中西互動(dòng)疼痛康復(fù)喬晉琳—建設(shè)中國特色疼痛康復(fù)醫(yī)療體系的探索與思考

1、建設(shè)中國特色疼痛康復(fù)醫(yī)療體系的探索與思考Exploration and Reflection on the Establishment of Pain Rehabilitation Medical System with China Characteristics,海軍總醫(yī)院康復(fù)醫(yī)學(xué)科暨疼痛診療中心Dep. of Rehabilitation Medicine and Pain Center,,康復(fù)醫(yī)學(xué)科,喬晉琳 Jinlin

2、Qiao2016年3月27日 27 MAR 2016,目錄 CONTENTS,,,疼痛康復(fù)醫(yī)療的需求與現(xiàn)狀,1,,,疼痛康復(fù)醫(yī)療的學(xué)科架構(gòu),2,,,存在問題,3,,,促進(jìn)中西醫(yī)疼痛康復(fù)的發(fā)展創(chuàng)新,4,,,我們的實(shí)踐與思考,5,,,參與醫(yī)藥衛(wèi)生體制改革的路徑,6,,Discipline Architecture of Pain and Rehabilitation Medical Treatment,Problems,Promote

3、 the Development and Innovation of Pain and Rehabilitation Medical Treatment with Chinese and Western Medicine,Our Practice and Reflection,Path to Participate in the Reform of Medical and Health System,Needs and&#

4、160;Current Situation of Pain and Rehabilitation Medical Treatment,,IMC,一、疼痛康復(fù)醫(yī)療的需求與現(xiàn)狀Ⅰ. Needs and current situation of pain and rehabilitation medical treatment,慢性疼痛類疾病已成為繼心腦血管病、癌癥、代謝性疾病，這些嚴(yán)重影響人類健康的又一類“健康殺手”

5、：是影響工作出勤率、家庭日常生活殘障率、死亡率的又一類公共健康問題！ Chronic pain diseases has been another health killer following cardio-cerebrovascular disease, cancer and metabolic disease that serious impact on human health, and also been

6、a public health problem that affect attendance, daily life disability and mortality.,急性疼痛/Acute Pain（軟組織及關(guān)節(jié)急性損傷疼痛，手術(shù)后疼痛，產(chǎn)科疼痛）Acute injury pain of Soft tissue and joint, postoperative pain, obstetric pain,慢性疼

7、痛/Chronic pain（軟組織及關(guān)節(jié)勞損性，椎間盤源性疼痛、神經(jīng)源性疼痛）Soft tissue and joint strain,discogenic pain,neuropathic pain,頑固性疼痛/Intractable pain（三叉神經(jīng)疼痛，帶狀皰疹后遺神經(jīng)疼痛，椎間盤突出癥）Trigeminal nerve pain,postherpetic neuralgia, lumbar disc herniat

8、ion,1、需求巨大，覆蓋疾病譜廣，學(xué)科交叉趨勢(shì)顯著1.The huge demand, wide coverage, significant interdisciplinary trend,,IMC,一、疼痛康復(fù)醫(yī)療的需求與現(xiàn)狀Ⅰ. Needs and current situation of pain and rehabilitation medical treatment,癌性疼痛 （晚期腫瘤痛，腫瘤

9、轉(zhuǎn)移病）cancer pain advanced cancer pain, tumor metastatic disease特殊疼痛類 （血栓性脈管炎，頑固性心絞痛,特發(fā)性胸腹痛）Special pain thromboangiitis, intractable angina pectoris, idiopathic thoracic

10、 abdominal pain相關(guān)學(xué)科疾?。ㄍ话l(fā)性耳聾，血管痙攣性疾?。㏑elated disciplines disease sudden deafness, vascular spasm非疼痛類疾?。ㄒ钟舭Y，睡眠障礙，心理疾病等）Non pain disease depression, dyssomnia, mental disease上述疾病的疼痛治療與康復(fù)，需結(jié)合臨床專科會(huì)診，共管的方式聯(lián)合診療

