：存在血管痉挛或迟发性脑缺血。应确定每位患者的目标BP
动脉瘤		收缩压≤ 140 mmHg		心动过速以及BP下降，尤其是当患者突然出现腹痛时
肺部疾病	60~120次/min			静息HR > 120次/min需注意；HR下降> 10次/min，停止OT介入
慢性限制性肺疾病			RR< 40次/min，能轻松交流
慢性阻塞性肺疾病			RR< 30次/min，能轻松交流
脊髓损伤		受伤后至少1周内：MAP 85~90 mmHg		患者的低血压(收缩压< 90 mmHg)应先由医疗团队处理后，治疗师再介入

血小板计数阈值	活动类型
< 10×10⁹/L	限制活动。患者可能需要输注血小板，之后才能恢复运动
(10~20)×10⁹/L	轻柔的活动，不抗阻。如坐着或站着锻炼、轻柔的拉伸和步行
(20~50)×10⁹/L	低水平的抗阻活动：如负重功能任务(从坐到站)，抗阻设备(弹力带等)，可以走得更快，爬台阶或楼梯

刺激	由家属执行
听觉刺激	自我介绍并呼唤患者姓名播放音乐朗读诗歌播放熟悉声音的录音
视觉刺激	熟悉的物品、家庭照片、影片等
触觉/感官刺激	抚摸面部和身体在手足涂抹润肤露
嗅觉刺激	10 s 喜爱的香味
运动觉刺激	被动关节活动
情感/认知刺激	谈论患者感兴趣的话题定向刺激

重症作业治疗中国专家共识(2026年版)

Chinese expert consensus on occupational therapy in critical care (2026)

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