医学交流课件：3 德国心脏康复医院6个月学习经历分享

欧洲心脏康复体系简述：德国心脏康复医院6个月学习经历分享董月 Dong, Yue Sports scientist and Sports therapistCardiac Rehabilitation in European:My experiences during a 6 months internship in a Cardiacrehabilitation clinic in Germany内容 Contents：1前言Background2Clinic Koenigsfeld 简介Introduction of ClinicKoenigsfeld3Clinic Koenigsfeld 心脏康复体系Concept of Cardiacrehabilitation in ClinicKoenigsfeld4欧洲心脏康复体系小结Summary of thecardiac rehabilitationprocess in Europe董月 Dong, Yue Sports scientist and Sports therapist1. 前言Background?欧洲心脏康复 Cardiac rehabilitation in Europe德国心脏康复 Cardiac rehabilitation in Germany心脏康复的目标 Goals of Cardiac rehabilitation心脏康复的效果 Outcomes of Cardiac rehabilitation董月 Dong, Yue Sports scientist and Sports therapist欧洲心脏康复 Cardiac rehabilitation in Europe董月 Dong, Yue Sports scientist and Sports therapist德国目前有超过200家康复诊所提供阶段II的康复治疗Around 200rehab clinicscurrentlyperformPhase IIrehabilitationin Germany德国心脏康复 Cardiac rehabilitation in Germany阶段I Phase I住院阶段 In hospital stage物理治疗和活动性练习Physical therapy and mobilization阶段II Phase II住院或门诊康复阶段Cardiac Rehabilitation心梗、心脏术后等，需尽早进入康复阶段Rehabilitation immediately after myocardialinfarction, heart surgery, etc.阶段III Phase III维持性治疗 Maintenance therapy持续终身的病后康复Life-long after-care董月 Dong, Yue Sports scientist and Sports therapist董月 Dong, Yue Sports scientist and Sports therapist德国心脏康复 Cardiac rehabilitation in Germany董月 Dong, Yue Sports scientist and Sports therapistShannon M. Dunlay, et.al. 2014心脏康复的目标 Goals of Cardiac rehabilitation? 降低死亡率及再次发病的几率Reduce the mortality and morbidity? 提高生活质量Improve the life quality? 改变生活方式，减少心血管疾病的危险因素Change the Lifestyle and reduce the risks of heart diseases? 提高重返日常生活及工作的几率Raise the possibility of the patients to return to daily life and work? 减轻因疾病及劳动力丧失导致的社会负担Alleviate the social burden caused by disease and labor loss心脏康复的效果 Outcomes of Cardiac rehabilitation死亡率 Mortality董月 Dong, Yue Sports scientist and Sports therapist发病率 MorbidityShannon M. Dunlay, et.al. 2014董月 Dong, Yue Sports scientist and Sports therapistGhanbari-Firoozabadi M et.al. 2014心脏康复的效果 Outcomes of Cardiac rehabilitation生活质量 The quality of live2.Clinic Koenigsfeld 简介Introduction of Clinic Koenigsfeld? 基本信息 Basic information? 康复中心视频 The video of Clinic Koenigsfeld? 康复治疗项目 Indications董月 Dong, Yue Sports scientist and Sports therapistKlinikum Knigsfeld der DeutschenRentenversicherung WestfalenHolthauser Talstrae 258256 EnnepetalGermany董月 Dong, Yue Sports scientist and Sports therapist董月 Dong, Yue Sports scientist and Sports therapist58256 EnnepetalGermanyKlinik Knigsfeld der DeutschenRentenversicherung WestfalenHolthauser Talstrae 258256 EnnepetalGermany骨科疾病 Orthopedics?髋膝关节置换手术术后 Hip / knee replacementsurgery?脊柱或人体各大关节手术术后 Post operation ofspine and joints?各种运动器官创伤性损伤 Accident withparticipation of the musculoskeletal system?骨质疏松 Osteoporosis?各种肩部问题：例如，肩周炎 complex shoulderproblemes: e.g. impingement syndromeHolthauser Talstrae 2Source: http:/koenigsfeld.deutsche-rentenversicherung-reha-zentren.deKlinik Knigsfeld der DeutschenRentenversicherung Westfalen康复治疗项目 Indications：董月 Dong, Yue Sports scientist and Sports therapist心血管疾病Cardiology伴有或不伴有心肌梗死的冠心病 Coronary heartdisease with or without myocardial infarction心脏手术术后：例如，心脏搭桥及心脏瓣膜移植手术 Post heart surgery: bypass / valvereplacement心肌性疾病 Cardiomyopathy周围血管手术术后：例如，腹主动脉或髂总动脉 Post Vessel surgery: e.g. Aorta abdominalis,Arteria common iliac心律不齐 等 Arrhythmia etc.3. Clinic Koenigsfeld 心脏康复体系Concept of Cardiac rehabilitationin Clinic Koenigsfeld? 治疗团队 Treatment team? 