长期慢性阻塞性肺病肺部表现成年患者的康复:综述

I. Grishechkina, Marianna A. Ansokova, L. A. Marchenkova, O. V. Yurova, A. D. Fesyun
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摘要

导言。新感染冠状病毒(COVID-19)的患者最常见的症状与肺部病变(气短、胸痛、咳嗽)有关,大多数长期感染冠状病毒的患者也会出现同样的症状,而冠状病毒在人群中的发生率和流行率与 COVID-19 的康复人数密不可分。 目的研究一家康复专科医院对长期慢性阻塞性肺病肺部表现患者的诊断、治疗和康复问题的现状,以便为这类患者的管理制定基本的实用建议。 材料与方法:2021 年 1 月 1 日至 2022 年 12 月 1 日期间,我们在 MEDLINE、Cyberleninka 和 eLIBRARY.RU 数据库中就长 COVID 肺部表现及其成年患者康复方法这一主题进行了系统检索,共找到 678 条匹配信息。根据 PRIZMA 指南中规定的方法进行进一步筛选后,我们选择了 60 篇出版物进行最终分析。 结果长程COVID的肺部表现,首先包括呼吸急促,在长程COVID中发生频率仅次于疲劳。诊断结果包括:一部分 1 岁以下患者的肺部组织发生放射学变化、肺活量测定出现限制性异常以及肺弥散能力受损。许多 COVID-19 患者很快就能康复,但其中一些患者会出现呼吸困难和身体疲劳等长期症状,需要在专业中心进行康复治疗。 最有效的治疗方法是让多学科康复团队参与康复过程,并根据呼吸康复的概念基础制定康复计划,其中首先包括各种物理治疗方法。 最有效的治疗方法是让多学科康复团队参与康复过程,并根据呼吸康复的概念框架制定康复计划,其中首先包括各种治疗性体育教育技术。 结论。目前,有关长期慢性阻塞性肺气肿的临床表现、诊断、治疗和康复措施的知识在不断更新和扩展。本文献综述分析了以成人肺部表现的治疗和康复为重点的研究论文,结合了 "经典俄罗斯治疗法 "和与之最接近的 "德国治疗法 "流派所特有的病因学和综合征方法。从世界卫生组织(WHO)发布的文件以及俄罗斯和欧洲当地的临床指南中提取的信息,将使从事长COVID肺部表现成人康复治疗的专家能够为每位患者制定有效的个性化康复计划。
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Rehabilitation of Adult Patients with Pulmonological Manifestations of Long COVID: a Review
INTRODUCTION. The most common symptoms in patients who have had a new coronavirus infection (COVID-19) are associated with pulmonary lesions (shortness of breath, chest pain, cough) and the same complaints persist in the majority of those suffering from long COVID the occurrence and prevalence of which in the population is inextricably linked with the number recovered from COVID-19. AIM. To study the current state of the problem of diagnosis, treatment and rehabilitation of patients with pulmonological manifestations of long COVID at the stage of a specialized rehabilitation hospital in order to formulate basic practical recommendations for the management of this category of patients. MATERIALS AND METHODS. During the period from January 1, 2021 to December 1, 2022, we performed a systematic search of the MEDLINE, Cyberleninka, and eLIBRARY.RU databases on the topic of pulmonary manifestations of long COVID and methods of their rehabilitation in adult patients that gave 678 matches. After further filtering steps according to the methodology outlined in the PRIZMA guidelines, we selected 60 publications for the final analysis. RESULTS. Pulmonary manifestations of long COVID, including, first of all, shortness of breath, rank second after fatigue in terms of frequency of occurrence in long COVID. Diagnostic findings include radiologic pulmonary tissue changes recorded in a proportion of patients under one year, restrictive abnormalities on spirometry, and impaired pulmonary diffusion capacity. Many patients who have had COVID-19 recover quite quickly, but some of them have a long-term symptom complex of dyspnea and physical fatigue, for which rehabilitation in a specialized centers is indicated. The most effective treatment is possible with the involvement of a multidisciplinary rehabilitation team in the rehabilitation process and the appointment of rehabilitation programs created in accordance with the conceptual basis of respiratory rehabilitation, including, first of all, a wide range of methods of therapeutic physical culture. The most effective treatment is possible by involving a multidisciplinary rehabilitation team in the rehabilitation process and prescribing rehabilitation programs designed in accordance with the conceptual framework of respiratory rehabilitation, including, above all, a wide range of therapeutic physical education techniques. CONCLUSION. Current knowledge of the clinical picture, diagnosis, treatment and rehabilitation measures in long COVID is constantly reassessed and expanded. This literature review gives an analysis of research papers focused on the treatment and rehabilitation of pulmonary manifestations in adults, combining the etiopathogenetic and syndromic approaches characteristic of the “classical Russian therapeutic” and, closest to it, the “German” schools. The information extracted both from documents published by World Health Organization (WHO) and from local Russian and European clinical guidelines will allow a specialist engaged in the rehabilitation of adults with pulmonary manifestations of long COVID to create an effective and personalized individual rehabilitation plan for each patient.
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