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1、BDH-Clinic Hessisch Oldendorf,Prof.Dr.Jens D.RollnikMedical DirectorInstitute for Neurorehabilitation Research(InFo),欢迎,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
2、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,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
3、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 beds113 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,New ICU,Investment:10.000.000 资产投入：一千万欧元ICU-beds:25 ICU床位：25,New ICU 全新的ICU病区,New ICU 全新的ICU病区,Neuroimagin
4、g MRI and CT 神经影像设备核磁及CT,The six-phase model of the Federal RehabilitationCouncil(BAR,1994)联邦康复委员会六级模式（联邦康复学会，1994）,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
5、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,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
6、 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,DRG-System:OPS 8-552 诊断相关分类系统,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
7、,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 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,(Rollnik,2013),Phase B Outcome B级 结果,年龄,巴塞尔量表改变,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）,
8、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 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 Mechanical ventilat
9、ion机械通气,(Rollnik et al.,2010),-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,Phase B Multiresistant germs多重耐药细菌,-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%
10、-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,Phase B MRSA and outcome 抗药性金黄色葡萄球菌 及结果,(Rollnik,2014),Phase B MRSA and outcome 抗药性金黄色葡萄球菌 及结果,
11、抗药性金黄色葡萄球菌(+),抗药性金黄色葡萄球菌(-),年龄,住院时间,早期康复时间,全部康复时间,共同诊断数,巴塞尔量表得分,转出时巴塞尔量表得分,入院时早期康复指数得分,传出时早期康复指数得分,早期功能评定营养,早期功能评定面口,早期功能评定感觉，运动,早期功能评定认知,Phase B ESBL and outcome 大肠埃希菌 及结果,(Rollnik,2015),Phase C C级-patients are still dependent on nursing,but they dont need ICU or IMC 患者仍需支持护理，但不需要ICU或IMC-patients c
12、ooperate more and more actively 患者日趋活跃，并合作良好,Phase C C级,Phase C diagnoses 诊断,(Rollnik,2009),Phase C Outcome C级 结果,(Rollnik,2009),Phase C Outcome C级 结果,(Rollnik,2009),Phase C LOS C级 病程,(Rollnik,2009),MEmbeR-study on medical-occupational rehab 职业医疗康复的研究,-Design of the MEmbeR-study:研究设计Multicenter 多中心M
13、ultiple indications(neurological,psychiatric,orthopedics,internal medicine)多学科参与 Prospective 预期,MEmbeR:Centers 多中心分布,MEmbeR:Study sample 研究样本-mean age 34.1(9.9)y,113 m,83 f 平均年龄34.19.9岁，男113，女83-LOS:148.6(SD=223)days(approx.5 months),range 10 1080 病程：平均148.6天，标准差223，（约5个月）范围处于10-1080天r=-0.47(p0.001)
14、,(Rollnik et al.,2014),MEmbeR:Unfit for work 无法适应工作Before:69.9%,24 months after rehab only 5.6%康复前：69.9%，康复24个月后仅5.6%,(Rollnik et al.,2014),MEmbeR:Jobless 失业Before:19.9%,24 months after rehab:3.1%康复前19.9%，24个月康复后3.1%,(Rollnik et al.,2014),MEmbeR:Return to work,(Rollnik et al.,2014),24 months after m
15、edical occupational rehabilitation,153/196(78.1%)returned to work!,职业医疗康复24个月后，78.1%病人回归社会工作生活,回归工作,Summary-The Federal Rehabilitation Council has established a successful 6-phase model forneurological and neurosurgical patients.联邦康复委员会为神内/外系统成功推出6级康复模式-The BDH-Clinic offers inpatient rehabilitation
16、 from phase A(acute-care hospital treatment)to E(medical-occupational rehab)本中心提供A-E 共五级康复-Early rehabilitation allows rehabilitation of mechanically ventilated and critically illpatients.Weaning is succesful in approx.70%of cases.早期康复接受机械通气及严重病患 70%可以成功转入下一级别-The burden of multiresistant germs(MRSA
17、,ESBL)is challenging in neurological early rehabilitation(prevalence on admission:approx.25%).对于早期神经系统康复，多重耐药菌（抗药性金黄色葡萄球菌、ESBL 菌）的压力是一大挑战（入院病人约25%）-Patients colonized with MRSA or ESBL-producing bacteria have a worse outcome(lower functional status on admission,higher morbidity).抗药性金黄色葡萄球菌、ESBL 菌感染病
18、人预后普遍较差，（入院时功能状态较差，高发病率）-Medical-occupational rehabilitation helps patients to return to work(two years afterrehab approx.80%return to work)!职业医疗康复有效帮助患者回归工作（2年内约80%）,ContactThank you for your attention!谢谢Prof.Dr.med.Jens D.RollnikMedical DirectorBDH-Clinic Hessisch Oldendorfprof.rollnikbdh-klinik-hessisch-oldendorf.deTel.+49 5152 781 231,
