基于国际健康分类架构构建新型冠状病毒病重症病区配对康复治疗模式及其效果

doi:10.3969/j.issn.1006-9771.2021.04.002

Abstract

Abstract: Objective

To construct a teamwork model, Partnership Rehabilitation Therapy (PRT), for therapists in critical wards for patients with Corona Virus Disease 2019 (COVID-19), and observe its effect.

Methods

PRT had been developed, in which one therapist (main) implementing therapy and another (assistant) monitoring and supporting in the treatment. Eleven COVID-19 patients from infectious critical ward were treated with PRT. The behavior safety of therapists was recorded during the treatment, and the patients were assessed with Borg Index, Cough Score, Miller Sputum Grading and World Health Organization Disability Assessment Schedule (WHODAS) 2.0 before and after treatment.

Results

No physiotherapist was infected by COVID-19. Seven times of infection risks were recorded and avoided, and six times of treatment risks were corrected instantly. All the patients improved in Borg Index (P < 0.01), Cough Score (P < 0.05), Miller Sputum Grading (P = 0.02) and WHODAS 2.0 (P < 0.01) after a 1-week physical therapy.

Conclusion

Based on the Family International Classifications, a teamwork model is established, which provides a safe and practicable way for rehabilitation for COVID-19 patients in critical wards.

Key words: Corona Virus Disease 2019, team work, Partnership Rehabilitation Therapy, infectious disease, ICU rehabilitation

CLC Number:

R511.7

Jin-ze TAN,Ming-sheng ZHANG,Fan-ling ZENG,Bin ZENG,Zhuo-ying QIU. Construction and Effect of Partnership Model of Rehabilitation for Patients with COVID-2019 in Critical Wards Using International Health Classifications Framework[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(4): 385-393.

Figures/Tables 6

References 54

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编码	疾病诊断
U07.1	COVID-19确认携带病毒
U07.2	COVID-19未确认携带病毒
U07.100	2019冠状病毒病
U07.100×001	新型冠状病毒肺炎
U07.100×002	新型冠状病毒感染
U07.100×003	新型冠状病毒肺炎临床诊断病例
Z03.800×001	新型冠状病毒肺炎疑似病例

一级类目	编码	内容	举例
s身体结构	s4301	肺的结构	肺实变，肺痰液积蓄
	s760	躯干的结构	气管切开
	s810	皮肤的结构	长期卧床后压疮，肢体肿胀
b身体功能	b440	呼吸功能	通气或/和换气功能下降
	b445	呼吸肌功能	吸气肌无力，脱机困难
	b450	辅助呼吸功能	咳嗽无效、无力
	b460	与心血管和呼吸功能相关的感觉	呼吸系统本体感觉减退
	b455	运动耐受功能	心肺运动耐力下降，容易疲劳
	b110	意识功能	昏迷等意识障碍
	b265	触觉功能	触觉减退
	b130	能量和驱力功能	患者疲倦，容易乏力
	b730	肌肉力量功能	肌力下降，获得性衰弱
	b152	情感功能	ICU综合征导致焦虑烦躁
d活动和参与	d330	说	气管切开或经口插管无法言语
	d310	交流-接收-口头讯息	无法接收外界信息
	d420	移动自身	手脚束缚无法移动身体
	d410	改变身体的基本姿势	手脚束缚导致无法自己姿势调整
	d520	护理身体各部位	手部束缚导致无法自主完成护理
	d450	步行	长期卧床无法离床运动
	d540	穿着	无法自主完成穿衣动作
	d710	基本人际互动	无法跟外界进行人际交流交往
e环境因素	e250	声音	中心电监护与呼吸机报警
	e310	直系亲属家庭	家属无法探视沟通
	e260	空气质量	密闭的环境
	e115	个人日常生活用的用品和技术	日常生活工具设备不能带进ICU

量表	描述
Borg指数	分0~10级，患者在运动时要求选择最能描述他们呼吸努力程度的等级
咳嗽评分	患者的咳嗽功能分为0~5分，功能分类为非功能咳嗽、弱功能咳嗽和功能性咳嗽
Miller痰液分级	将痰液按黏稠度分级
WHODAS2.0	采用36题版，包括6个维度：认知、活动性、自我照护、与人相处、生活活动和社会参与