11、 The pain treatment and rehabilitation of diseases above-mentioned need combined treatment with clinical specialist consultation and co-management.,2、疼痛康復(fù)醫(yī)療的需求2. Needs of pain and rehabilitation medic

12、al treatment,,,,IMC,一、疼痛康復(fù)醫(yī)療的需求與現(xiàn)狀Ⅰ. Needs and current situation of pain and rehabilitation medical treatment,,,世界衛(wèi)生組織（WHO）將疼痛作為第五大生命體征，于2000年將疼痛定義為一類疾病 2004年國際疼痛學(xué)會(huì)（IASP）確定每年10月中旬的第一周為“世界疼痛日”。 WHO made

13、pain as the the fifth vital sign, and defined pain as a kind of disease at 2000. At 2004, ISAP determined the first week in October of every year as "Global Day Against Pain“.中國也將每年10月第二周定為“中國疼痛周”。 China al

14、so made the 2nd week in October of every year as "China Week Against Pain”美國國會(huì)通過決議：將21世紀(jì)的前十年確定為疼痛研究與控制的十年。 USA Congress passed a resolution: determined the first ten years in 21st Century as

15、to study and control the pain.在歐美發(fā)達(dá)國家，疼痛康復(fù)也成為康復(fù)醫(yī)學(xué)的重要分支，形成綜合醫(yī)院康復(fù)醫(yī)學(xué)科（含疼痛治療中心）、?？铺弁纯祻?fù)中心、社區(qū)疼痛康復(fù)診所三級(jí)醫(yī)療網(wǎng)絡(luò)。 In Europe and America countries, pain and rehabilitation has become an important branch of reha

16、bilitation medicine, and forms three grade medical network: department of rehabilitation medicine(include pain treatment center)in general hospital, specialist pain and rehabilitation center, community pain and rehabilit

17、ation clinic.,3、疼痛康復(fù)的現(xiàn)狀3. Current situation of pain and rehabilitation medical treatment,,IMC,一、疼痛康復(fù)醫(yī)療的需求與現(xiàn)狀Ⅰ. Needs and current situation of pain and rehabilitation medical treatment,,,3、疼痛康復(fù)的現(xiàn)狀3. Current s

18、ituation of pain and rehabilitation medical treatment,在中國，疼痛專科業(yè)已成為二級(jí)學(xué)科，成為獨(dú)立的門診、病房及護(hù)理單元的新型學(xué)科有些醫(yī)院組建疼痛中心或疼痛診療學(xué)者組。不少中醫(yī)院，將從事麻醉科、中醫(yī)外科、中醫(yī)骨傷、中醫(yī)針灸針刀等專業(yè)人員組合成新的疼痛?？苹蛑嗅t(yī)康復(fù)科。疼痛康復(fù)醫(yī)療在我國醫(yī)療體系中點(diǎn)多面廣，各具特色，同時(shí)又缺乏嚴(yán)謹(jǐn)?shù)男袠I(yè)監(jiān)管，在實(shí)踐中需要引起足夠重視，盡快規(guī)范化、標(biāo)準(zhǔn)

19、化、制度化，實(shí)現(xiàn)從業(yè)人員的持久發(fā)展和歸屬感。,In China, the pain specialty has become second-rate discipline, and a new branch of science with the formaulation of independent clinic, ward and nursing unit. Some hospitals form pain center

20、or pain clinic scholar groups.In many hospitals, new rehabilitation departments are founded, these departments are composed of different professionals from department of anesthesiology, Chinese surgery, orthopaedics an

21、d traumatology, traditional Chinese medicine acupuncture needle.In Chinese medical system, pain and rehabilitation medical cover a broad area, distinctive with each other, and lack of strict supervision of the industry

22、. So, it needs to cause enough attention and come into institutionalization, normalization  andstandardization, to achieve lasting personnel development and a sense of belonging.,,IMC,二、疼痛康復(fù)