康复体系 Rehabilitation concept康复流程 Treatment process诊断与评估测试 Diagnosis and assessment分组 Grouping运动康复 Sport therapy其他 OthersSource: http:/koenigsfeld.deutsche-rentenversicherung-reha-zentren.deHolthauser Talstrae 258256 EnnepetalGermany董月 Dong, Yue Sports scientist and Sports therapistKlinik Knigsfeld der DeutschenRentenversicherung Westfalen治疗团队 Treatment Team：? 医生 （心血管专科、骨科、康复医学、内科学、全科医学、社会医学、运动医学等）Med. Doctors ( Cardiology, Orthopedics, Rehabilitation medicine,Internal medicine, General medicine, Social medicine, Sport medicine etc.)?护士 Nurses运动康复治疗师 Sport therapists物理治疗师 Physical therapists医学按摩师 Med. massagists营养师 Nutritionist心理治疗师 Psychotherapist业余生活指导老师 Hobby teachers病房医生Residentdoctor检查评估Examine护士Nurse医生：诊断、确立康复方案Doctors:Diagnose,Therapyconcept病人管理中心Patientsmanagement center康复治疗3-4周Therapy:3-4 weeks前台Reception检查评估及出院建议Examineandsuggest入院Admissionto hospital出院DischargefromhospitalKlinik Knigsfeld der DeutschenRentenversicherung WestfalenHolthauser Talstrae 258256 EnnepetalGermany董月 Dong, Yue Sports scientist and Sports therapistKlinik Knigsfeld der DeutschenRentenversicherung Westfalen评估检测 Diagnose and Examines:心电图、负荷心电图、24h-心电图 ECG,ECG stress test, Holter monitor带气体分析的负荷心电图Spiroergometrie睡眠呼吸停止风险筛查 Sleep apnea screening肺功能检查 Test of the lung function呼吸肌功能检查 Test of the respiratory muscles function实验室检查 LabHolthauser Talstrae 258256 EnnepetalGermany24h-血压监控 24h-Blood pressure心动彩超检查 Echocardiography腹部超声 Ultrasound of the abdomen甲状腺超声 Ultrasound of the thyroid周围血管的多普勒彩超检查 Dopplersonography of the vessels董月 Dong, Yue Sports scientist and Sports therapistKlinik Knigsfeld der DeutschenRentenversicherung Westfalen分组 Grouping:FrhmonilisationHockergymnastik: max. HF 25-50 wFit fr Herz: max. HF 75 100 wFit fr Herz OP: max. HF 75 wTrainingsgruppe: max. HF 125wHolthauser Talstrae 258256 EnnepetalGermany董月 Dong, Yue Sports scientist and Sports therapistKlinik Knigsfeld der DeutschenRentenversicherung Westfalen运动康复 - 带心电监控的自行车训练Sport therapy Ergometer training withmonitoring? 首次培训 Education? 训练 Training:17min 1-2/ d每天进行 Everyday? 目标: 提升基础耐力水平和心肺系统功能Goal: Improve the basic endurance andthe function of the cardiovascular systemHolthauser Talstrae 258256 EnnepetalGermany董月 Dong, Yue Sports scientist and Sports therapistKlinik Knigsfeld der DeutschenRentenversicherung Westfalen运动康复 - 小组训练Sport Therapy Group trainingHolthauser Talstrae 258256 EnnepetalGermany? 训练 Training:30/60 min 1/d每天 Everyday? 目标 Goals: 改善身体姿势Improve the posture呼吸训练 Breathing training增加关节活动度 Improve the ROM of the joints提升基础及局部耐力 Improve the basic endurance andlocal endurance提高协调及平衡能力 Improve the coordination andbalance提高社会交往能力及调节心理情绪 Improve the socialcommunication abilities and emotion regulation ability董月 Dong, Yue Sports scientist and Sports therapistKlinik Knigsfeld der DeutschenRentenversicherung Westfalen运动康复 MTTSport therapy - MTT? 制定MTT训练计划 Draw up the MTT training plan? 训练 Training:30 min2-3/周 2-3/week? 目标 Goals : 提高肌肉力量及增加肌肉含量 Improve themuscles strength and increase the muscle mass增加关节活动度 Improve the ROM of the joints提高局部肌肉力量耐力 Improve the localstrength endurance提高协调及平衡能力 Improve the coordinationand balanceHolthauser Talstrae 258256 EnnepetalGermany董月 Dong, Yue Sports scientist and Sports therapistKlinik Knigsfeld der DeutschenRentenversicherung Westfalen运动康复运动康复 - 户外训练户外训练Sport therapy - Terrain training? 训练 Training:30 min 1/d每天 Everyday? 目标 Goals: 提升基础耐力 Improve thebasic endurance提升对外界环境的适应能力Improve the ability to adapt to the externalenvironmentHolthauser Talstrae 258256 EnnepetalGermany董月 Dong, Yue Sports scientist and Sports therapistKlinik Knigsfeld der DeutschenRentenversicherung Westfalen运动康复 - 健步走及Nordic-WalkingSport therapy Walking and Nordic-Walking? 