针药结合治疗缺血性中风病的系统研究课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,1,针药结合治疗缺血性中风病的系统研究,The s,ystem research of Acupuncture and herbs to treat ischemic stroke,石学敏,SHI Xuemin,天津中医药大学第一附属医院,The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,1针药结合治疗缺血性中风病的系统研究 The system,1,中风病的治疗难点,The problem of treating apoplexy,如何减轻血管神经单元的损害、促进重构神经组织、重建脑组织循环是神经功能恢复的根本。中风病治疗的难点及突破点，聚焦在神经与血管的新生。,How to reduce the damage of neurovascular unit, promote reconstruction nerve tissue and reconstruction brain circulation is neurological recovery. The treatment of stroke, focus on problems and breakthrough of new blood vessels and nerves.,中风病的治疗难点The problem of treati,2,目前，治疗中风病最有效的方法是卒中单元，但是现代医学意义上的卒中单元需要较高的软硬件配备，无法于现有医疗资源基础上推广应用。所以，如何利用有效的中医手段构建符合中国特色的“中风单元”是今后重要的研究方向。,Currently, the treatment of stroke are the most effective ways to stroke, but modern medical unit on the significance of the software and hardware unit needs higher stroke with existing medical resources, not in based on application. Therefore, how to effectively use the traditional method to set up Chinese characteristic stroke unit is an important research direction in future.,目前，治疗中风病最有效的方法是卒中单元，但是现代医学意义上的,3,针刺和有效中药制剂是我国治疗中风病的重要手段，也是构建“中风单元”的主要因素。由“醒脑开窍针刺法”、“丹芪偏瘫胶囊”相结合为关键内核的“石氏中风单元”，在临床上取得了显著疗效，并被国家列为重大科技推广项目。,Acupuncture and herbs are effective treatment in China and an important factor of stroke unit. “Shis stroke unit “which be made of “XNKQ”acupuncture therapy and Danqi hemiplegia capsule, get great clinical effect, and has achieved remarkable listed by the state science and technology major promotion projects,针刺和有效中药制剂是我国治疗中风病的重要手段，也是构建“中风,4,“醒脑开窍”针法,简介,“醒脑开窍”针法,5,在选穴上以阴经和督脉穴为主，并强调针刺手法量学规范，有别于传统的取穴和针刺方法。,The points on Yin meridians and Du meridian are mainly selected and standard quantitative manipulations are applied emphatically, which are quite different from traditional point selection and acupuncture manipulations in treatment of apoplexy.,在选穴上以阴经和督脉穴为主，并强调针刺手法量学规范，,6,治 疗 方 法,Treatment,治 疗 方 法 Treatment,7,1.处 方,主穴：,内关(手厥阴心包经),人中(督脉),三阴交(足太阴脾经),1. Point Prescription,Mainpoints:,Neiguan(PC 6,the Pericardium Meridian of Hand-Juejin),Renzhong(DU 26,the DU Meridian),Sanjinjiao(SP 6,the Spleen Meridian of Foot-Taiyin),1.处 方,8,辅穴：,极泉(手少阴心经),委中(足太阳膀胱经),尺泽(手太阴肺经),Supplementary points：,Jiquan(HT 1,the Heart Meridian of Hand-shaoyin),Weizhong(BL 40,the Bladder Meridian of Foot- Taiyang),Chize(LU 5, the Lung Meridian of Hand-Taiyin,),辅穴：极泉(手少阴心经),9,配穴：,吞咽障碍加风池、翳风、完骨；手指握固加合谷；语言不利加上廉泉，金津、玉液放血；足内翻加丘墟透照海。