23、醫(yī)療的學(xué)科架構(gòu)Ⅱ.Discipline Architecture of Pain and Rehabilitation Medical TreatmentⅠ,,,中國是人口大國，經(jīng)濟(jì)發(fā)展極不平衡，相對(duì)基層衛(wèi)生醫(yī)療來說，建立中醫(yī)、西醫(yī)相結(jié)合的疼痛康復(fù)醫(yī)療服務(wù)體系，更加符合國情和實(shí)情！,我國農(nóng)村有2億多青壯年農(nóng)民工客居城市務(wù)工，廣大農(nóng)村人口以老年人和留守兒童為主。,,China is a populous&#

24、160;country, and develops unevenly in different regions. Comparated with community-level medical and health, to establish the pain and rehabilitation medical service system combined wit

25、h Chinese and western medicine will be in accordance with China's national situation.,In China, there are 2 million young migrant workers working in cities,and  the elderly an

26、d the left-behind children are left in rural area.,,,IMC,二、疼痛康復(fù)醫(yī)療的學(xué)科架構(gòu)Ⅱ.Discipline Architecture of Pain and Rehabilitation Medical TreatmentⅠ,,,在大中城市以老年人為主要成員的空巢家庭越來越多！農(nóng)村和城市的65歲以上人口約占我國總?cè)丝诘?/4，未來還將直線上升，2030年將超過1/3。,疼痛疾病

27、與疼痛康復(fù)人群將呈井噴式增長，而我們?cè)撊绾螒?yīng)對(duì)？,,,More and more empty nest families with elderly people as the main members are arising in large and medium-sized cities. The population of more than 65 years accounts for 1/4 of the

28、60;total population in China. The ratio will rise in a straight line and reach to 1/3 in 2030.,The pain disease and pain rehabilitation population will show a growth spurt, how should we dea

29、l with?,問題決定需求，問題決定導(dǎo)向Problems determine needs, Problems determine directions,在二級(jí)以上醫(yī)療機(jī)構(gòu)建立疼痛科（疼痛門診過渡到疼痛科），同時(shí)與康復(fù)學(xué)科對(duì)接，共同完成診療計(jì)劃，患者康復(fù)出院。存在問題： 1、康復(fù)學(xué)科也是新興學(xué)科，許多二級(jí)以上醫(yī)院還缺乏建制標(biāo)準(zhǔn)的學(xué)科體系。 2、目前科室為單位的衛(wèi)生經(jīng)濟(jì)核算制度，難以保證科間協(xié)調(diào)合作。結(jié)果:

30、患者享受到的醫(yī)療服務(wù)不完整。,Found  Department of pain in medical institutions above secondary hospitals(from pain clinic to Department of pain),and combine with rehabilitation medicine, work together to finish treatment plan.Pr

31、oblems: 1. rehabilitation is an emerging discipline, many hospitals above secondary are lack of discipline system with Construction standards. 2. system of economic calculation based on each

32、 department is difficult to ensure the coordination among different departments.Result: incomplete medical and health service for patients.,模式一,Mode 1,問題決定需求，問題決定導(dǎo)向Problems determine need

33、s, Problems determine directions,模式二,Mode 2,在二級(jí)以上醫(yī)療機(jī)構(gòu)建立具有疼痛亞專科的康復(fù)學(xué)科（或中心），從科室內(nèi)部完成淘疼痛診療與康復(fù)的完整醫(yī)療過程。存在問題： 1、疼痛康復(fù)亞專科發(fā)展是否受到人為壓制？科主任支持力度？ 2、發(fā)展壯大后可能分科單獨(dú)成立疼痛科（好事？壞事？）； 3、科室從業(yè)醫(yī)師的專業(yè)認(rèn)證如何界定、雙認(rèn)證？結(jié)果：患者比較滿意的全方位醫(yī)療服務(wù),Found

34、 Department of rehabilitation that has pain subspeciality in medical institutions above secondary hospitals(or center), complete the process of pain treatment and rehabilitation from the department.Problems:

35、 1.Whether the development of pain and rehabilitation subspeciality is suppressed artificially? Support from director of department? 2. The discipline may establish branch of pain department after deve

36、lopment (good or bad?) 3. How define the professional certification of department practitioners? dual authentication? Result: A full range of medical services with more satisfactory,問題決定需求，問題決定導(dǎo)

