1、建设中国特色疼痛康复医疗体系的探索与思考Exploration and Reflection on the Establishment of Pain Rehabilitation Medical System with China Characteristics,海军总医院康复医学科暨疼痛诊疗中心Dep. of Rehabilitation Medicine and Pain Center,康复医学科,乔晋琳 Jinlin Qiao2016年3月27日 27 MAR 2016,目录 CONTENTS,疼痛康复医疗的需求与现状,1,疼痛康复医疗的学科架构,2,存在问题,3,促进中西医疼痛康复的
2、发展创新,4,我们的实践与思考,5,参与医药卫生体制改革的路径,6,Discipline Architecture of Pain and Rehabilitation Medical Treatment,Problems,Promote 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 Medic
3、al and Health System,NeedsandCurrent Situation of Pain and Rehabilitation Medical Treatment,IMC,一、疼痛康复医疗的需求与现状. Needsandcurrent situation of pain and rehabilitation medical treatment,慢性疼痛类疾病已成为继心脑血管病、癌症、代谢性疾病，这些严重影响人类健康的又一类“健康杀手”：是影响工作出勤率、家庭日常生活残障率、死亡率的又一类公共健康问题！ Chronic pain diseases has been anoth
4、er health killer following cardio-cerebrovascular disease, cancer and metabolic disease that serious impact on human health, and also been a publichealthproblem that affect attendance, daily life disability and mortality.,急性疼痛/Acute Pain（软组织及关节急性损伤疼痛，手术后疼痛，产科疼痛）Acute injury pain of Soft tissue and j
5、oint, postoperative pain, obstetric pain,慢性疼痛/Chronic pain（软组织及关节劳损性，椎间盘源性疼痛、神经源性疼痛）Soft tissue and joint strain,discogenic pain,neuropathic pain,顽固性疼痛/Intractable pain（三叉神经疼痛，带状疱疹后遗神经疼痛，椎间盘突出症）Trigeminal nerve pain,postherpetic neuralgia, lumbar disc herniation,1、需求巨大，覆盖疾病谱广，学科交叉趋势显著1.The huge dema
6、nd, wide coverage, significant interdisciplinary trend,IMC,一、疼痛康复医疗的需求与现状. Needsandcurrent situation of pain and rehabilitation medical treatment,癌性疼痛 （晚期肿瘤痛，肿瘤转移病）cancer pain advanced cancer pain, tumor metastatic disease特殊疼痛类 （血栓性脉管炎，顽固性心绞痛,特发性胸腹痛）Special pain thromboangiitis, intractable angina p
7、ectoris, idiopathic thoracic abdominal pain相关学科疾病（突发性耳聋，血管痉挛性疾病）Related disciplines disease sudden deafness, vascular spasm非疼痛类疾病（抑郁症，睡眠障碍，心理疾病等）Non pain disease depression, dyssomnia, mental disease上述疾病的疼痛治疗与康复，需结合临床专科会诊，共管的方式联合诊疗 The pain treatment and rehabilitation of diseases above-mentioned ne
8、ed combined treatment withclinical specialist consultation and co-management.,2、疼痛康复医疗的需求2. Needs of pain and rehabilitation medical treatment,IMC,一、疼痛康复医疗的需求与现状. Needsandcurrent situation of pain and rehabilitation medical treatment,世界卫生组织（WHO）将疼痛作为第五大生命体征，于2000年将疼痛定义为一类疾病 2004年国际疼痛学会（IASP）确定每年10月中
9、旬的第一周为“世界疼痛日”。 WHO made 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“.中国也将每年10月第二周定为“中国疼痛周”。 China also made the 2nd week in October of every year as China Week Against Pai
10、n”美国国会通过决议：将21世纪的前十年确定为疼痛研究与控制的十年。 USA Congresspassedaresolution: determined the first ten years in 21st Century as to study and control the pain.在欧美发达国家，疼痛康复也成为康复医学的重要分支，形成综合医院康复医学科（含疼痛治疗中心）、专科疼痛康复中心、社区疼痛康复诊所三级医疗网络。 In EuropeandAmericacountries, pain and rehabilitation has become an important branc
11、h of rehabilitation 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 rehabilitation clinic.,3、疼痛康复的现状3. Current situation of pain and rehabilitation
12、medical treatment,IMC,一、疼痛康复医疗的需求与现状. Needsandcurrent situation of pain and rehabilitation medical treatment,3、疼痛康复的现状3. Current situation of pain and rehabilitation medical treatment,在中国，疼痛专科业已成为二级学科，成为独立的门诊、病房及护理单元的新型学科有些医院组建疼痛中心或疼痛诊疗学者组。不少中医院，将从事麻醉科、中医外科、中医骨伤、中医针灸针刀等专业人员组合成新的疼痛专科或中医康复科。疼痛康复医疗在我国医
