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基层中西医结合心脏康复临床实践
$45.98
康复医学是20世纪中期出现的一门新兴学科,目标是帮助各类患者重新回归社会、
生活、工作。现代医学体系已把预防、医疗、康复相互联系,组成一个相互不可或缺的统
一体,并深刻地改变着医疗模式。
医学模式的核心就是医学观,是哲学思想在医学中的反映。随着疾病谱、死因谱的转
变,医学模式在经历了神灵主义医学模式、自然哲学医学模式、机械论医学模式、生物医
学模式之后,进入到了生物—心理—社会医学模式时代。
新型医学模式的出现,需要临床医师在思维方式、工作方法以及教科书的表述上都要
发生质的变化,而这一变化过程必然是一个长期的、渐进的过程,需要所有医务工作者各
自贡献自己的临床心得,并不断地去伪存真。
具体到心脏康复领域,我国心脏康复的起步并不晚,吴英恺于1981年在《中华心血
管病杂志》撰文,强调要重视心血管疾病的康复治疗研究工作,之后也不断有综述和文献
阐述心脏康复的必要性,但一些专家仍然质疑心脏康复的安全性,在很长一段时间内心脏
康复并未得到国内心血管学术界和管理部门的重视。
直到20世纪末期,一直没有停止的科研探索和越来越多的心脏康复论坛极大地普及
了心脏康复概念,终于使更多的专家学者认识到心脏康复的意义,并且加入到心脏康复
的临床实践中。其中,早形成规模效应的是心脏支架术后和心脏外科术后的康复临床
实践。
值得一提的是,具备心脏支架术后和心脏外科术后康复临床条件的医疗机构毕竟是有
限的。同时,随着我国经济的发展,人们的生活水平有了显著的提高,一些生活习惯和环
境改变所导致的疾病也逐步增多,如高血压、高血脂、糖尿病等慢性病人群和亚健康人群
也不断扩大,严重影响居民健康。这些心血管慢病患者依然渴望回归社会、回归生活、回
归工作。而这些心血管慢病患者主要就医于基层医疗机构,特别是基层中医院。
《“健康中国2030”规划纲要》指出:“建设健康中国的核心是以人民健康为中心,
坚持以基层为重点,以改革创新为动力,预防为主,中西医并重,把健康融入所有政策,
人民共建共享的卫生与健康工作方针,针对生活行为方式、生产生活环境以及医疗卫生服
务等健康影响因素,坚持政府主导与调动社会、个人的积极性相结合,推动人人参与、人
人尽力、人人享有,落实预防为主,推行健康生活方式,减少疾病发生,强化早诊断、早
治疗、早康复,实现全民健康。”
孙艳玲,主任医师,河南省区域中医心病专科诊疗中心负责人,河南中医药大学附属医院洛阳市中医院心血管病科主任,洛阳市第六届学术技术带头人。
学术兼职:中国医师协会心力衰竭专业委员会青年委员,中国医师协会中西医结合医师分会心脏康复专业委员会常务委员,中国中医药研究促进会中西医结合心血管病预
防与康复专业委员会常务委员,河南省康复医学会心血管病康复分会副主任委员,中国中医药研究促进会中西医结合心血管病预防与康复专业委员会豫西地区专家委员会主任
委员,洛阳市医学会心血管专业委员会副主任委员,洛阳市医学会心血管专业委员会高血压学组组长,洛阳市中医学会心病专业委员会主任委员。
基 础 篇
章 心脏康复的中医基础理论及历史沿革003
第二章 基层心脏康复中心建设探索007
第三章 洛阳市中医院心脏康复十年心路历程013
临 床 篇
第四章 高血压病021
节 相同的血压,不同的风险 021
第二节 高血压管理,从中青年开始 023
第三节 高血压管理,把好慢病的关卡 027
第四节 知晓您的血压——自我管理 034
第五节 知晓您的血压——价值医疗 040
第六节 知晓您的血压——长程管理 042
第七节 知晓您的血压——MDT协同管理 044
第八节 从高血压管理视角谈难治性高血压 046
第五章 心力衰竭052
节 早期康复、延缓心力衰竭 052
第二节 分级诊疗政策下的心力衰竭管理策略初探 056
第三节 从例心力衰竭病例看心力衰竭的管理 060
第六章 冠心病064
节 冠心病急性心肌梗死中西医康复流程 064
第二节 冠心病康复新视点——冠脉微血管疾病康复初始 072
第三节 冠心病加速康复 079
第七章 肺动脉高压084
加强高危人群管理,前移肺动脉高压防治关口 084
第八章 先天性心脏病087
从心脏康复的视角谈先天性心脏病的长程管理 087
第九章 心律失常096
从中医视角谈心律失常的治疗 096
第十章 药源性疾病108
从心脏康复视角谈药源性疾病的预防 108
适宜技术篇
第十一章 运动113
节 个体化运动处方与相关概念的商榷 113
第二节 心脏康复需要精准运动而非随意活动 116
第十二章 营养118
关于心脏康复营养处方的思考 118
第十三章 双心124
节 经方论治双心疾病 124
第二节 躯体化症状自评量表使心理康复从模糊到逐渐清晰 140
第十四章 动静态无创心输出量监测145
节 使用无创心排量技术评估体外反搏疗效 145
第二节 无创运动心排助力冠心病诊治 146
第三节 关于无创心排量监测评估指导高血压用药的商榷 148
第四节 心排量在心血管疾病评定中的探索 152
第十五章 6分钟步行试验159
6 分钟步行试验的意义、价值及实施 159
第十六章 体外反搏164
节 体外反搏操作常见问题及处理对策 164
第二节 从体外反搏的安全保证和质控评价看心脏康复临床路径的调整 167
第三节 体外反搏的规范化操作 169
病例分享篇
第十七章 高血压病例183
病例1 OSAHS相关的继发性高血压 183
病例2 原发性醛固酮增多症相关的继发性高血压 189
病例3 原发性高血压综合管理 195
第十八章 心力衰竭病例204
病例1 冠状动脉旁路移植术后反复心力衰竭 204
病例2 扩张型心肌病心力衰竭(1) 210
病例3 青年扩张型心肌病心力衰竭 214
病例4 扩张型心肌病心力衰竭(2) 220
病例5 难治性心力衰竭 226
病例6 急性心肌梗死后心力衰竭 232
病例7 “多病共存”患者心力衰竭 236
第十九章 冠心病病例241
病例1 冠心病不稳定型心绞痛 241
病例2 PCI术后亚急性期心肌梗死 247
病例3 家族性高胆固醇血症致反复心绞痛 253
病例4 搭桥术后反复发作心绞痛 257
第二十章 先天性心脏病病例264
病例1 卵圆孔未闭型先天性心脏病 264
第二十一章 心理疾病病例270
病例1 焦虑引起的继发性高血压 270
病例2 “双心疾病”致反复心绞痛 274
第二十二章 心脏瓣膜病病例281
病例 二尖瓣关闭不全综合管理 281
跋287
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