37、向Problems determine needs, Problems determine directions,模式三,Mode 3,在二級(jí)及以下醫(yī)療機(jī)構(gòu)建立疼痛康復(fù)中心門診，下設(shè)疼痛及康復(fù)科（或?qū)W組、亞?？疲?，吸納中醫(yī)、中西醫(yī)結(jié)合康復(fù)人員加入，衛(wèi)生經(jīng)濟(jì)核算一體化。存在問題 1、疼痛治療與康復(fù)人員之間可能因?qū)I(yè)取向不一致，工作強(qiáng)度和特點(diǎn)不一致產(chǎn)生隔閡、矛盾。不同工而同籌？ 2、專業(yè)認(rèn)證問題。結(jié)果：患者認(rèn)可的醫(yī)

38、療服務(wù)模式。,Found Pain Rehabilitation Center Outpatient in secondary hospitals and below, set up Pain and rehabilitation group, attract persons with Combination of Traditional Chinese and Western Medicine to join, and achieve

39、 economic calculation integration Problems: 1. Estrangement and conflict will arise between Pain treatment and rehabilitation personnel for the differences of specialty, work strength and characteristics

40、 2.problems of Professional certification Result: The medical service model accepted by patients,問題決定需求，問題決定導(dǎo)向Problems determine needs, Problems determine directions,模式四,Mode 4,Found Pain Rehabi

41、litation medicine center based on persons with Combination of Traditional Chinese and Western Medicine in tertiary medical institutions, or department of rehabilitation medicine in pain treatment as the focus s

42、ubspeciality. To achieve  the integration of pain and rehabilitation medical service with Combination of Traditional Chinese and Western Medicine.Problems: 1.Disciplinary structure is complex, large and compre

43、hensive, need support from Other clinical disciplines.it’s difficult to manage Discipline. 2.problems of Professional certification. Result: Comprehensive rehabilitation model accepted by patients,在三級(jí)醫(yī)療機(jī)

44、構(gòu)中建立集西醫(yī)、中醫(yī)及中西醫(yī)結(jié)合從業(yè)人員的疼痛康復(fù)醫(yī)學(xué)中心或以疼痛治療為重點(diǎn)亞?？频目祻?fù)醫(yī)學(xué)科。實(shí)現(xiàn)西醫(yī)、中醫(yī)一體化疼痛康復(fù)醫(yī)療服務(wù)。存在問題 1、學(xué)科架構(gòu)比較復(fù)雜、大而全，需要其它臨床學(xué)科支援病人，學(xué)科管理及人員培訓(xùn)難度大。 2、專業(yè)認(rèn)證問題。結(jié)果：患者認(rèn)可的全面康復(fù)模式。,,IMC,,,,,,,,,,,,是新興學(xué)科，專業(yè)醫(yī)生、治療師及護(hù)理師奇缺,,跨學(xué)科的復(fù)合型學(xué)術(shù)及管理型人才嚴(yán)重不足,,疼痛與康復(fù)的大眾認(rèn)知

45、度不夠，缺少宣傳平臺(tái),,,,,學(xué)科發(fā)展不平衡，容易受到其它成熟學(xué)科的擠壓,,,定位及服務(wù)模式不夠規(guī)范，應(yīng)明確內(nèi)涵與外延,,加強(qiáng)教育與規(guī)范化培養(yǎng)自身隊(duì)伍 Strengthen education, standard cultivate,,疼痛康復(fù)Pain and rehabilitation,三、存在問題Ⅲ. Problems,An Emerging discipline, critical shortage of Pr

46、ofessional doctors, therapists and nurses,Severely insufficient in inter-disciplinary academic and Management talent,Not enough recognition,  lack of publicity platform,Unbalanced subject development, easy to be squ

47、eezed by other mature subjects,Non-standard localization and service mode, define the Intension and extension,,IMC,傳統(tǒng)中醫(yī)學(xué) 提出“氣滯血瘀，不通則痛”，有了活血化瘀止痛的治則大法。 The traditional Chinese Medicine: advance a theory