,Point Modification：For difficulty of swallowing, Fengchi(GB 20),Yifeng(SJ 17) and Wangu(GB 12) are added. For failing to extend fingers with stiffness, Hegu (LI 4) is added. For slurred speech, Shanglianquan(EX-HN) is added, and Jinjin(EX-HN 12) and Yuye(EX-HN13) are used with blood-letting method. For strephenopodia, penetrating method from Qiuxu(GB 40) to Zhaohai(KI 6) is used.,配穴：吞咽障碍加风池、翳风、完骨；手指握固加合谷；语言不利加,10,2.操作方法,Manipulation,内 关,Neiguan,(PC 6),直刺0.5,1寸，采用捻转提插结,合泻法，施手法1分钟；,First puncture bilateral Neiguan(PC 6) perpendicularly for 0.5-1 cun, using combinative reducing method of lifting-thrusting and twirling-rotating the needle for 1 minute;,2.操作方法 Manipulation内 关 直刺0.5,11,补法,（左侧顺时针；右侧逆时针）,泻法,（左侧逆时针；右侧顺时针）,右,R,左,L,左,L,右,R,补法（左侧顺时针；右侧逆时针）泻法（左侧逆时针；右侧顺时针）,12,人 中,Renzhong,(DU 26),Secondly puncture Renzhong(DU 26) obliquely upwards to the nasal septum for 0.3-0.5 cun with heavy bird-pecking method until the patients eyeballs are moistened or tears flow down.,向鼻中隔方向斜刺0.3,0.5寸，用重雀啄法，至眼球湿润或流泪为度；,人 中Secondly puncture Renzhon,13,三 阴 交,Sanyinjiao,(SP 6),沿胫骨内侧缘与皮肤呈45度角斜刺，进针1,1.5，用提插补法，使患侧下肢抽动3次为度,Thirdly puncture Sanyinjiao(SP 6) obliquely for 1-1.5 cun, at the angle of 45 degrees with the skin surface along the posterior border of the medial aspect of the tibia, with reinforcing method of lifting and thrusting the needle to make the affected low limb have tic for three times.,三 阴 交沿胫骨内侧缘与皮肤呈45度角斜刺，进针11.5，,14,极 泉,Jiquan,(HT 1),原穴沿经下移1寸，避开腋毛，直刺1,1.5寸，,用提插泻法，以患侧上肢抽动3次为度。,Select Jiquan(HT 1) point at 1 cun below the original location along the heart meridian to keep away from the armpit hair,puncture perpendicularly for 1-1.5 cun with reducing method of lifting and thrusting the needle to make the affected upper limb have tic for three times.,极 泉原穴沿经下移1寸，避开腋毛，直刺11.5寸，Se,15,尺 泽,Chize,(LU 5),屈肘成120度角，直刺1寸，用提插泻法，,使患者前臂、手指抽动3次为度。,Perpendicularly puncture Chize(LU 5) for 1 cun depth while the forearm bends to form an angle of 120 degrees with reducing manipulation of lifting and thrusting the needle until the affected arm and fingers have tic for three times.,尺 泽屈肘成120度角，直刺1寸，用提插泻法，Perpen,16,委 中,Weizhong,(BL 40),仰卧直腿抬高取穴，直刺0.5,1寸，施提插泻法，使患侧下肢抽动3次为度。