姑息康复的意义与价值——以个案分析为例。

IF 1.6 4区 医学 Q2 NURSING
Valerio Massimo Magro, Andrea Sorbino, Nicola Manocchio, Concetta Ljoka, Calogero Foti
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引用次数: 0

摘要

目的:姑息康复被定义为帮助患有进行性,通常是晚期或无法治愈的疾病的个体在生理和环境限制以及生活偏好的情况下实现其生理,心理和社会潜力的过程。然而,在医学科学文献中,关于这一主题的证据非常不一致,研究的结果也因治疗的病理和研究的结果测量以及对患者的干预措施的类型而异。此外,人们对理疗师在姑息性康复中的作用知之甚少。因此,我们提出了一个复杂的血液学病例,以强调团队为基础的治疗方法,是由物理医生加强。设计:我们研究了一位患有多种并发症的复杂血液病患者,并试图描述我们在与其他专家(血液病专家、肺病专家、传染病专家、骨科医生)接触时,在生理方面对他的管理所做的贡献。方法:44岁男性急性淋巴细胞白血病化疗耐药患者,既往有匹配非亲属供体造血干细胞移植史,一般情况严重。在评估时存在血小板减少,脓毒性表现和冠状病毒肺炎。在就诊时,患者能够用四肢进行反重力运动(根据医学研究委员会的力量评估为3/5),但由于剧烈疼痛,下肢的Mingazzini体征未能长期维持。鉴于患者的病情,我们实施了全面的个人康复项目。这包括一个谨慎的运动再教育计划,重点是被动运动练习,特别是下肢运动。与骨科医生的密切合作对于评估股骨和骨盆骨折的风险以及适当的锻炼剂量至关重要。一项呼吸再教育计划也被启动,包括将呼吸技术与运动相结合的治疗性练习。该计划包括吸气和呼气训练,并根据患者的临床状态和对疼痛管理的反应定期调整。理疗师的专业贡献有助于患者的整体护理,试图提高患者的依赖程度和生活质量,即使受到疾病的损害。结果:物理医学和康复方法使患者的运动和呼吸康复方案减轻了患者的痛苦,使其呼吸更好,移动时小心翼翼,以免使其在床上无法移动,从而防止了压疮的形成。此外,患者也从治疗中受益,孤独感减少,情绪得到积极影响。结论:虽然单个病例不构成重要的科学证据,但我们与血液肿瘤学家一起解决了患者护理问题,以便决定会诊中要求的物理治疗的各个方面。因此,我们试图确定这种治疗的优势和局限性,它的好处和关键问题,以便能够清楚地界定其治疗和姑息领域,在研究中检查。在这方面,物理学可以在与各种学科的相互作用中发挥重要作用,这些学科试图为受到严重病理和严重预后影响的患者带来缓解。临床意义:随着其众所周知的使命致力于康复,物理医学和康复的作用也可以是姑息治疗。这意味着,通过评估和规定的干预措施,力求确保最佳的生活质量,即使是由于其病理性质、严重程度和病情进展,不幸面临“健康状况”和“健康状况”两方面预后不良的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Meaning and Value of Palliative Rehabilitation Through a Case Report Analysis.

Purpose: Palliative rehabilitation is defined as the process of helping individuals with a progressive, often advanced or incurable disease reach their physical, psychological, and social potential consistent with physiologic and environmental limitations and life preferences. However, the evidence on this topic is very heterogeneous in the medical scientific literature and studies diverge in their results depending on both the pathologies treated and the outcome measures studied as well as the types of interventions brought to the patients. Additionally, little is known about the role of the physiatrist within palliative rehabilitation. Thus, we present a complex hematology case to highlight a team-based treatment approach that is strengthened by the physiatrist.

Design: We studied a complex hematology patient burdened by several complications and attempted to describe our contribution on the physiatry side to his comanagement with the other specialists (hematologists, pulmonologists, infectious disease specialists, orthopedists) with whom we came into contact.

Methods: A 44-year-old male patient suffering from acute lymphoblastic leukemia resistant to chemotherapy with a history of matched unrelated donor hematopoietic stem cell transplantation came to physiatric observation with a severe general condition. Thrombocytopenia, septic manifestations, and coronavirus pneumonia were present at the time of assessment. At the visit, the patient was able to perform antigravity movements with the four limbs (strength evaluated at 3/5 according to the Medical Research Council), but because of intense pain, the Mingazzini sign in the lower limbs was never maintained for a long time. Given the patient's condition, we implemented a comprehensive individual rehabilitation project. This included a cautious motor reeducation program focusing on passive mobilization exercises, particularly of the lower limbs. Close collaboration with the orthopedic surgeon was essential to assess the risk of fracture at the femoral and pelvic levels and to appropriately dose the exercises. A respiratory reeducation program was initiated as well, incorporating therapeutic exercises that integrated breathing techniques with movement. This program included inspiratory and expiratory training and was regularly adjusted based on the patient's clinical status and response to pain management. The physiatrist's specialist contribution contributed to the global care of the patient, attempting to improve both the patient's level of dependence and his quality of life even if compromised by the disease.

Results: The physical medicine and rehabilitation approach led to a motor and respiratory rehabilitation program that alleviated the patient's suffering and allowed him to breathe better, moving him carefully so as not to leave him immobile in bed, thus preventing the formation of pressure ulcers. Furthermore, the patient also experienced human benefits from the treatment, with a reduced sense of loneliness and positive effects on his mood.

Conclusions: Although a single case does not constitute significant scientific evidence, We addressed the issue of patient care together with the hemato-oncologist, in order to decide on the various aspects of the physiotherapy treatment requested in the consultation. We thus sought to establish the strengths and limitations of this treatment, its benefits and critical issues, so as to be able to clearly define its therapeutic and palliative areas, examined in the study. Physiatry in this regard can play an important role in the interaction with the various disciplines that attempt to bring relief to the patient affected by a serious pathology and severe prognosis.

Clinical implications: Along with its well-known mission dedicated to rehabilitation, the role of physical medicine and rehabilitation can also be palliative. This means seeking to ensure, through its assessment and prescribed interventions, the best quality of life, even in patients who, due to the nature of their pathologies, their severity, and their progression, unfortunately face a poor prognosis both "quoad vitam" and "quoad valitudinem".

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来源期刊
Pain Management Nursing
Pain Management Nursing 医学-护理
CiteScore
3.00
自引率
5.90%
发文量
187
审稿时长
>12 weeks
期刊介绍: This peer-reviewed journal offers a unique focus on the realm of pain management as it applies to nursing. Original and review articles from experts in the field offer key insights in the areas of clinical practice, advocacy, education, administration, and research. Additional features include practice guidelines and pharmacology updates.
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