Rehabilitation plan for discharged patients with new coronavirus pneumonia

The health and health committees of provinces, autonomous regions, municipalities and Xinjiang Production and Construction Corps:

In order to improve the respiratory function, physical function, psychological function, ability of daily living and social participation of discharged patients with new coronary pneumonia, standardize rehabilitation operation techniques and procedures, and further promote their full rehabilitation, we organized experts to formulate (Trial). Is now issued to you, please refer to the implementation.

General Office of National Health Commission

March 4, 2020

(Information disclosure: Active disclosure)

Rehabilitation plan for discharged patients with new coronavirus pneumonia

(Trial)

This plan is specially formulated to improve the respiratory function, physical function, and psychological dysfunction of patients with new coronary pneumonia, and to standardize the operating techniques and procedures for rehabilitation.

First, the goal

Improve the symptoms of dyspnea and dysfunction in discharged patients with new coronary pneumonia, reduce complications, alleviate anxiety and depression, reduce disability rate, maximize the ability of daily living and improve the quality of life.

Ii. Applicable people and places

(1) The crowd. Patients with new coronary pneumonia discharged.

(2) Place. Designated post-discharge patient rehabilitation medical institutions, isolation places, nursing homes, communities, and families.

III. Main content

(1) Dysfunction that requires rehabilitation.

Respiratory dysfunction. It manifests as cough, sputum, dyspnea, shortness of breath after activity, and may be accompanied by respiratory muscle weakness and impaired lung function.

Physical dysfunction. Manifestations include general weakness, fatigue, muscle soreness, and some may be accompanied by muscle atrophy and decreased muscle strength.

Psychological dysfunction. There are emotional problems such as fear, anger, anxiety, depression.

障碍 Impairment of daily living activities and social participation ability. Unable to complete undressing, toileting, bathing, etc. Inability to achieve normal interpersonal communication and return to work.

(2) Evaluation of rehabilitation function.

Respiratory function assessment. Assessment is made using the Dyspnea Index Scale (mMRC), etc., and lung function tests are recommended in areas or institutions with conditions.

Physical function assessment. Evaluation was performed using the Borg conscious fatigue scale and free hand muscle tests.

Psychological function assessment. Self-depression scale (SDS), anxiety scale (SAS), and Pittsburgh sleep questionnaire were used for evaluation.

Assessment of daily living activities. The evaluation was performed using a modified Pap index index.

Six-minute walk test. The patient is required to walk as fast as possible in a straight corridor, and the six-minute walking distance is measured. The minimum reentry distance is ≥30 meters.

(3) Rehabilitation methods.

1. Respiratory training

Active Circulation Breathing Technology (ACBT): A circulation cycle consists of three parts: breathing control, thoracic expansion movement and forced exhalation technology. The breathing control phase instructs the patient to breathe at a normal tidal volume in a relaxed manner, encourages the shoulders and upper chest to remain relaxed, the lower chest and abdomen actively contract, and completes breathing in the diaphragm breathing mode. Adaptation to needs. The chest expansion phase emphasizes inhalation, instructing the patient to inhale deeply to the inspiratory reserve, hold their breath for 1-2 seconds, and then exhale passively and easily. The forced exhalation phase is interspersed with breathing control and breath. Breathing is a quick but hard-working exhalation, and the glottis should remain open during the process. Use the technique of sputum to expel sputum instead of cough to reduce work of respiratory muscles. Be careful to cover with a mask during the breath.

Breathing mode training: including adjusting breathing rhythm (inhalation: exhalation = 1: 2), abdominal breathing training, lip shrinking breathing training, etc.

Respiratory rehabilitation exercises: According to the patient's physical condition, perform a series of exercises such as neck flexion and extension, chest expansion, turning, waist rotation, side body, squat, leg lift, open leg, ankle pump and other exercises in the supine, sitting and standing positions.

2. Physical function training

Aerobic exercise: formulate aerobic exercise prescriptions for patients with combined basic diseases and residual dysfunction. Including stepping, jogging, brisk walking, jogging, swimming, Taijiquan, Baduanjin and other sports. It is advisable to exercise without fatigue the next day after exercise, starting from low intensity and gradually, 20-30 minutes each time, 3-5 times a week. For patients who are prone to fatigue, intermittent exercise can be used. Started 1 hour after a meal.

Strength training: Use sandbags, dumbbells, elastic bands or bottled water for progressive resistance training, 15-20 movements per group, 1-2 groups per day, 3-5 days per week.

3. Psychological rehabilitation intervention

Design occupational therapy that can produce pleasant effects and divert attention to achieve the purpose of adjusting emotions and relieving stress. Nursing staff and rehabilitation therapists trained in professional psychology can also conduct professional psychological counseling, including mindfulness relaxation and cognitive behavioral therapy. Be careful to use a method that allows the patient to repeat the traumatic experience, so as not to cause repeated injuries. If mental disorders occur, psychiatric intervention is recommended.

4. Training in daily life activities

指导 Guidance on daily activities for patients. It is mainly energy-saving technical guidance, which will decompose daily life activities such as putting on clothes, using the toilet, taking a bath, and so on. It will be performed intermittently, and it will return to normal gradually as the physical strength recovers.

24. Relevant matters needing attention

(1) Contraindications. If the patient has one of the following conditions, the above rehabilitation treatment is not recommended.

1. Static heart rate> 100 beats / min.

2. Blood pressure <90 / 60mmHg,> 140 / 90mmHg or blood pressure fluctuations exceeding the baseline 20mmHg, accompanied by obvious discomfort such as dizziness and headache.

3. Blood oxygen saturation ≤95%.

4. Combining other diseases that are not suitable for sports.

(2) When the patient has the following conditions during the treatment, the above rehabilitation treatment should be stopped immediately, and the treatment plan should be re-evaluated and adjusted.

1. Obvious fatigue occurs and cannot be relieved after rest.

2. Chest tightness, chest pain, dyspnea, severe cough, dizziness, headache, unclear vision, palpitations, sweating, unstable standing, etc.

三 (C) When patients with pulmonary hypertension, congestive heart failure, deep vein thrombosis, unstable fractures and other diseases, you should consult a specialist for relevant precautions before starting respiratory rehabilitation.

(4) Elderly patients are often accompanied by a variety of basic diseases, poor physical fitness, and poor tolerance for rehabilitation training. Comprehensive assessment should be performed before rehabilitation treatment. Rehabilitation training should start with small doses and proceed gradually to avoid training injuries and other problems. Serious complications.

(5) After being discharged from the hospital, patients with severe or critical illness may be rehabilitated at the designated rehabilitation medical institution or primary health care institution depending on the actual situation of local rehabilitation medical work. After being discharged from hospitals with light or ordinary patients, the community and home should take appropriate rest and exercise to restore physical fitness, physique and immunity as much as possible.