,Select Weizhong(BL 40) point with the supine position and the lower limb lifted, puncture perpendicularly for 0.5-1 cun, with reducing method of lifting and thrusting to make the lower limb have tic for 3 times.,委 中仰卧直腿抬高取穴，直刺0.51寸，施提插泻法，使患,17,风池、完骨、翳风,Fengchi(GB 20),Wangu(GB 12),Yifeng(SJ 17),针向结喉，进针2,2.5寸采用小幅度高频率捻转补法，,每穴施手法1分钟；,Puncture Fengchi(GB 20),Wangu(GB 12) and Yifeng(SJ 17) in the direction of the laryngeal protuberance for 2-2.5 cun, with reinforcing manipulation of twirling and rotating the needle in high frequency and small amplitude for 1 minute to each acupoint.,风池、完骨、翳风针向结喉，进针22.5寸采用小幅度高频率捻,18,合谷针向三间穴,Hegu(LI 4),to,Sanjian(LI 3),进针1,1.5寸，采用提插泻法，使患者第二手,指抽动或五指自然伸展为度；,Puncture Hegu(LI 4) 1-1.5 cun in depth with the needle tip toward Sanjian(LI 3), with reducing method of lifting and thrusting to make the patients second finger or five fingers extended freely.,合谷针向三间穴进针11.5寸，采用提插泻法，使患者第二手P,19,上廉泉,Shanglianquan,(EX-HN),针向舌根1.5,2寸，用提插泻法；,Puncture Shanglianquan(EX-HN) for 1.5-2 cun, with the needle tip towards the root of the tongue and reducing method of lifting and thrusting the needle.,上廉泉针向舌根1.52寸，用提插泻法；Puncture S,20,金津、玉液,Jinjin(EX-HN12),Yuye(EX-HN13),用三棱针点刺放血，出血1,2毫升；,Prick Jinjin(EX-HN12) and Yuye(EX-HN13) with the three-edged needle to cause bleeding for 1-2ml.,金津、玉液 用三棱针点刺放血，出血12毫升；Prick,21,丘墟透向照海穴,Qiuxu(GB 40),to,Zhaohai(KI 6),约1.5,2寸，局部酸胀为度。,Puncture Qiuxu (GB 40) 1.5-2 cun in depth with the needle tip toward Zhaohai(KI 6),until soreness and distension occurred locally.,丘墟透向照海穴约1.52寸，局部酸胀为度。Puncture,22,中风病其他并发症的治疗,Treatment of Complications,中风病其他并发症的治疗,23,便秘：,针外水道、外归来、丰隆。,Constipation: Puncture Waishuidao(EX-CA), Waiguilai(EX-CA) and Fenglong(ST 40),便秘：针外水道、外归来、丰隆。 Constipation:,24,(2) 呼衰：,针刺双侧气舍,Respiratory Failure:Puncture bilateral Qishe(ST 11),(2) 呼衰：针刺双侧气舍Respiratory Failu,25,(3) 尿失禁、尿潴留：,针中极、曲骨、,关元、局部施灸、按摩或热敷,Incontinence of Urine, Retention of Urine: Puncture Zhongji(RN 3),Qugu(RN 4), Sanyinjiao (SP 6), Yinlingquan(SP 9). Moxibustion is applied on the local area, while massage and hot compress are applicable too.,(3) 尿失禁、尿潴留：针中极、曲骨、 Incontinen,26,(,4) 共济失调：,针风府、哑门、颈椎夹脊穴。,Ataxia:Puncture Fengfu(DU 16),Yamen(DU 15) and cervical Jiaji points(EX-B2).,(4) 共济失调：针风府、哑门、颈椎夹脊穴。