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Thema,Mastertextformat bearbeiten,Zweite Ebene,Dritte Ebene,Vierte Ebene,Fnfte Ebene,*,BDH-Clinic Hessisch Oldendorf,Prof.Dr.Jens D.Rollnik,Medical Director,Institute for Neurorehabilitation Research(InFo),欢迎,BDH-Clinic Hessisch OldendorfP,Schedule,9:30 Welcome-meeting(Prof.Rollnik),欢迎见面会,9:35Lecture on neurological rehabilitation in Germany,(Prof.Rollnik),讲座,-,神经康复在德国,10:15Tour of the BDH-Clinic Hessisch Oldendorf(Dr.Lenz and co-workers),参观,BDH-Clinic Hessisch Oldendorf,11:30Question time(Dr.Lenz),提问环节,12:00Lunchtime snack,午餐时间,Schedule9:30 Welcome-meeting,BDH-Clinic Hess.Oldendorf,-non-profit organisation,非营利性组织,-Teaching Hospital of Hannover Medical School,汉诺威医学院教学医院,-Institute for Neurorehabilitation Research(InFo),Medical School Hannover,汉诺威医学院神经康复研究所,-KTQ-certified,certified Stroke Unit,优质,-,透明,-,医疗服务合作培训中心，中风单元培训中心,-113 hospital beds(incl.25 ICU-and 39 IMC-beds)and 140 rehabilitation beds,113,张临床床位（包括,ICU 25,张，,IMC 39,张）康复床位,140,张,-400 employees 400,名员工,BDH-Clinic Hess.Oldendorf-non,New ICU,Investment:10.000.000,资产投入：一千万欧元,ICU-beds:25,ICU,床位：,25,New ICUInvestment:10.000.000,New ICU,全新的,ICU,病区,New ICU 全新的ICU病区,New ICU,全新的,ICU,病区,New ICU 全新的ICU病区,Neuroimaging MRI and CT,神经影像设备,核磁及,CT,Neuroimaging MRI and CT 神经影像,The six-phase model of the Federal Rehabilitation,Council(BAR,1994),联邦康复委员会六级模式（联邦康复学会，,1994,）,The six-phase model of the Fed,Six-phase model of the German Federal,Rehabilitation Council,德意志联邦康复委员会六级模式,资方主体,健康保险公司,健康保险公司,健康保险公司,私人保险公司,雇主及私保公司,护理及健康保险公司,联邦康复学会分段,分段特点,急诊入院治疗,早期康复巴塞尔量表得分,六级模式由德国联邦康复委员会确立,对早期康复影响较大的，急性期，,需要密集治疗的，包括辅助呼吸病人,康复分级仍处在需要高度护理及医疗处置期的,康复分级处于大部分获得深度日常独立活动能力，剩余康复以后续治疗为主,医疗专业康复达到,2,级，包括门诊随诊,长期维持性看护，转相关专科,Six-phase model of the German,X,X,Phase B(Early Rehabilitation),B,级 早期康复,-admission to neurological and neurosurgical early rehabilitation immediately after acute-care hospital stay,神内,/,外科早期入院，急诊处理后立即进入康复,-patients suffer from disorders of consciousness,意识障碍病人,-patients need mechanical ventilation and monitoring on ICU or IMC wards,ICU,或,IMC,病房需要机械通气及监护的病人,-challenge:multiresistant germs,挑战：多重耐药性细菌,Phase B(Early Rehabilitation),DRG-System:OPS 8-552,诊断相关分类系统,DRG-System:OPS 8-552 诊断相关分类,Phase B Admission diagnoses B,级 入院诊断,(Rollnik&Janosch,2010),早期康复病例的诊断相关分类，降序或频率,诊断相关分类,比例,男,/,女,平均年龄,平均住院时间,脑缺血,颅脑外伤,脑出血,蛛网膜下腔出血,缺氧性损害,肿瘤形成,感染,传染性疾病,脊髓损伤，截瘫,格林巴利综合症,其他诊断,总计,Phase B Admission diagnoses,Phase B Outcome,B,级 结果,(Rollnik und Janosch,2010),排除类别，降序或频率,排除类别,转后续康复,转院,转其他护理机构,常规转出,死亡,自动转出,转临终关怀,Phase B Outcome B级 结果(R,(Rollnik,2013),Phase