48、of “qi-stagnancy and blood stasis, stagnation of QI and blood may bring about pain ”, and have the rules of treatment “promoting blood circulation to remove blood stasis, analgesic”.中醫(yī)傳統(tǒng)康復(fù)方法起源于春秋戰(zhàn)國時(shí)期，如《莊子.刻意》云：“吹呴呼吸，吐故納

49、新，熊經(jīng)鳥申”，是通過氣功、導(dǎo)引方法恢復(fù)健康。 Traditional Chinese medicine rehabilitation: This method originated from spring and autumn period, which return health through Qigong method.,四、以新的視野促進(jìn)中西醫(yī)疼痛康復(fù)的發(fā)展創(chuàng)新Ⅳ.Promote the Development

50、 and Innovation of Pain and Rehabilitation Medical Treatment with Chinese and Western Medicine in new insight.,,,IMC,中醫(yī)傳統(tǒng)康復(fù)Traditional Chinese Medicine Rehabilitation,南北朝時(shí)期，官方將康復(fù)機(jī)構(gòu)稱為“坊”，專門收治老弱病殘疾者，類似現(xiàn)今的老年康復(fù)中心；唐代官方

51、位殘疾人設(shè)立“養(yǎng)病坊”、“按摩?？啤钡瓤祻?fù)治療機(jī)構(gòu)。公元610年巢元方撰寫《諸病源候論》，是我國第一部采用醫(yī)療體育與物理療法對(duì)多種疾病進(jìn)行康復(fù)醫(yī)療的專著，專設(shè)“養(yǎng)生方導(dǎo)引法”內(nèi)容。清代俞根初的《通俗傷寒論》“調(diào)理諸法”中，專門講述了瘥后藥物調(diào)理、食物調(diào)理、氣候調(diào)理、起居調(diào)理等，是全面闡述中醫(yī)康復(fù)醫(yī)療的代表作。,“瑤田”養(yǎng)病坊“Yaotian” Recuperate Fang,“于是”養(yǎng)病坊“Yushi” Recuperate F

52、ang,“悲田”養(yǎng)病坊“Beitian” Recuperate Fang,Northern and southern dynasties period, the official institutions called rehabilitation “Fang”, specialized treatment of the old and disability person, similar to today's elderly

53、 rehabilitation center. Tang Dynasty official set up rehabilitation institutions for disabled people “Recuperate Fang” , “Massage Specialist” .In 610 ad Yuanfang Chao wrote a book called “General Treatise on the Cause

54、and Symptoms of Diseases”, which was our country the first monographs adopted health sports and physical therapy for rehabilitation.In Qing dynasty Genchu Yu wrote a book called “Common treatise on Febrile Diseases”, in

55、 the part of conditioning methods, he introduced drug conditioning, food conditioning, climate conditioning, living conditioning, etc. This book is a representative work of TCM rehabilitation.,中醫(yī)傳統(tǒng)康復(fù)Traditional Chines

56、e Medicine Rehabilitation,中醫(yī)康復(fù)特點(diǎn)是: 順應(yīng)自然 形神共治 食藥配合 動(dòng)靜相宜 內(nèi)治與外 治相結(jié)合 形成了獨(dú)特的傳統(tǒng)康復(fù)療法體系！,The characteristics of TCM rehabilitation:Adapt to nature Physique and spirit t

57、reatment Food and drug cooperation Movement and still moderationThe combination of internal and external treatment The formation of the system of traditional rehabilitation therapy!,1、自然康復(fù)法，如泉水療法、日光療法；2、傳統(tǒng)物理康復(fù)，如磁

58、療、聲療、五色療；3、藥物外治康復(fù)法；4、情志康復(fù)法：如喜療、思療；5、傳統(tǒng)文娛康復(fù)法；6、傳統(tǒng)音樂康復(fù)法；,中醫(yī)傳統(tǒng)康復(fù)Traditional Chinese Medicine Rehabilitation,1.The natural rehabilitation method, such as spring water therapy, phacotherapy;2.The traditional physical re

59、habilitation method, such as magnet therapy, sound therapy, five color therapy;3.Topical drugs rehabilitation method:4.Emotional rehabilitation method, such as joy therapy, contemplation therapy; 5.Traditional enterta

