2016年6月,美国心脏协会(American Heart Association,AHA)/美国卒中协会(American Stroke Association,ASA)发布了首次针对成人脑卒中康复治疗的指南(下文简称为2016 AHA/ASA指南)。本文旨在对2016 AHA/ASA指南与2011中国脑卒中康复治疗指南(下文简称为2011国内版指南)和2016中国脑梗死急性期康复专家共识(下文简称为2016国内版共识)进行比较,为国内脑卒中后康复治疗提供参考。这3个版本的指南或共识均提倡早期康复,但未对具体的介入时间给出明确的界定;明确了适当的康复锻炼可以预防成人脑卒中后压疮、关节挛缩、深静脉血栓、肺部感染和泌尿系统感染等并发症,并推荐了相关的防治建议。2016 AHA/ASA指南对于脑卒中后并发症的康复治疗方法、强度、时间、联合预防方案以及共病预防等措施的建议更为详尽。2016 AHA/ASA指南与2011国内版指南和2016国内版共识对于防治深静脉血栓和卒中后中枢性疼痛以及心理干预的推荐意见存在差异。2016 AHA/ASA指南还对恢复卒中后日常生活活动能力提供了休闲娱乐活动和职业康复的具体推荐。与国外康复治疗规范相比,国内脑卒中康复治疗规范的发展依然任重而道远。
Abstract
In June 2016, American Heart Association (AHA)/American Stroke Association (ASA) released the first guideline for adult stroke rehabilitation—AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery (2016 GASRR). This paper aims to compare the 2016 GASRR with Chinese Adult Stroke Rehabilitation Guideline in 2011 (2011 CASRG) and Consensus of Rehabilitation Experts on Acute Cerebral Infarction in 2016 (2016 CREACI) to provide references for rehabilitation therapy of stroke in China. The 2016 GASRR, 2011 CASRG and 2016 CREACI all suggest that early rehabilitation during acute stage is essential for optimal outcomes, but do not provide the specified timing of intervention. Suggestions on rehabilitation methods are mentioned given specific training programs can prevent pressure sore, joint contracture, deep venous thrombosis (DVT), lung infection and urinary tract infection. The 2016 GASRR gives more detailed information on rehabilitation methods, level of rehabilitation activities, rehabilitation schedule, and the interventions to prevent pro-stroke complications. Furthermore, different approaches are suggested in the 2016 GASRR, 2011 CASRG and 2016 CREACI on prevention of DVT and post-stroke central pain and the psychological intervention. The 2016 GASRR also has covered recommendations for improvement of activities of daily living (ADL) and instrumental activities of daily living (IDAL) which are specified to leisure activities and occupational treatments. As compared with the criteria of stroke rehabilitation abroad, there is still a long way to go for the development of stroke rehabilitation in China. In the future, more researches are needed to be done in China in order to standardize the post-stroke rehabilitation.
关键词
卒中 /
康复 /
指南 /
专家共识 /
美国心脏协会 /
美国卒中协会
Key words
Stroke /
Rehabilitation /
Guideline /
Expert consensus /
American Heart Association /
American Stroke Association
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参考文献
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基金
上海市进一步加快中医药事业发展三年行动计划(编号:ZY3-FWMS-2-1012);上海中医药大学校级科研项目(编号:2016YG36);上海中医药大学附属第七人民医院“七院新星”项目(编号:XX2016-03、XX2016-09)