WEBVTT00:00:03.400 --> 00:00:07.300来介绍一下呼吸康复治疗的效果和长期影响00:00:08.480 --> 00:00:11.220我们将从以下五个方面来进行介绍00:00:11.320 --> 00:00:13.980首先是呼吸康复治疗的短期效果00:00:14.320 --> 00:00:19.860接下来是介绍呼吸康复治疗的长期效果以及呼吸康复治疗的长期影响00:00:20.240 --> 00:00:23.780适用范围还有呼吸康复治疗的实施与推广00:00:24.040 --> 00:00:26.900首先介绍呼吸康复治疗的短期效果00:00:28.560 --> 00:00:34.900呼吸呃呼吸康复治疗首先是可以改善我们的呼吸功能提高肺活量与通气功能00:00:37.840 --> 00:00:40.860可以缓解我们的呼吸困难症状00:00:50.680 --> 00:00:53.780提升我们的运动耐力来增强运动的能力00:00:53.880 --> 00:01:00.820运动训练是呼吸康复的核心适当的运动可以提高患者的运动耐力改善身体的机能00:01:01.120 --> 00:01:06.700研究表明呼吸康复训练可显著提高患者的六分钟步行试验距离00:01:09.480 --> 00:01:11.660呼吸康复治疗的长期效果00:01:11.920 --> 00:01:14.660首先它是可以提高人们的生活质量00:01:14.760 --> 00:01:20.700呼吸康复可帮助患者改善生活自理能力提高日常生活活动的独立性00:01:21.080 --> 00:01:23.780例如一位长期不能下地的老太太00:01:23.800 --> 00:01:27.380经过呼吸康复后能够借助步行器来行走00:01:29.000 --> 00:01:30.980可以降低我们的再入院率00:01:31.200 --> 00:01:37.580呼吸康复可降低慢性呼吸系统疾病患者的再入院率减少医疗资源的占用00:01:38.160 --> 00:01:41.780临床研究显示接受呼吸康复治疗的患者00:01:42.160 --> 00:01:43.700而其再入院率00:01:43.800 --> 00:01:46.260显著低于未接受康复00:01:46.680 --> 00:01:48.140康复治疗的患者00:01:49.600 --> 00:01:51.860它可以延缓疾病的进展00:01:52.800 --> 00:01:54.700减缓肺功能的下降00:01:55.160 --> 00:01:58.140呼吸康复有助于延缓疾病的进展00:01:58.240 --> 00:02:00.580减缓肺功能的下降速度00:02:00.640 --> 00:02:03.580通过长期的呼吸训练和运动锻炼00:02:03.600 --> 00:02:16.620患者的肺功能得到一定程度的改善和维持呼吸康复治疗的长期影响嗯它可以对心理感进行改善来缓解焦虑抑郁的情绪00:02:17.200 --> 00:02:22.740呼吸康复可缓者可缓解患者的焦虑抑郁情绪改善心理状态00:02:22.920 --> 00:02:29.940例如中等强度的运动训练能改善慢性阻塞性肺部疾病患者的焦虑抑郁情绪00:02:30.720 --> 00:02:38.100帮助患者社会功能恢复期康复有助于患者恢复社会功能提高社会适应能力00:02:38.320 --> 00:02:44.700患者在康复过程中学会自我管理增强与社会的互动提高生活质量00:02:45.760 --> 00:02:48.580二提高患者的社会适应能力00:02:49.160 --> 00:02:51.100促进健康行为的养成00:02:51.280 --> 00:02:54.340可以帮助患者培养长期锻炼的习惯00:02:54.680 --> 00:03:01.100呼吸康复强调患者长期坚持健康的行为方式如定期锻炼戒烟等00:03:01.200 --> 00:03:03.660通过健康教育和行为干预00:03:03.680 --> 00:03:06.860患者能够养成良好的生活习惯00:03:06.880 --> 00:03:08.820来减少疾病的复发00:03:11.440 --> 00:03:13.740呼吸康复治疗的适用范围00:03:15.320 --> 00:03:20.020常用于慢性呼吸系统的疾病比如说慢性阻塞性肺病00:03:20.440 --> 00:03:26.940慢性阻塞性肺病是呼吸康复的主要适用对象之一康复治疗效果显著00:03:27.200 --> 00:03:29.980呼吸康复可改善患者的呼吸功能00:03:30.000 --> 00:03:32.660运动耐力和生活质量00:03:34.520 --> 00:03:37.140再比如呼吸道疾病术后康复00:03:37.320 --> 00:03:44.420对于肺癌术后的康复呼吸康复在肺癌术前术后康复中发挥了非常重要的作用00:03:44.440 --> 00:03:46.540可减少术后并发症00:03:46.960 --> 00:03:50.700例如术前运动干预可缩短住院的时间00:03:50.760 --> 00:03:53.180改善患者术后生活质量00:03:57.360 --> 00:03:59.100其他呼吸系统的疾病00:04:01.520 --> 00:04:03.700比如哮喘和支气管扩张00:04:03.920 --> 00:04:08.300哮喘和支气管扩张患者也可从呼吸康复中获益00:04:08.360 --> 00:04:10.860改善呼吸困难和运动能力00:04:11.200 --> 00:04:15.700呼吸康复训练可提高哮喘患者的运动耐力和生活质量00:04:19.480 --> 00:04:21.980呼吸康复治疗的实施与推广00:04:23.240 --> 00:04:30.100我们基于患者的基本情况来评估制定方案建立个性化的健康康复方案00:04:30.640 --> 00:04:35.340呼吸康复强调为患者量身定制个性化的康复方案00:04:35.840 --> 00:04:38.620通过全面评估患者的病情00:04:38.680 --> 00:04:40.900肺功能运动耐力等00:04:40.920 --> 00:04:43.420制定适合患者的康复计划00:04:46.640 --> 00:04:48.740多学科的写作模式00:04:49.320 --> 00:04:51.300跨学科的团队合作00:04:51.640 --> 00:04:57.900呼吸康复需要多学科协作包括呼吸科康复科营养科等00:04:58.080 --> 00:05:02.740化学科的团队合作可为患者提供全面的康复服务00:05:03.600 --> 00:05:05.580提高康复效果00:05:07.320 --> 00:05:12.100远程康复与居家康复远程康复技术00:05:13.120 --> 00:05:19.340远程呼吸康复利用现代通信技术将康复与服务延伸到患者的家中00:05:19.760 --> 00:05:22.340远程康复可提高患者的依从性00:05:22.480 --> 00:05:24.740使康复治疗更加便捷00:05:29.160 --> 00:05:30.180呼吸康复00:05:30.920 --> 00:05:33.540作为针对慢性呼吸系统疾病00:05:33.600 --> 00:05:35.780患者的综合干预手段00:05:35.840 --> 00:05:37.620以改善呼吸功能00:05:37.680 --> 00:05:39.860提升生活质量为核心00:05:39.960 --> 00:05:44.260在社区场景中具有广泛的应用价值和事件意义00:05:44.520 --> 00:05:48.460社区作为患者日常居住和生活的主要场所00:05:48.520 --> 00:05:52.660能为呼吸康复提供便捷持续的干预环境00:05:52.760 --> 00:05:55.580有效弥补医院康复资源有限00:05:55.640 --> 00:05:58.140患者出院后管理断层的问题00:05:58.200 --> 00:06:01.260成为呼吸康复体系中不可或缺的一环00:06:01.760 --> 00:06:06.500社区呼吸康复的服务对象主要聚集于慢性阻塞性肺疾病00:06:06.600 --> 00:06:09.420支气管哮喘稳定期肺结核00:06:09.480 --> 00:06:12.780间质性肺病等慢性呼吸疾病患者00:06:13.080 --> 00:06:17.180同时也涵盖术后需呼吸功能恢复的人群00:06:17.320 --> 00:06:20.220及老年呼吸功能减退者00:06:20.360 --> 00:06:24.100这些群体往往需要长期的康复干预00:06:24.440 --> 00:06:26.340但受限于出行不便00:06:26.520 --> 00:06:29.140医院康复周期短等因素00:06:29.160 --> 00:06:31.660难以获得持续性治疗00:06:32.760 --> 00:06:36.860而社区的近距离优势可有效的缓解这一痛点00:06:37.480 --> 00:06:41.100在具体应用模式上社区康复00:06:41.800 --> 00:06:46.700社区呼吸康复形成了基础服务加个性化干预的奇迹00:06:47.000 --> 00:06:50.180基础服务包括建立患者的健康档案00:06:50.360 --> 00:06:54.500通过定期随访免费筛查等方式00:06:55.000 --> 00:06:56.980掌握患者的病情变化00:06:57.040 --> 00:06:59.740肺功能状况及生活习惯00:06:59.880 --> 00:07:01.980开展健康宣教活动00:07:02.040 --> 00:07:05.780通过讲座手册短视频等形式00:07:05.840 --> 00:07:08.820普及呼吸功能呼吸疾病的知识00:07:08.840 --> 00:07:12.100康复训练方法及家庭护理技巧00:07:12.360 --> 00:07:14.980提升患者自我管理的能力00:07:15.320 --> 00:07:19.340个性化干预则针对不同患者的病情严重程度00:07:19.600 --> 00:07:22.340身体耐受度制定方案00:07:22.560 --> 00:07:30.860恶心训练内容涵盖呼吸训练如腹式呼吸蜷缩呼吸运动呼吸00:07:31.200 --> 00:07:35.660如慢走太极拳弹力带抗阻训练等等00:07:36.000 --> 00:07:38.500心理干预及营养指导等00:07:38.680 --> 00:07:42.500由社区医护人员或康复师现场指导00:07:42.720 --> 00:07:45.420确保训练的安全性和有效性00:07:46.720 --> 00:07:51.980社区康复呼吸康复的落地还依赖于多维度的支持条件00:07:52.160 --> 00:07:54.940一方面需要搭建专业团队00:07:55.000 --> 00:07:58.980配备具备呼吸康复知识的全科医生00:07:59.040 --> 00:08:01.940护士及康复治疗师00:08:02.040 --> 00:08:07.820同时可联动医院专家开展远程会诊或定期坐诊00:08:08.160 --> 00:08:10.020提升服务的专业性00:08:10.320 --> 00:08:13.620另一方面要完善社区的康复设备00:08:14.000 --> 00:08:17.780配备简易的肺功能仪呼吸训练器00:08:17.800 --> 00:08:19.660运动康复器材等00:08:20.040 --> 00:08:22.620为康复训练提供硬件保障00:08:22.880 --> 00:08:28.300此外构建社区家庭联动机制至关重要00:08:28.480 --> 00:08:35.460通过培训患者家属让其协助监督康复训练做好家庭护理00:08:35.520 --> 00:08:38.260形成持续性的康复支持环境00:08:39.400 --> 00:08:45.060当前社区呼吸康复在实践中也取得了显著成效00:08:45.160 --> 00:08:48.540不仅能有效改善患者的肺功能指标00:08:48.640 --> 00:08:51.100减轻气短胸闷等症状00:08:51.320 --> 00:08:53.740还能增强患者的运动耐力00:08:53.760 --> 00:08:56.380帮助其恢复日常活动能力00:08:56.480 --> 00:08:58.940降低急性加重入院率00:08:58.960 --> 00:09:01.580减轻家庭和社会的医疗负担00:09:02.000 --> 00:09:05.380同时通过社区内的群体康复活动00:09:05.400 --> 00:09:08.020患者之间可相互交流经验00:09:08.040 --> 00:09:09.140彼此鼓励00:09:09.160 --> 00:09:16.860缓解因疾病产生的焦虑抑郁情绪提升心理健康水平00:09:17.480 --> 00:09:22.660未来社区康呼吸康复需进一步推进规范化的建设00:09:22.920 --> 00:09:27.660制定统一的服务标准和评估体系00:09:28.240 --> 00:09:30.060加强人才队伍培训00:09:30.200 --> 00:09:33.140同时借助智慧医疗技术00:09:33.200 --> 00:09:36.540开发远程康复指导平台00:09:36.720 --> 00:09:39.700实现患者病情实时监测00:09:39.840 --> 00:09:42.700和个性化方案的动态调整00:09:44.000 --> 00:09:47.100随着社区呼吸康复服务的不断完善00:09:47.440 --> 00:09:54.500将为更多呼吸疾病患者带来便捷高效的康复服务00:09:54.720 --> 00:09:59.180助力构建全方位全周期的健康保障体系00:09:59.720 --> 00:10:05.020同时呼吸康复还具有很多中医配合的治疗00:10:07.600 --> 00:10:11.620比如说中医方面的中医八段锦00:10:15.280 --> 00:10:17.980协助患者提高肺功能的改善00:10:19.120 --> 00:10:26.780中医在呼吸康复中以整体调整体调理辨证失治为核心00:10:26.960 --> 00:10:30.700注重通过调理肺脾肾三脏的功能00:10:31.400 --> 00:10:37.780在中医中认为肺主气思呼吸即为气血生化之源肺之母肾主纳气00:10:38.400 --> 00:10:43.740通过肺脾肾三脏的改善来改善呼吸功能增强机体抵抗力00:10:43.920 --> 00:10:51.340适用于慢性阻塞性肺疾病哮喘稳定期肺间质纤维化恢复期等呼吸疾病的康复阶段00:10:52.200 --> 00:10:59.420呃常用的方法呃是核心治疗方法是内调外治结合中药内服00:10:59.440 --> 00:11:05.100通过辨证问症辨证分型根据患者的体质和症状差异00:11:05.200 --> 00:11:07.060将呼吸疾病康复期00:11:07.080 --> 00:11:09.020主要分为以下的症型00:11:09.200 --> 00:11:10.700来针对性的用药00:11:10.720 --> 00:11:12.500比如说肺气虚型00:11:12.520 --> 00:11:21.340表现为气短乏力活动后加重咳嗽无力易感冒我们会常用玉屏风散或补肺汤00:11:21.400 --> 00:11:22.700补肺益肾00:11:23.000 --> 00:11:30.340肺脾气虚型补肺气虚的症状外还伴有食欲不振腹胀便溏神疲懒言00:11:30.400 --> 00:11:35.820常用六君子汤健脾益气或者参苓白术散健脾益肺00:11:37.200 --> 00:11:48.100内肾气虚型多见于病程较长者表现为气短难续腰膝酸软畏寒肢冷夜尿增多常用清水六君煎补肾化痰00:11:48.160 --> 00:11:50.820或者金匮肾气丸温肾纳气00:11:51.280 --> 00:11:58.420痰浊阻肺型表现为咳嗽痰多色白粘稠胸闷气短常用二陈汤燥湿化痰00:11:58.480 --> 00:12:01.100或三级养清汤降气化痰00:12:01.880 --> 00:12:11.540外治疗法便捷浅易配合康复啊通常比如说针灸艾灸通过刺激特定穴位来调节脏腑的功能00:12:11.800 --> 00:12:15.620常用的穴位包括肺腧膻中足三里00:12:15.640 --> 00:12:22.900肾腧艾灸多用于气虚阳虚的患者可艾灸关元气海足三里等穴位00:12:22.960 --> 00:12:26.860来增强机体的阳气改善畏寒气短的症状00:12:27.400 --> 00:12:30.980穴位敷贴最具代表性的是三伏贴和三九贴00:12:31.240 --> 00:12:33.300通过将温热性的中药00:12:33.880 --> 00:12:36.140如白芥子细辛甘髓等00:12:36.160 --> 00:12:41.460贴敷于肺腧膻中大椎等穴位利用药物渗透性和经络传导00:12:41.520 --> 00:12:43.860温通肺气散寒化痰00:12:43.920 --> 00:12:47.340减少呼吸病呼吸疾病的并发作00:12:47.440 --> 00:12:49.620适合康复期的长期调理00:12:49.920 --> 00:12:54.060拔罐推拿拔罐挑选背部膀胱经00:12:54.200 --> 00:12:59.220通过负压刺激疏通经络行气活血缓解胸闷背部不适00:12:59.400 --> 00:13:02.220推拿则以按揉胸背部穴位00:13:02.240 --> 00:13:05.500梳理肋间肌为主配合腹部按摩00:13:05.680 --> 00:13:08.940辅助改善呼吸不畅腹胀等问题00:13:11.200 --> 00:13:21.460特色的康复手段如呼吸导引术结合中医调剂的理念指导患者进行呼吸训练如腹式呼吸法八段颈00:13:22.680 --> 00:13:31.500等动作可舒展胸廓增强肺功能太极拳均匀呼吸能改善呼吸节律提升运动耐力00:13:32.080 --> 00:13:35.540饮食调理方面遵循药食同源原则00:13:35.600 --> 00:13:39.260肺气虚者建议食用黄芪粥山药粥00:13:39.360 --> 00:13:46.500痰浊阻肺者宜清淡饮食可食用冬瓜白萝卜薏米等健脾化痰的食物00:13:46.840 --> 00:13:52.380肺肾气虚者可适量饮用核桃黑芝麻枸杞等补肾食物00:13:52.480 --> 00:13:55.340避免生冷辛辣油腻食物00:13:55.360 --> 00:13:57.260减少对呼吸道的刺激00:13:58.040 --> 00:14:01.820注意事项方面中医治疗需要辨证施治00:14:01.840 --> 00:14:05.340患者不可自行用药或者是盲目的贴敷00:14:05.520 --> 00:14:10.180需由专业中医师根据体质症状制定方案00:14:10.400 --> 00:14:13.860尤其合并高血压糖尿病等基础病者00:14:14.000 --> 00:14:17.220需要注意中药与西药的相互作用00:14:17.720 --> 00:14:20.020中医康复是个长期的过程00:14:20.160 --> 00:14:22.380需要配合规律作息00:14:22.400 --> 00:14:24.660避免劳累和受凉00:14:24.680 --> 00:14:28.580同时结合现代医学的呼吸训练00:14:29.080 --> 00:14:34.380比如说缩床呼吸来形成中西医结合的康复体系00:14:34.560 --> 00:14:36.780更利于改善预后00:14:37.640 --> 00:14:44.500若出现急性加重如呼吸困难加剧咳黄脓痰发热00:14:44.640 --> 00:14:46.580是出现急性症状时00:14:46.640 --> 00:14:49.020要及时立即的就医00:14:49.040 --> 00:14:51.380不可单纯依靠中医康复00:14:51.520 --> 00:14:53.340避免延误转行00:14:53.680 --> 00:14:57.500对于呼吸的康复治疗它是一个长久的过程00:14:57.560 --> 00:14:58.820需要坚持00:14:59.480 --> 00:15:03.980是习惯的按照呃我们的治疗方案来进行