13、疗体系中点多面广，各具特色，同时又缺乏严谨的行业监管，在实践中需要引起足够重视，尽快规范化、标准化、制度化，实现从业人员的持久发展和归属感。,In China, the pain specialty has become second-ratediscipline, and a new branch of science with the formaulation of independent clinic, ward and nursing unit. Some hospitals form pain center or pain clinic scholar groups.In many
14、hospitals, new rehabilitation departments are founded, these departments are composed of different professionals from department of anesthesiology, Chinese surgery, orthopaedics and traumatology, traditional Chinese medicine acupuncture needle.In Chinese medical system, pain and rehabilitation medic
15、al cover a broad area, distinctive with each other, and lack of strict supervision of the industry. So, it needs to cause enough attention and comeintoinstitutionalization,normalization andstandardization, to achieve lasting personnel development and a sense of belonging.,IMC,二、疼痛康复医疗的学科架构.Disciplin
16、e Architecture of Pain and Rehabilitation Medical Treatment,中国是人口大国，经济发展极不平衡，相对基层卫生医疗来说，建立中医、西医相结合的疼痛康复医疗服务体系，更加符合国情和实情！,我国农村有2亿多青壮年农民工客居城市务工，广大农村人口以老年人和留守儿童为主。,Chinaisapopulouscountry, and developsunevenlyindifferentregions. Comparated with community-levelmedicalandhealth, to establish the pain and
17、 rehabilitation medical service system combined with Chinese and western medicine willbeinaccordancewithChinasnationalsituation.,In China, there are 2 million young migrant workers working in cities,and the elderly and the left-behind children are left in rural area.,IMC,二、疼痛康复医疗的学科架构.Discipline Arc
18、hitecture of Pain and Rehabilitation Medical Treatment,在大中城市以老年人为主要成员的空巢家庭越来越多！农村和城市的65岁以上人口约占我国总人口的1/4，未来还将直线上升，2030年将超过1/3。,疼痛疾病与疼痛康复人群将呈井喷式增长，而我们该如何应对？,More and more empty nest families with elderly people as the main members are arising in large and medium-sized cities. Thepopulation of more tha
19、n 65 years accounts for 1/4 ofthetotalpopulationinChina. 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, howshouldwedeal with?,问题决定需求，问题决定导向Problems determine needs, Problems determine directions,在二级以上医疗机构
20、建立疼痛科（疼痛门诊过渡到疼痛科），同时与康复学科对接，共同完成诊疗计划，患者康复出院。存在问题： 1、康复学科也是新兴学科，许多二级以上医院还缺乏建制标准的学科体系。 2、目前科室为单位的卫生经济核算制度，难以保证科间协调合作。结果:患者享受到的医疗服务不完整。,Found Department of pain in medical institutions above secondary hospitals(from pain clinic to Department of pain),and combine with rehabilitation medicine, work toget
21、her to finish treatment plan.Problems: 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 department is difficult to ensure the coordination among different departments
22、.Result: incompletemedicalandhealthserviceforpatients.,模式一,Mode 1,问题决定需求，问题决定导向Problems determine needs, Problems determine directions,模式二,Mode 2,在二级以上医疗机构建立具有疼痛亚专科的康复学科（或中心），从科室内部完成淘疼痛诊疗与康复的完整医疗过程。存在问题： 1、疼痛康复亚专科发展是否受到人为压制？科主任支持力度？ 2、发展壮大后可能分科单独成立疼痛科（好事？坏事？）； 3、科室从业医师的专业认证如何界定、双认证？结果：患者比较满意的全方位医疗服务
23、,Found 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: 1.Whether the development of pain and rehabilitation subspeciality is suppressed artif
24、icially? Support from director of department? 2. The discipline may establish branch of pain department after development (good or bad?) 3. How define the professional certification of department practitioners? dual authentication? Result: A full range of medical services with more satisfactory,问题决定
