Paine R, Make B J
Clin Geriatr Med. 1986 May;2(2):313-35.
The elements of a pulmonary rehabilitation program require a variety of different skills. However, the number of people involved in a rehabilitation program will vary with the clinical setting and the number of patients served. In a large program, a physician, respiratory nurse, physical and occupational therapist, psychologist, social worker, respiratory therapist, and dietitian might all be involved on a full- or part-time basis. In other settings, two or three individuals, mostly working part-time, may be the entire team. Pulmonary rehabilitation may be performed on an outpatient basis, in a group practice setting, or in an inpatient hospital unit. Whatever its size, a system must be developed that allows for thorough initial evaluation of patients, formation of rational goals with the patient, adequate time for patient education and training, ongoing re-enforcement to consolidate and maintain gains, and an appropriate means of intervention when the patient experiences an exacerbation of his disease. It should also be recognized that in many areas of the country, there are too few patients and scarce medical resources to mount an intensive pulmonary rehabilitation program. In such instances, referral can be made to larger medical centers. More importantly, the individual practitioner can successfully incorporate many of the elements of pulmonary rehabilitation into his practice by taking the time and effort necessary to ascertain how illness affects the daily lives of the patient with COPD and then addressing patient concerns in an ongoing, comprehensive manner.
肺康复计划的组成要素需要多种不同的技能。然而，参与康复计划的人员数量会因临床环境和所服务患者的数量而有所不同。在大型计划中，医生、呼吸科护士、物理治疗师和职业治疗师、心理学家、社会工作者、呼吸治疗师和营养师可能都会全职或兼职参与。在其他环境中，两三名主要兼职工作的人员可能就是整个团队。肺康复可以在门诊、集体诊疗环境或住院病房进行。无论规模大小，都必须建立一个系统，以便对患者进行全面的初始评估，与患者共同制定合理的目标，为患者提供足够的教育和培训时间，持续强化以巩固和维持康复成果，以及在患者病情加重时采取适当的干预措施。还应该认识到，在该国的许多地区，患者数量太少且医疗资源稀缺，无法开展强化肺康复计划。在这种情况下，可以转诊到更大的医疗中心。更重要的是，个体从业者可以通过花时间和精力确定疾病如何影响慢性阻塞性肺疾病患者的日常生活，然后以持续、全面的方式解决患者的问题，成功地将肺康复的许多要素纳入其诊疗工作中。