Ataxia:P,27,颈 椎 夹 脊 穴,Cervical Jiaji Points(EX-B2),颈 椎 夹 脊 穴Cervical Jiaji Points,28,(5) 复视,：针天柱、晴明、球后,Double Vision:Puncture Fengchi(GB 20), Tianzhu(BL 10), Jingming(BL 1) and Qiuhou(EX-HN7),(5) 复视：针天柱、晴明、球后Double Vision:,29,(6) 癫痫：,针大陵、鸠尾,Epilepsy: Puncture Daling(PC 7), Jiuwei(RN 15),(6) 癫痫： 针大陵、鸠尾Epilepsy: Punc,30,(7) 肩周炎：,针肩髃、肩髎、肩内陵、,肩贞、肩中俞、肩外俞，痛点刺络拔罐,Periarthritis of Shoulder: Puncture Jianneiling(EX-UE), Jianliao(SJ 14), Jianzhen(SI 9), Jianzhongshu(SI 15), Jianwaishu (SI 14).Apply blood letting and cupping method to the local pain point.,(7) 肩周炎：针肩髃、肩髎、肩内陵、Periarthrit,31,(8) 血管性痴呆：,针百会、四神聪、,四白、太冲,Vascular Dementia:Puncture Baihui (DU 20), Sishencong(EX-HN1), Sibai(ST 2) and Taichong(LR 3).,(8) 血管性痴呆：针百会、四神聪、Vascular Dem,32,太 冲,Taichong(LR 3),太 冲Taichong(LR 3),33,(9) 睡眠倒错：,针上星、神门,Paradoxic Sleep: Puncture Shangxing (DU 23), Shenmen(HT 7).,(9) 睡眠倒错：针上星、神门Paradoxic Sleep,34,“醒脑开窍”针法,最新研究进展,“醒脑开窍”针法,35,在30余年的临床实践中，逐步形成了针刺治疗缺血性中风病及其并发症的诊疗规范和评价体系。近年来更是引入先进的研究方法和手段，对其疗效进行了综合系统的评价，获得了高级别的临床证据，并结合现代科学技术，系统地阐明了针刺治疗缺血性中风病的科学内涵及疗效机理。,In more than 30 years of clinical practice, gradually formed the acupuncture treatment of ischemic apoplexy and the treatment of complication norms and evaluation system. In recent years is introduced advanced research methods and its effect on the comprehensive evaluation system, advanced clinical evidence, and combined with the modern science and technology, systematically expounds the acupuncture treatment of ischemic stroke mechanism of scientific connotation and curative effect.,在30余年的临床实践中，逐步形成了针刺治疗缺血性中风病及其并,36,37,针刺可明显改善各期中风患者神经功能缺损程度,Acupuncture can obviously improve the neurologic deficits in stroke patients,NIHSS,CSS,SSS,临床研究严格按照循证医学原则进行RCT试验证明：,Clinical studies in strict accordance with the principle of evidence-based medicine RCT experiments prove：,37针刺可明显改善各期中风患者神经功能缺损程度Acupun,37,BI,BI改变量,针刺可改善各期中风患者日常生活能力，急性期的改善尤其明显,Acupuncture may improve the stroke patients in daily life, especially in the acute phase of improvement,BIBI改变量针刺可改善各期中风患者日常生活能力，急性期的改,38,39,神经功能缺损（SSS）,日常生活能力（SS-QOL）,6个月随访证实，针刺可改善各期中风患者神经功能缺损及日常生活能力的作用,6 months follow-up, acupuncture can improve the stroke patients neurologic deficits and daily life,39神经功能缺损（SSS）日常生活能力（SS-QOL）6个月,39,急性期,恢复期,后遗症期,牛津残障评分（OHS）,针刺可降低各期中风患者残障程度,Acupuncture may reduce the degree of disability in stroke patients,33%,40%,40%,66%,76%,63%,急性期恢复期后遗症期牛津残障评分（OHS）针刺可降低各期中风,40,针刺可降低缺血性中风病患者的复发率和死亡率,Acupuncture may reduce the recurrence of patients with ischemic stroke mortality,终点指标：,End index：,15.9%,28.8%,6.7%,3.3%,4.3%,2.2%,急性期,恢复期,后遗症期,1.1%,0.86%,0,1.1%,1.7%,2.2%,复 发 率,死 亡 率,针刺可降低缺血性中风病患者的复发率和死亡率Acupunct,41,不良反应：未出现严重不良反应,Adverse reaction: did not appear serious adverse reactions,极少数出现轻微不良反应，主要有皮下出血，血肿，,疼痛。