组织泌尿系统结石病人康复的方法论证

M. D. Diachuk
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European clinical guidelines for the treatment of urolithiasis, systematic reviews and scientific sources from the PUBMED and NICE databases, administrative data for the years 2019-2023 and 236 medical records of inpatients operated on for urolithiasis were selected as research materials; methods: bibliosemantic, systematic approach and analysis, medical-statistical, descriptive and graphic modeling. \nResults. It was found that traditional rehabilitation measures on the clinical path of a patient with urolithiasis are fragmentary and limited in content and scope. At the same time, manageable risk factors have been identified that can be targeted for rehabilitation: high levels of chronic non-infectious diseases – circulatory system and endocrine system (respectively, 8,826.7 and 4,809.1 per 10,000 population). In general, there were 1.6 manageable risk factors (irrational diet, overweight, low physical activity, smoking) common to chronic non-communicable diseases per person. The specific weight of urolithiasis in the structure of urological pathology (12.7%) remained stable during the study, and the specific weight of patients with the need for surgical treatment was equal to 90.7%-93.2%. A typical clinical route of a patient with urolithiasis has been substantiated and developed. A feature of the route is the use of a short-term rehabilitation program during conservative treatment, perioperative rehabilitation - in the case of operative treatment, long-term rehabilitation – at the ambulatory stage after conservative and/or operative treatment of urolithiasis. The programs are aimed at reducing the impact of risk factors on the development and/or recurrence of urolithiasis and other most common chronic non-infectious diseases. The programs are carried out by multidisciplinary teams of specialist doctors. The interaction of doctors is ensured by the local medical information system. \nConclusions. 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引用次数: 0

摘要

导言。康复治疗可以改善治疗效果,提高患者的生活质量,降低医疗费用。目前,国内尚未开发出以证据为基础的手术患者康复技术,尤其是针对尿路结石患者的康复技术。目的调查多学科医疗机构中泌尿系结石患者康复的传统临床实践,论证并制定包含康复技术的典型患者临床路径。材料和方法。选取欧洲治疗泌尿系结石的临床指南、PUBMED和NICE数据库中的系统综述和科学资料、2019-2023年的行政数据以及236例因泌尿系结石而接受手术的住院患者的医疗记录作为研究材料;方法:书目文献法、系统方法和分析法、医学统计法、描述性和图形建模法。结果研究发现,泌尿系结石患者临床路径上的传统康复措施比较零散,内容和范围有限。与此同时,还发现了一些可控的风险因素,可作为康复治疗的目标:慢性非传染性疾病--循环系统和内分泌系统--发病率高(分别为每万人 8 826.7 例和 4 809.1 例)。一般来说,每人有 1.6 个可控的慢性非传染性疾病常见风险因素(不合理饮食、超重、体力活动少、吸烟)。在研究期间,泌尿系统病理结构中尿路结石的比重(12.7%)保持稳定,需要手术治疗的患者比重为 90.7%-93.2%。尿路结石患者的典型临床路径已经得到证实和发展。该路线的一个特点是在保守治疗期间使用短期康复方案,在手术治疗的情况下使用围手术期康复方案,在保守治疗和/或手术治疗尿路结石后的非卧床阶段使用长期康复方案。这些方案旨在减少风险因素对尿路结石和其他最常见的慢性非传染性疾病发病和/或复发的影响。这些计划由专科医生组成的多学科团队负责实施。当地的医疗信息系统确保了医生之间的互动。结论泌尿系统结石患者的典型临床路径包括短期、围手术期和长期康复计划。这些方案不仅有可能影响个人的健康,还有可能影响所服务人群的整体素质。
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JUSTIFICATION OF APPROACHES TO THE ORGANIZATION OF REHABILITATION OF PATIENTS WITH UROLITHIASIS
Introduction. Rehabilitation makes it possible to improve the results of treatment and the quality of a person's life, as well as to reduce health care costs. Evidence-based domestic technologies for the rehabilitation of patients with a surgical profile have not been developed, in particular, for patients with urolithiasis. Aim. To investigate traditional clinical practice for the rehabilitation of a patient with urolithiasis in a multidisciplinary healthcare facility and to justify and develop a typical patient clinical pathway incorporating rehabilitation technologies. Materials and methods. European clinical guidelines for the treatment of urolithiasis, systematic reviews and scientific sources from the PUBMED and NICE databases, administrative data for the years 2019-2023 and 236 medical records of inpatients operated on for urolithiasis were selected as research materials; methods: bibliosemantic, systematic approach and analysis, medical-statistical, descriptive and graphic modeling. Results. It was found that traditional rehabilitation measures on the clinical path of a patient with urolithiasis are fragmentary and limited in content and scope. At the same time, manageable risk factors have been identified that can be targeted for rehabilitation: high levels of chronic non-infectious diseases – circulatory system and endocrine system (respectively, 8,826.7 and 4,809.1 per 10,000 population). In general, there were 1.6 manageable risk factors (irrational diet, overweight, low physical activity, smoking) common to chronic non-communicable diseases per person. The specific weight of urolithiasis in the structure of urological pathology (12.7%) remained stable during the study, and the specific weight of patients with the need for surgical treatment was equal to 90.7%-93.2%. A typical clinical route of a patient with urolithiasis has been substantiated and developed. A feature of the route is the use of a short-term rehabilitation program during conservative treatment, perioperative rehabilitation - in the case of operative treatment, long-term rehabilitation – at the ambulatory stage after conservative and/or operative treatment of urolithiasis. The programs are aimed at reducing the impact of risk factors on the development and/or recurrence of urolithiasis and other most common chronic non-infectious diseases. The programs are carried out by multidisciplinary teams of specialist doctors. The interaction of doctors is ensured by the local medical information system. Conclusions. A typical clinical pathway for a patient with urolithiasis includes short-term, perioperative and long-term rehabilitation programs. They have the potential to affect not only the health of an individual, but also the entire contingent of the population being served.
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