25、需求，问题决定导向Problems determine needs, Problems determine directions,模式三,Mode 3,在二级及以下医疗机构建立疼痛康复中心门诊，下设疼痛及康复科（或学组、亚专科），吸纳中医、中西医结合康复人员加入，卫生经济核算一体化。存在问题 1、疼痛治疗与康复人员之间可能因专业取向不一致，工作强度和特点不一致产生隔阂、矛盾。不同工而同筹？ 2、专业认证问题。结果：患者认可的医疗服务模式。,Found Pain Rehabilitation Center Outpatient in secondary hospitals and below,
26、set up Pain and rehabilitation group, attract persons with Combination of Traditional Chinese and Western Medicine to join, and achieve economic calculation integration Problems: 1. Estrangement and conflict will arise between Pain treatment and rehabilitation personnel for the differences of specia
27、lty, work strength and characteristics 2.problems of Professional certification Result: The medical service model accepted by patients,问题决定需求，问题决定导向Problems determine needs, Problems determine directions,模式四,Mode 4,Found Pain Rehabilitationmedicinecenter based on persons with Combination of Traditio
28、nal Chinese and Western Medicine in tertiary medical institutions, or department of rehabilitation medicine in pain treatment as the focus subspeciality. To achieve the integration of pain and rehabilitation medical service with Combination of Traditional Chinese and Western Medicine.Problems: 1.Dis
29、ciplinary structure is complex, large and comprehensive, need support from Other clinical disciplines.its difficult to manage Discipline. 2.problems of Professional certification. Result: Comprehensive rehabilitation model accepted by patients,在三级医疗机构中建立集西医、中医及中西医结合从业人员的疼痛康复医学中心或以疼痛治疗为重点亚专科的康复医学科。实现
30、西医、中医一体化疼痛康复医疗服务。存在问题 1、学科架构比较复杂、大而全，需要其它临床学科支援病人，学科管理及人员培训难度大。 2、专业认证问题。结果：患者认可的全面康复模式。,IMC,是新兴学科，专业医生、治疗师及护理师奇缺,跨学科的复合型学术及管理型人才严重不足,疼痛与康复的大众认知度不够，缺少宣传平台,学科发展不平衡，容易受到其它成熟学科的挤压,定位及服务模式不够规范，应明确内涵与外延,加强教育与规范化培养自身队伍 Strengtheneducation, standard cultivate,疼痛康复Pain and rehabilitation,三、存在问题. Problems,An
31、 Emerging discipline, critical shortage of Professional 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 squeezed by other mature subjects,Non-standa
32、rd localization and service mode, define the Intensionandextension,IMC,传统中医学 提出“气滞血瘀，不通则痛”，有了活血化瘀止痛的治则大法。 The traditional Chinese Medicine: advance a theory of “qi-stagnancy and blood stasis, stagnation of QI and blood may bring about pain ”, and have the rules of treatment “promoting blood circulat
33、ion to remove blood stasis, analgesic”.中医传统康复方法起源于春秋战国时期，如庄子.刻意云：“吹呴呼吸，吐故纳新，熊经鸟申”，是通过气功、导引方法恢复健康。 Traditional Chinese medicine rehabilitation: This method originated from spring and autumn period, which return health through Qigong method.,四、以新的视野促进中西医疼痛康复的发展创新.Promote the Development and Innovation
34、 of Pain and Rehabilitation Medical Treatment with Chinese and Western Medicine in newinsight.,IMC,中医传统康复Traditional Chinese Medicine Rehabilitation,南北朝时期，官方将康复机构称为“坊”，专门收治老弱病残疾者，类似现今的老年康复中心；唐代官方位残疾人设立“养病坊”、“按摩专科”等康复治疗机构。公元610年巢元方撰写诸病源候论，是我国第一部采用医疗体育与物理疗法对多种疾病进行康复医疗的专著，专设“养生方导引法”内容。清代俞根初的通俗伤寒论“调理诸法”
35、中，专门讲述了瘥后药物调理、食物调理、气候调理、起居调理等，是全面阐述中医康复医疗的代表作。,“瑶田”养病坊“Yaotian” Recuperate Fang,“于是”养病坊“Yushi” Recuperate Fang,“悲田”养病坊“Beitian” Recuperate Fang,Northern and southern dynasties period, the official institutions called rehabilitation “Fang”, specialized treatment of the old and disability person, simi
36、lar to todays elderly 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 and Symptoms of Diseases”, which was our country the first mo