,A mild adverse reactions, subcutaneous bleeding, hematoma, pain,安全性评价：,Safety evaluation,不良反应：未出现严重不良反应安全性评价：,42,本研究获得了天津市科技进步一等奖,The research of the tianjin science,and technology progress prize,本研究获得了天津市科技进步一等奖,43,机理研究紧扣中风病的治疗难点及突破点，聚焦在神经与血管的再生。研究针刺手段促进损伤后脑循环重建及神经细胞再生的作用，从形态学、生物化学、中枢神经机制、分子生物学等方面开展了二十余项基础实验。,Defines the mechanism research and treatment of apoplexy, focusing on nerve and breakthrough of blood vessels. Research methods to promote the head injury acupuncture and nerve cells regeneration cycle, from the morphology, biochemistry, molecular biology, central nervous mechanism for more than twenty experiments.,针刺治疗缺血性中风病的机理研究,The,mechanism research of,Acupuncture treatment ischemic stroke,机理研究紧扣中风病的治疗难点及突破点，聚焦在神经与血管的再生,44,45,形态学研究，证明针刺可促进侧枝循环建立,Morphology research that acupuncture can promote collateral circulation,梗塞半球,脑表面缺血区,Cerebral infarction hemisphere surface ischemia,阻断大脑中动脉后，大脑表面缺血区所见：,Block after middle cerebral artery surface area, the brain ischemia,缺血后,自身代偿情况,After compensatory. Their ischemia,针刺干预情况,Acupuncture intervention,醒脑开窍针刺法对缺血区脑组织的改善,“XNKQ” can improve the brain ischemia area,45形态学研究，证明针刺可促进侧枝循环建立梗塞半球阻断大脑中,45,针刺前：,神经细胞溶解、破坏,针刺3h后：,线粒体轻度肿胀,针刺,6h后：,线粒体肿胀减轻,针刺12h后：,线粒体完整，,出现微管微丝,针刺24h后：,神经细胞基本正常,针刺保护细胞形态、减轻神经元损伤、12h内促进微管微丝等细胞的“骨架”的再生与修复,Acupuncture protect cells form, reduce damage, promote neurons 12h microtubules microfilament cells skeleton renewable and repair,醒脑开窍针刺法对病变神经元结构的修复,Acupuncture to repair pathological neuron structure,针刺前：针刺3h后：针刺 6h后：针刺12h后：针刺24h后,46,47,醒脑开窍针法对脑梗死患者脑葡萄糖代谢的影响,Acupuncture in patients with cerebral infarction of the brain glucose metabolism,醒脑开窍针刺法可以：,促进病灶周围功能重组,Promote surrounding function restructuring,激活运动功能区域,Activation function area,促使正常脑区的代偿,To decompensation the normal brain areas,改善与记忆、认知、语言功能和情绪等相关区域的代谢。,Improve memory, cognition, emotion and language functions related areas of metabolism,47醒脑开窍针法对脑梗死患者脑葡萄糖代谢的影响醒脑开窍针刺法,47,丹芪偏瘫胶囊,治疗中风病的最新成果,丹芪偏瘫胶囊,48,治疗中风病恢复期的国家新药，纯中药制剂。,Treatment of national drug stroke recovery, traditional Chinese medicine,preparation,具有补气活血、豁痰熄风的功效,Fill with blood, and the efficacy of wind tax-exempt phlegm off,2001年获国家新药证书（国药准字z20010105）,2001 was approved by the state drug certificate (z20010105),2002年获得国家GMP认证并投产上市,2002 obtains the national GMP authentication and production,治疗中风病恢复期的国家新药，纯中药制剂。,49,丹芪偏瘫胶囊的药物组成及功效,The capsule and partial drug efficacy,处方：黄芪、丹参、川芎、水蛭、人工牛黄、全蝎、石菖蒲等。