B Outcome,B,级 结果,年龄,巴塞尔,量表改变,(Rollnik,2013)Phase B Outco,Phase B length of stay(LOS),(Rollnik und Janosch,2010),病例百分比,住院时间（月）,住院时间（病程）,Phase B length of stay(LOS),Phase B LOS,病程,(Rollnik und Janosch,2010),平均住院时间（天）,早期康复巴塞尔量表得分区间,Phase B LOS 病程(Rollnik und,Phase B Weaning from mechanical ventilation,取下呼吸机,(Rollnik et al.,2010),-Mortality:6.1%,死亡,-Weaning was successful after a mean of 12.9(12.0)days of neurological early rehabilitation,早期康复中，平均,12.912.0,天可以成功取下呼吸机,Phase B Weaning from mechani,Phase B Mechanical ventilation,机械通气,(Rollnik et al.,2010),Outcome,结果,n,%,1.Succesful weaning,成功取下呼吸机,56,68.3,2.Discharge to another hospital,still on ventilation,转院，仍使用呼吸辅助,16,19.5,3.Discharge to a long-term care facility,still on ventilation,转入长期看护，仍呼吸辅助,5,6.1,4.Death,死亡,5,6.1,Sum,82,100,Phase B Mechanical ventilati,-Results from a multicenter study(Oehmichen et al.,2012),多中心研究结果,-n=1486,69.8%weaned successfully 1486,例，,69.8%,成功取下呼吸机,Phase B Mechanical ventilation,机械通气,-Results from a multicenter st,Phase B Multiresistant germs,多重耐药细菌,Phase B Multiresistant germs,-high prevalence of ESBL-producing gram-negative bacteria:11.8%,大肠埃希菌,高发病率，革兰氏阴性细菌,11.8%,-MRSA prevalence:11.4%,抗药性金黄色葡萄球菌发病率,11.4%,SUM:One out of four early rehabilitation patients is colonized with multiresistant germs on admission!,小结：四分之一的早期康复病人入院时遭遇多重耐药菌感染,Phase B Multiresistant germs,多重耐药细菌,-high prevalence of ESBL-produ,Phase B MRSA and outcome,抗药性金黄色葡萄球菌 及结果,Phase B MRSA and outcome 抗药,MRSA positive,MRSA negative,p-value*,Age years,65.8(15.1),67.0(15.8),n.s.,Length of stay(LOS)referring hospital days,32.8(42.9),34.4(260.5),n.s.,LOS neurological early rehabilitation days,63.7(37.1),25.8(24.5),0.001,LOS entire neurological rehabilitation days,75.0(42.5),46.8(47.1),0.001,Number of co-diagnoses n,20.5(5.1),13.3(5.5),0.001,Barthel Index(BI)on admission 0 to 100,13.6(9.9),25.6(24.1),0.001,Barthel index on discharge 0 to 100,25.5(21.2),47.4(31.0),0.001,Early Rehabilitation Index(ERI)on admission -325 to 0,-80.1(59.5),-47.9(47.6),0.001,ERI on discharge-325 to 0,-47.3(51.4),-26.0(35.4),0.001,Coma Remission Scale(CRS)0 to 24,昏迷量表得分,11.0(6.2),14.0(6.8),n.s.,Glasgow Coma Scale(GCS)3 to 15,格拉斯哥昏迷量表,9.5(3.2),12.0(3.3),0.001,Early functional abilities(EFA)vegetative 4 to 20,8.6(3.0),12.4(7.0),0.001,EFA faciooral 4 to 20,9.2(5.0),15.4(5.3),0.001,EFA sensorymotor 7 to 35,14.4(6.9),22.8(8.2),0.001,EFA cognitive 5 to 25,13.3(6.4),18.7(5.2),0.001,Total main therapies min/day,131.6(16.6),140.2(18.7),0.001,(Rollnik,2014),
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