倡导大康复医学理念-365心血管网.ppt

针刺风靡全美 针刺风靡全美 协和三宝 协和“三宝” 对常见临床问题制定循证最佳康复方案 Thanks for Attention 谢谢大家 The process of angiogenesis begins with VEGF-A binding to its receptor on vascular endothelial cells. Activated endothelium secretes a variety of cytokines which in turn stimulate many signalling pathways resulting in: Basement membrane degradation, mediated by induction of matrix metalloproteinases (MMPs), which in concert with “loosening” of tight junctions leads to increased vessel permeability and fluid leakage. Basement membrane breakdown is followed by endothelial cell proliferation which migrate to form vascular buds. The buds elongate and remodel to form tubes and eventually new vessels. The vessel maturation process is complete as supportive pericytes are recruited and attach to on the exterior of the new vessels. 跌倒致髋部骨折的影响 1% of falls result in hip fracture $2 billion + in medical costs annually（US) 25% die within 6 months 60% have restricted mobility 25% remain functionally more dependent 老年人临床康复问题 髋部骨折 Hip Fracture 中风 Stroke 营养不良 Under-nutrition 抑郁症 Depression 认知缺陷 Cognitive Impairment 大康复医学理念 融入全科医学 融汇现代医学 融入社区康复卫生服务 （Community Based Rehabilitation Service,CBRS) 社区康复的开展 中国国情 社会和家庭支持的极端重要性 世界同心 合家一心 PCI致MI（NEJM) Comparison of clinical end-point event 两组临床终点事件的比较 Note: There was significant difference between the two groups(p0.05). Death 死亡 0 0.00 0 0.00 Nonfatal MI 非致命性心梗 1 0.64 1 0.64 Repeat PCI 重复介入治疗 15 1.91 31 4.46 Event 终点事件 Treatment 治疗组 Control 对照组 N (%) N (%) CABG 冠脉搭桥 0 0.00 3 0.00 干预PCI术后再狭窄临床结果比较 注: 两组比较有显著性差异(p0.05). □ Treatment ▲ Placebo 活血化瘀中药防治PCI后再狭窄的Meta分析 共纳入13篇文献（截至2007年6月） 6篇文献使用了盲法，其中2篇对设盲、揭盲详细描述； 2篇文献Jadad评分4分，属高质量文献； 5篇描述了不良反应； 试验组再狭窄率和心绞痛复发率低于对照组 J Am Coll Cardiol, 2010,56(19):1605 在过去的10年间，这位56岁的患者，共接受了28次冠脉造影，置入了67个支架。 病变具体情况？？ 应寻找‘罪犯’血管与病变 不应以支架简单覆盖 支架植入治疗阴茎勃起功能障碍 康复程度的三个层次 低水平：只在身体功能和/或心理功能上有某些改善，尚未能走出家门重返社会 中等水平：身心功能有显著改善，生活能自理或基本自理，但尚有各种障碍而影响其重返社会 高水平：身心功能显著恢复，生活可自