,Prescription: astragalus, danshen, artificial bezoar and leeches, chuanxiong rhizoma, whole xie, etc.,功能：益气活血，豁痰熄风。,Function: qi, sputum extinguish wind. Tax-exempt,丹芪偏瘫胶囊的药物组成及功效,50,药物作用及特点,Drug and characteristics,1. 减少脑梗死面积：药理实验表明，该药可以有效降低脑梗塞组织百分比，改善实验动物行为障碍。,1.Reduce cerebral infarction area: the pharmacological experiments show that can effectively reduce cerebral infarction, the improvement of experimental animals percentage organization behavior.,2. 保护及修复受损脑细胞：药理实验表明，该药增加脑供血，有效恢复受损脑细胞功能。,2. protection and repair damaged brain cells: that the drug increases pharmacological experiments, recover damaged brain cells cerebral blood.,药物作用及特点Drug and characteristi,51,3. 有效恢复肢体功能：临床实验结果显示，该药对改善肢体功能效果明显。,3 .effectively restore limb function: clinical experiment results show that the drug to improve functional effect is obvious.,4. 降低血粘度：药理实验及临床实验表明，该药改善血液流变学指标，降低血粘度。,4 reduced blood viscosity, pharmacological experimental and clinical experiments showed that the drug improving hemorheology indices, reduce blood viscosity.,3. 有效恢复肢体功能：临床实验结果显示，该药对改善肢体功,52,5. 重病重剂，起效迅速：脑卒中病情较重，不用重剂难以起效，故每日每次用量较大，经过临床观察，该药对恢复早期脑卒中患者，起效迅速。,5 Illness weight, agent quickly: stroke disease is heavier, not heavy agent to effect, so every large dosage, daily clinical observation, the drug for early stroke patients, quickly.,6. 全成分提取生产工艺先进：采用韩国技术制造的动态提取设备，充分提取有效成份。,6 .All components extraction advanced production technology, USES the south Korean technology of manufacturing equipment, fully dynamic extracting effective components extraction.,5. 重病重剂，起效迅速：脑卒中病情较重，不用重剂难,53,丹芪偏瘫胶囊，已获得国际认可,Hemiplegia capsule, has gained international recognition,题目：,Dianqi Piantang Jiaonang(DJ),a traditional Chinese Medicine in,post-stroke recovery,中药丹芪偏瘫胶囊在中风后的康复作用,杂志：,Stroke,卒中（美国） 影响因子：6.499,作者：,Christopher Chen, MD,;(新加坡国立大学药理学博士),结论：,经过对605例患者进行随机对照研究证明，与对照中成药相比丹芪偏,瘫胶囊可显著改善患者神经功能缺损，提高生活质量，且具有较好的,安全性。,After patients required for 605 randomized study compared with controls, proprietary hemiplegia capsules can significantly improve patient neurologic deficits, and improve the quality of life, and has good safety.,丹芪偏瘫胶囊，已获得国际认可Hemiplegia caps,54,题目：,Neuroprotective and neuroproliferative activities of NeuroAid (MLC601, MLC901), a Chinese medicine, in vitro and in vivo,中药丹芪偏瘫胶囊(MLC601, MLC901)在体内、体外的神经保护及再生作用,杂志：,Neuropharmacology,神经药理学杂志（英国） 影响因子：3.383,作者：,C. Heurteaux,（法国瓦勒堡尼斯大学）,摘要：,丹芪偏瘫胶囊可以防止神经元死亡，促进神经再生，促进细胞增殖、神经突起生长，促进密集性的轴突、树突网络的发展。