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荷兰Enraf-Nonius公司针对新冠肺炎患者康复进行第一期全球线上直播培训

2020-05-22                    浏览:414

近日,针对新型冠状病毒COVID-19(以下简称新冠)疫情,荷兰Enraf-Nonius公司在康复的基础上进行了一次全球线上培训交流,其目的在于帮助大家了解新冠肺炎,以及介绍康复在新冠肺炎中的作用。下面是本次培训的简单梳理:

01新冠介绍:

第一批住进ICU的新冠患者现已出院。

目前已经清楚的是,许多新冠患者在ICU出院后会出现身体、认知和心理问题,也称为重症监护后综合征(PICS)。并伴随一种新的肺部疾病出现,我们暂时称之为“冠状阻塞性肺病”。

发生PICS的可能原因是,新冠患者在ICU里停留的时间明显长于需要在ICU进行急性护理的其他患者。新冠患者平均住ICU时间为23天,非新冠患者平均住ICU时间为10天。与ICU相关的症状导致日常功能长期受限和生活质量下降。PICS的长期后果:1年后60%的人有身体不适。有些人甚至不能再独立完成他们的日常活动,如穿衣和洗澡。

住院的新冠患者在住院后需要加强物理治疗咨询。有了Enraf - Nonius设备,就可以获得充分治疗新冠患者的知识和治疗方案,并加速患者返回熟悉的(家庭)环境。


02新冠可能引起的症状:

新冠患者从ICU入院到康复,预计会出现一种或多种身体、认知和心理方面的不适,可能包括:

  • 肺功能:肺纤维化/肺容量减少

  • 呼吸肌力量下降(吸气和呼气)

  • 长时间不活动导致的获得性肌无力(ICUAW)

  • 获得性多神经病和肌病

  • 有氧和无氧耐力下降

  • 关节疼痛或僵硬

  • 整体疲劳

  • ADL问题

  • 营养不良

  • 认知:记忆,注意力,处理刺激和计划

  • 焦虑和抑郁

  • 创伤后应激综合症(PTSD)

  • 重症监护综合症(PICS)

  • 新冠患者的身体不适(肌无力、关节疼痛、肺功能下降、耐力下降)可追溯至固定时间和通气

03ICU康复 时间的长短及性


ICU获得性肌无力(ICUAW)是重症疾病最明显的后果之一,也是主要的治疗目标之一。

Enraf - Nonius设备(684V)可以在早期部署——ICU或护理病房期间通过肌肉刺激,防止肌肉质量的损失和获得力量。在这个过程中进行NMES针对四头肌和小腿肌肉进行电刺激。改设备具有相位间隔的双相脉冲。使用这种特殊的脉冲的好处是它增强了股四头肌的收缩力。这种疗法对于刺激患者运动以维持一般状态很重要,防止其功能的丧失。


04NMES对于新冠的作用

严重的慢性阻塞性肺病,容易造成周边肌肉张力减退和萎缩,NMES可以显著提高外围肌肉力量,治疗安全、可靠,它可以在任何医院环境下进行,从ICU到普通病房,并有可能缩短重症患者的住院时间。

这种早期康复可以防止严重的肌肉损失,极大的帮助病人从ICU转出,可以有效的应用于肺部疾病的患者。



NMES由对称的双相方波组成(脉冲持续时间为400微秒)。收缩松弛周期为16秒,包括:

  • 1秒斜坡上升

  • 6秒收缩

  • 1秒斜坡下降

  • 8秒休息

首先从3分钟的热身阶段开始频率为5Hz,然后将频率设置为15Hz或75Hz,强度根据个体可容忍值进行调整,总训练时间为18分钟(包括预热时间)。

电极放置方法:

在股四头肌上放置两对8*12cm电极,横向放置在距离腹股沟远端5-10cm和髌骨近端4-8cm位置;小腿肌肉放置2对4*6cm的电极,纵向放置在腓肠肌的腹部。

四通道同时刺激,可进行左右下肢股四头肌,腓肠肌同时刺激



05新冠患者重症监护室后期康复及出院后康复

目前还没有关于新冠患者的最佳康复或后续护理效果的研究。物理治疗康复是在专家意见和其他传染病(非典,中东呼吸综合征等)的康复文献基础上的治疗

对新冠患者康复的治疗侧重于增加肌力,改善肺功能,提高有氧和无氧耐力。使用EN-DYNAMIC和EN-CARDIO运动机,可以测试和改善新冠患者的心肺功能和身体负荷及性能。



06新冠康复治疗总结


建议每周治疗2 - 5次,其中力量训练每周2 - 3次。顺序是频率——持续时间——强度。建议以非常低的强度(40-50% HRmax)进行第一次耐力训练。根据储备心率,训练强度一般在40-60%之间,或者在改良的Borg量表(COPD指南)中为4分或5分,或者最大心率50-80%(心脏康复指南)。当耐力训练不可行时,可以选择持续力量训练(肌肉耐力)或间隔训练。


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