首次培训 Education? 训练 Training:45-60 min1/d每天 Everyday? 目标 Goals: 提升基础耐力 Improve the basicendurance提升对外界环境的适应能力 Improvethe ability to adapt to the external environmentHolthauser Talstrae 258256 EnnepetalGermany董月 Dong, Yue Sports scientist and Sports therapistKlinik Knigsfeld der DeutschenRentenversicherung Westfalen运动康复运动康复 - 水中康复水中康复Sport therapy Aqua training? 训练 Training:30 min1/d每天 Everyday? 目标 Goals: 提升基础耐力 Improve thebasic endurance提高全身协调及平衡能力Improve the coordination and balance ofall body减少心理压力 Reduce thepsycho stressHolthauser Talstrae 258256 EnnepetalGermany董月 Dong, Yue Sports scientist and Sports therapist物理治疗 Physical therapy对手术病人的物理治疗：For the patients with operation:? 手术瘢痕治疗 Treatment for the scar? 减轻疼痛及肿胀 Reduce the pain and swelling? 等 etc.医学按摩 Med. massage? 放松紧张肌肉 Relax the tense muscles? 减轻精神压力 Reduce the psychostressKlinik Knigsfeld der DeutschenRentenversicherung Westfalen对非常虚弱病人进行的身体转移训练：Mobility training for the very weak patients:? 被动的关节活动 Passive mobility treatment ofjoints? 坐、站及走的训练 Sitting, standing andwalking training? 等 etc.Holthauser Talstrae 258256 EnnepetalGermany董月 Dong, Yue Sports scientist and Sports therapist心理辅导：Psychologic education andtherapy: ? 心理状况评估 Assessment ofthe psychologic status? 小组分享训练 Group training? 心理治疗: 抑郁, 恐惧及恐慌等心理问题Psychologic therapy:Depression, fear and dread Klinik Knigsfeld der DeutschenRentenversicherung Westfalen休闲指导：Hobby courses: ? 帮助患者找到健康并适合自己的兴趣爱好 Help thepatients to find a healthand suitable hobbyHolthauser Talstrae 258256 EnnepetalGermany营养学教育及建议Nutrition education and suggest? 营养学治疗教育 Nutritioneducation? Lehrkueche? 营养学建议 Nutrition suggest“Let the Patients to know theright way to eat and to drink”董月 Dong, Yue Sports scientist and Sports therapist4.欧洲心脏康复体系小结Summary of the cardiac rehabilitationprocess in Europe? 团队性合作紧密Good teamwork? 康复治疗以患者回归日常生活及工作为出发点The treatment and therapy focus on theADL and work? 检测评估及治疗干预联系紧密 Systematic combining from examines and treatment? 教学科研与实践联系紧密 Close connection between research, education and practice董月 Dong, Yue Sports scientist and Sports therapist欧洲心脏康复体系小结 Summery? 完善的心脏康复标准 Completed cardiac rehabilitation standard? 跨学科性强：心血管学、康复医学、运动科学、营养学、心理学、社会学Interdisciplinary: cardiology, rehabilitation medicine, sport science, nutrition, psychology,sociology etc.? 干预方式多种多样 Various training methods, combining different treatment approachesLiterature? Shannon M. Dunlay et.al. Participation in Cardiac Rehabilitation, Readmissions andDeath After Acute Myocardial Infarction. Am J Med. 2014 June ; 127(6): 538546.? Ghanbari-Firoozabadi M et.al. A Study of the Effect of Cardiac Rehabilitation on Heart FailurePatientsLife Quality. J Med Life. 2014 Mar 15;7(1):51-4? Bjarnason-Wehrens, B. et.al. Cardiac Rehabilitation in Europe: Results from the European CardiacRehabilitation Inventory Survey. Eur J cardiovasc prve rehabil. 2010 Aug 17 (4): 410-8.? Lindsey Anderson, et.al. Exercise-Based Cardiac Rehabilitation for Coronary Heart DiseaseCochrane Systematic Review and Meta-Analysis. JOURNAL OF T H E AMERICAN COL LE GE OFCARD IOLOGY 2015: 10.044? Sabina Borg. et.al. The role of a behavioural medicine intervention in physiotherapy for the effectsof rehabilitation outcomes in exercise-based cardiac rehabilitation (ECRA) the study protocol of arandomised, controlled trial. Borg et al. BMC Cardiovascular Disorders 2017:17:134? Jessica T Servey. et.al. Cardiac Rehabilitation: Improving Function and Reducing Risk. AmericanFamily Physician 2016 Jun 1: 37-43:Thank you