中风超早期应用本品,可以降低死亡率，对于中风不同时期的治疗有着重要的意义。,Hemiplegia,capsules can prevent neurons, promote nerve regeneration death, promote cell proliferation, nerve growth and promote protuberant coarctation of axons, dendritic network development. Use this product super early stroke reduces mortality, different period of treatment for stroke has important significance,.,题目：Neuroprotective and neuropr,55,题目：,Danqi Piantan Jiaonang Does Not Modify Hemostasis, Hematology,and,Biochemistry in Normal subjects and Stroke Patients,丹芪偏瘫胶囊对正常受试者和中风病人凝血、生化指标的影响,杂志：,cerebrovascular diseases,脑血管病杂志 瑞士 影响因子：3.041,作者：,Robert Gan,新加坡国立脑神经医学院,结论：,丹芪偏瘫胶囊不会明显改变正常受试者和中风病人的血液、止血和生化参数。,具有很好的安全性。,Hemiplegia capsules wont change significantly normal subjects and stroke patients, bleeding and biochemical parameters of blood. Good safety,题目：Danqi Piantan Jiaonang Does,56,题目：,A double-blind, placebo-controlled, randomized phase II pilot study to,investigate the potential efficacy of the traditional chinese medicine Neuroaid,(MLC 601) in enhancing recovery after stroke (TIERS).,丹芪偏瘫胶囊治疗中风后恢复期的二期临床研究：随机、对照、双盲试验,杂志：,cerebrovascular diseases,脑血管病杂志 瑞士 影响因子：,3.041,作者：,Keng He Kong,新加坡，宏茂桥医院,结论：,丹芪偏瘫胶囊可以显著改善中风患者神经功能和生活能力，而且对,后循环梗,死和严重的中风患者也有良好的治疗效应,Hemiplegia capsules can significantly improve neural function and stroke patients, but also for life cycle and serious infarction after stroke patients also has a good effect,题目：A double-blind, placebo-con,57,58,国家科技部、中医药管理局科技成果推广项目,National science and technology department, administration of traditional,Chinese medicine science promotion project,已推广到全国和世界60多个国家和地区，形成了辐射全球的技术平台,Has extended to the world in more than 60 countries and regions of the world, formed the radiation technology platform,以“醒脑开窍”针法、丹芪偏瘫胶囊为组合的针药结合治疗缺血性中风病取得了巨大的成果,“XNKQ”acupuncture therapy and Danqi hemiplegia capsule,treatment of ischemic apoplexy made great achievements,58国家科技部、中医药管理局科技成果推广项目以“醒脑开窍”针,58,59,收治数百名外籍中风患者，取得了显著的临床疗效，形成一批标志性的成果，被国外媒体广为宣传。,患脑干（桥脑）出血4年,经针刺治疗后痊愈，正常工作,将自身治疗经过写成书籍,走出黑暗,（ Out of the DARKNESS ）,在美国出版引起轰动。,患者：Ruth,职业：护士,国籍：美国,59 收治数百名外籍中风患者，取得了显著的临床疗效，形,59,60,一个关乎希望、勇气和整个家庭奔向中风康复的非凡旅程,摘自“9000 Needls”网站,患者：Deven,职业：健美教练,国籍：美国,患大面积脑梗死2年，神经功能缺损严重，,经针刺治疗后显著改善,治疗过程被好莱坞拍成80分钟科技商业纪录片,治疗中应用9000根银针，命名为9000银针,在美巡回公演，引起广泛关注,建立了专门的同名网站。