60、inment rehabilitation method; 6.Traditional music rehabilitation method;,,,中醫(yī)傳統(tǒng)康復(fù)Traditional Chinese Medicine Rehabilitation,7、傳統(tǒng)體育康復(fù)法：如五禽戲； 8、氣功康復(fù)法；9、針灸康復(fù)法； 10、按摩康復(fù)法；11、飲食康復(fù)法；

61、 12、藥物內(nèi)治康復(fù)法。,7.Traditional sports rehabilitation method, such as five- animal exercises.8.Qigong Rehabilitation Method;9.Acupuncture rehabilitation method;10.Massage rehabilitation method;

62、11.Dietary rehabilitation method;12.Medicine rehabilitation method,現(xiàn)代中西醫(yī)康復(fù)Modern Chinese and Western Medicine Rehabilitation,在中國，以二、三級(jí)醫(yī)院為主的醫(yī)療疼痛康復(fù)科（或中心）是治療康復(fù)的主體，以康復(fù)中心療養(yǎng)院、一級(jí)醫(yī)院（社區(qū)醫(yī)療中心）為主的疼痛康復(fù)中心是維持康復(fù)或療養(yǎng)康復(fù)的主體。 In Ch

63、ina, with secondary and tertiary hospitals based medical pain rehabilitation department (or center) as the main body of the treatment and rehabilitation, with sanatorium and hospital (Community Medical Center) based pain

64、 rehabilitation center is the main body to maintain or convalescent rehabilitation.形成有機(jī)的、規(guī)范的、標(biāo)準(zhǔn)化的、中西醫(yī)結(jié)合的疼痛康復(fù)構(gòu)架，是建設(shè)具有中國特色疼痛康復(fù)醫(yī)療體系的基本保障。 To form an organic and normative framework of pain rehabilitation is the bas

65、ic guarantee of construction of pain and rehabilitation medical system with China characteristics.,二級(jí)醫(yī)院康復(fù)科Rehabilitation Department,Secondary Hospital,三級(jí)醫(yī)院康復(fù)科Rehabilitation Department,Tertiary Hospitals,,社區(qū)康復(fù)中心Communi

66、ty Medical Center,五、我們的實(shí)踐與思考Ⅴ.Our Practice and Reflection,,IMC,海軍總醫(yī)院康復(fù)醫(yī)學(xué)科暨疼痛診療中心，在國內(nèi)較早提出“大康復(fù)”的理念（治療康復(fù)理念），以病房、康復(fù)治療中心、疼痛治療中心、康復(fù)護(hù)理為依托，門診為窗口，建立了神經(jīng)康復(fù)、骨骼肌肉康復(fù)、疼痛康復(fù)、中醫(yī)康復(fù)及物理治療亞專科（學(xué)組）。 Department of rehabilitation medicine

67、 and pain center, PLA Naval General Hospital, earlier puts forward the concept of “Generalized Rehabilitation”, supported by ward, rehabilitation center, pain treatment center, rehabilitation nursing and as outpatient se

68、rvice for the window, establishes the neural rehabilitation, skeletal muscle rehabilitation, pain Chinese medicine rehabilitation, physicotherapeutics subspecialities(study groups).,形成了針刀整脊治療脊柱病、頸肩腰腿軟組織?。簧窠?jīng)康復(fù)治療腦卒中/神

69、經(jīng)損傷；運(yùn)動(dòng)康復(fù)治療骨關(guān)節(jié)功能障礙；疼痛康復(fù)治療頸腰椎退行性改變、椎間盤疾病、下腰痛及各種神經(jīng)損傷；針灸推拿康復(fù)等一批特色項(xiàng)目。 The formation of some characteristics projects: Acupotomology chiropractic treatment for spinal disease and neck shoulder waist leg soft tissue dis

70、ease; nerve rehabilitation treatment for stroke / nerve injury; exercise rehabilitation treatment for bone and joint dysfunction; pain and rehabilitation treatment for cervical and lumbar degenerative changes, lumbar dis