37、nographs adopted health sports and physical therapy for rehabilitation.In Qing dynasty Genchu Yu wrote a book called “Common treatise on Febrile Diseases”, in the part of conditioning methods, he introduced drug conditioning, food conditioning, climate conditioning, living conditioning, etc. This bo
38、ok is a representative work of TCM rehabilitation.,中医传统康复Traditional Chinese Medicine Rehabilitation,中医康复特点是: 顺应自然 形神共治 食药配合 动静相宜 内治与外 治相结合 形成了独特的传统康复疗法体系！,The characteristics of TCM rehabilitation:Adapt to nature Physique and spirit treatment Food and drug cooperation Movement and still moderationT
39、he combination of internal and external treatment The formation of the system of traditional rehabilitation therapy!,1、自然康复法，如泉水疗法、日光疗法；2、传统物理康复，如磁疗、声疗、五色疗；3、药物外治康复法；4、情志康复法：如喜疗、思疗；5、传统文娱康复法；6、传统音乐康复法；,中医传统康复Traditional Chinese Medicine Rehabilitation,1.The natural rehabilitation method, such as spr
40、ing water therapy, phacotherapy;2.The traditional physical rehabilitation 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 entertainment rehabilitation
41、method; 6.Traditional music rehabilitation method;,中医传统康复Traditional Chinese Medicine Rehabilitation,7、传统体育康复法：如五禽戏； 8、气功康复法；9、针灸康复法； 10、按摩康复法；11、饮食康复法； 12、药物内治康复法。,7.Traditional sports rehabilitation method, such as five- animal exercises.8.Qigong Rehabilitation Method;9.Acupuncture rehabilitation
42、method;10.Massage rehabilitation method;11.Dietary rehabilitation method;12.Medicine rehabilitation method,现代中西医康复Modern Chinese and Western Medicine Rehabilitation,在中国，以二、三级医院为主的医疗疼痛康复科（或中心）是治疗康复的主体，以康复中心疗养院、一级医院（社区医疗中心）为主的疼痛康复中心是维持康复或疗养康复的主体。 In China, with secondary and tertiary hospitals based m
43、edical pain rehabilitation department (or center) as the main body of the treatment and rehabilitation, with sanatorium and hospital (Community Medical Center) based pain rehabilitation center is the main body to maintain or convalescent rehabilitation.形成有机的、规范的、标准化的、中西医结合的疼痛康复构架，是建设具有中国特色疼痛康复医疗体系的基
44、本保障。 To form an organic and normative framework of pain rehabilitation is the basic guarantee of construction of pain and rehabilitation medical system with China characteristics.,二级医院康复科Rehabilitation Department,Secondary Hospital,三级医院康复科Rehabilitation Department,Tertiary Hospitals,社区康复中心Community
45、Medical Center,五、我们的实践与思考.Our Practice and Reflection,IMC,海军总医院康复医学科暨疼痛诊疗中心，在国内较早提出“大康复”的理念（治疗康复理念），以病房、康复治疗中心、疼痛治疗中心、康复护理为依托，门诊为窗口，建立了神经康复、骨骼肌肉康复、疼痛康复、中医康复及物理治疗亚专科（学组）。 Department of rehabilitation medicine and pain center, PLA Naval General Hospital, earlier puts forward the concept of “Generalize
46、d Rehabilitation”, supported by ward, rehabilitation center, pain treatment center, rehabilitation nursing and as outpatient service for the window, establishes the neural rehabilitation, skeletal muscle rehabilitation, pain Chinesemedicine rehabilitation, physicotherapeutics subspecialities(study g
47、roups).,形成了针刀整脊治疗脊柱病、颈肩腰腿软组织病；神经康复治疗脑卒中/神经损伤；运动康复治疗骨关节功能障碍；疼痛康复治疗颈腰椎退行性改变、椎间盘疾病、下腰痛及各种神经损伤；针灸推拿康复等一批特色项目。 The formation of some characteristics projects: Acupotomology chiropractic treatment for spinal disease and neck shoulder waist leg soft tissue disease; 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 disc disease, low back pain and various nerve injury; Acupuncture and massage rehabilitation, and so on.,