,“9000 Needls” 网址：, 谢,谢 谢,61,护理查房,护理查房,62,目 录,查房的基本概念,1,6,查房的内容和方法,3,查房的目的和意义,4,查房的分类,查房的注意事项,5,查房的指导思想,2,目 录查房的基本概念16查房的内容和方法3查房的目的和意,63,基本概念,护理查房,是护理工作中，护理专家、上级护师对下级护士的护理方案进行检查、修正、指导的过程，是促进护理程序在临床运用的有效手段，是评价护理程序最基本最主要的方法。,基本概念护理查房是护理工作中，护理专家、上级护师对下级护士的,64,“以病人为中心，以护理程序为框架”的护理查房,指导思想,“以问题为中心”的护理查房,“以病人为中心，以护理程序为框架”的护理查房 指导思想“以问,65,护理查房目的,了解病人的病情、思想、生活情况，制定合理的护理方案，观察护理效果；,检查护理工作完成情况和质量，发现问题并及时调整，是提高护理质量的重要环节；,可以结合临床护理实践进行教学工作，是培养各级护理人员的重要手段。,护理查房目的了解病人的病情、思想、生活情况，制定合理的护理方,66,护理查房的意义,对病人来说，能得到更全面的优质服务。,对护士来说，能激发其学习多学科知识的兴 趣，提高运用多学科知识分析问题、解决问题 的能力及提高临床护理质量。,采取多种护理查房形式，能促进护理科研的开展。,对护理管理者来说，能及时发现危重病人的护理情况和了解护士解决问题的能力。,护理查房的意义对病人来说，能得到更全面的优质服务。,67,1、,对具体病例按护理程序的内容进行查房,，如收集病人的健康资料、评价护理计划和健康计划的制定及其实施效果等。,2、,重点查房内容,：如临床罕见的病例，特殊危重病例，复杂大手术，新业务新技术开展等。,3、,检查,护理程序的实施情况，危重病人护理，健康教育落实情况等。,护理查房的内容,1、对具体病例按护理程序的内容进行查房，如收集病人的健康资料,68,护理查房方法,整体护理查房,主题性护理行政查房,案例启发式护理教学查房,对比性护理查房,评价性护理查房,个案护理查房,以学生主体的护理教学查房,护理查房方法 案例启发式护理教学查房,69,查房的分类,组织形,式分类,性质和作用分类,内容分类,查房的分类组织形,70,按性质和,作用分类,护理教学查房,护理业务查房,护理行政查房,按性质和 护理教学查房 护理业务,71,护理行政查房是指各级护理管理者对护理工作质量的检查，内容包括：各项规章制度的贯彻执行；医嘱的执行；护理文件的书写；急救药品、设备的管理与使用；消毒隔离及防止院内交叉感染措施；病房管理；基础护理以及操作规程的执行情况等。其目的是检查各级护理人员岗位责任制落实情况，加强质量控制。,护理行政查房,护理行政查房是指各级护理管理者对护理工作质量的,72,护士长每天评价性查房,护士长总值班查房,护士长每周一次管理查房,护理部每月一次管理查房,护理行政查房,护士长每天评价性查房护理行政查房,73,护理业务查房,是在主查人的引导下，以,病人为中心,，以,护理程序,为框架，以,解决问题,为目的，突出对重点内容的深入讨论，并制定护理查房方案。,采用灵活方式，实行互动查房。要多样化，有提问、回答和补充，大家共同参与。,包括分析讨论危重病人、典型、疑难、死亡病例的护理；检查基础护理、专科护理落实情况；结合病例学习国外护理新动态、新业务、新技术等。,护理业务查房,74,制定查房计划,查房前资料的收集,查房人员组成,查房时限,物品准备,查房人员站位,查房前准备,护理业务查房,制定查房计划 查房前资料的收集 查房人员组成查房时限 物品准,75,查房前资料的收集,病种资料的收集：查房前一周(2-3天），护士长与责任护士共同商讨，确定查房病种。,查房要点的确定与收集：确定查房病种后，护士长对所查患者涉及的护理内容进行整理，根据临床工作中的薄弱环节，确定出某个方面的讨论议题。,查房前资料的收集 病种资料的收集：查房前一周(2-3天），护,76,制定查房计划,制定出详细的查房计划，查房前一周（2-3天），根据确定的查房要点，护士长选出几个方面的讨论议题，分配给科室护士，每人一题，大家分别查阅资料，收集信息。,制定查房计划,77,物品准备,查房车放有查房需用物品，如病历、听诊器、血压计、压舌板、洗手液、手电筒或专科专用物品等，至于床尾。,物品准备查房车放有查房需用物品，如病历、听诊器、血压计、压舌,78,查房人员组成,有护士长、护士组长、责任护士及相关护士、进修生、实习护生等人员组成。护理部查房要有护理部人员、科护士长或有护理部安排相关科室护士长以及业务骨干参加。如果进行护理查房考核，要有考核小组成员参加。,查房人员组成 有护士长、护士组长、责任护士及相关护士、进修生,79,查房人员站位,以病人卧位分，,右侧,：主查人、护士长或护理部人员；,左侧,：责任护士、护士组长、高级职称护师、主管护师、护师及护士、进修护士、实习护士；,床尾,：配合护士。,查房人员站位以病人卧位分，右侧：主查人、护士长或护理部人员；,80,查房时限,根据查房的性质和内容而定，每位病人的查房时间一般在20-40分钟，不超过60分钟。教学指导性查房可根据情况适当延长。,查房时限根据查房的性质和内容而定，每位病人的查房时间一般在2,81,查房程序,到病人床旁，按规定排列，主查人说明查房的形式、目的及需要重点讨论、解决的问题。（主查人为护士长、护士组长或高级中级职称的护理业务骨干）,责任护士报告病人情况。重点说明病人现存、潜在的护理诊断（问题）、诊断依据、护理措施、护理效果以及需要讨论解决的问题。,主查人评估病人。主查人根据责任护士的报告和病历记录情况，询问病人重要病史并进行护理体检。,查房程序到病人床旁，按规定排列，主查人说明查房的形式、目的及,82,病人的病情、精神状态,责任护士基础护理是否到位（包括,病人床铺卫生和个人卫生）,病人对健康指导掌握程度,病人还有哪些护理需求和护理问题