编号	脱机困难	咳嗽无力	气道有痰液积蓄	肺不张	肢体乏力	体位转移障碍	步行功能障碍
1	√	√			√	√	√
2	√	√	√		√	√	√
3	√		√		√	√	√
4	√	√	√	√	√	√	√
5					√	√	√
6	√	√					√
7	√	√			√	√	√
8	√	√	√	√	√	√	√
9	√	√			√	√	√
10			√		√	√	√
11	√	√	√		√	√	√

功能障碍	表现	分类	康复措施
脱机困难	呼吸模式异常、肺功能障碍、呼吸急促、PEEP较高，呼吸肌无力	b440呼吸功能 b445呼吸肌功能 b450辅助呼吸功能	腹式呼吸、缩唇呼吸训练、呼吸综合训练
咳嗽无力	咳嗽无效无力，建立人工气道，气道廓清能力较差，气道有痰液积蓄	s760躯干的结构 s4301肺的结构 d330说	有效咳嗽训练、刺激咳嗽训练
气道有痰液积蓄	气道有痰液积蓄,气道廓清能力较差，可自主配合完成咳嗽动作，自主咳嗽较差	s4301肺的结构	主动呼吸循环技术、体位引流、呼气振动训练、运动呼气正压震荡系统
肺不张	气道有痰液积蓄,气道廓清能力较差，可自主配合完成咳嗽动作，自主咳嗽较差	s4301肺的结构 b460与心血管和呼吸功能相关的感觉	徒手肺过度充气技术和激励式呼吸训练器
肢体乏力	肌力不足，肌力减退	b455运动耐受功能 b130精力与驱动力 b760肌肉力量	呼吸操训练、抗阻系统肌力训练
体位转移障碍	长期卧床，坐位平衡障碍，无法自主体位转移	d420移动自身 d410改变身体的基本姿势	翻身训练、摇高床头训练、床边坐位训练
步行功能障碍	站立与步行功能障碍	d450步行 d410改变身体的基本姿势	离床站立训练与步行训练

Construction and Effect of Partnership Model of Rehabilitation for Patients with COVID-2019 in Critical Wards Using International Health Classifications Framework

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编号	脱机困难	咳嗽无力	气道有痰液积蓄	肺不张	肢体乏力	体位转移障碍	步行功能障碍
1	√	√			√	√	√
2	√	√	√		√	√	√
3	√		√		√	√	√
4	√	√	√	√	√	√	√
5					√	√	√
6	√	√					√
7	√	√			√	√	√
8	√	√	√	√	√	√	√
9	√	√			√	√	√
10			√		√	√	√
11	√	√	√		√	√	√

评估指标		治疗前	治疗后	t/χ2值	P值
咳嗽评分		3.45±1.21	4.18±0.75	-3.068	0.012
Borg指数		2.82±1.17	0.82±0.87	10.488	0.001
WHO-DAS2.0		121.64±5.12	101.55±5.34	15.993	0.001
Miller痰液分级(n)	黏稠	10	3	12.769	0.020
	不黏稠	1	8

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编号	脱机困难	咳嗽无力	气道有痰液积蓄	肺不张	肢体乏力	体位转移障碍	步行功能障碍
1	√	√			√	√	√
2	√	√	√		√	√	√
3	√		√		√	√	√
4	√	√	√	√	√	√	√
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6	√	√					√
7	√	√			√	√	√
8	√	√	√	√	√	√	√
9	√	√			√	√	√
10			√		√	√	√
11	√	√	√		√	√	√

编号	脱机困难	咳嗽无力	气道有痰液积蓄	肺不张	肢体乏力	体位转移障碍	步行功能障碍
1	√	√			√	√	√
2	√	√	√		√	√	√
3	√		√		√	√	√
4	√	√	√	√	√	√	√
5					√	√	√
6	√	√					√
7	√	√			√	√	√
8	√	√	√	√	√	√	√
9	√	√			√	√	√
10			√		√	√	√
11	√	√	√		√	√	√