On the morning of June 27, 2023, Jishuitan Xiaotangshan Rehabilitation Center welcomed a rare disease patient with severe pneumonia. Although I was mentally prepared in advance, the moment I saw the patient being carried from the 120 ambulance to the ward, I was still surprised by her weight of 20 kg (BMI 8.32kg/m2), which is not too much to describe as skinny. In addition to the ultra-low body weight, he wears various tubes all over his body, tracheostomy and ventilator to assist breathing, indwelling nasogastric tube, urethral tube, PICC, and stage 2 pressure ulcer in the sacrococcygeal.
The department's medical staff carefully cared for the angel with broken wings. The patient's mitochondrial encephalomyopathy was the primary disease, and after being infected with the new crown, he experienced decreased immunity, gradual weight loss, and later impaired consciousness. After admission, we immediately started the "whole-process management of the neurocritical early rehabilitation unit", admitted the patient to the intensive care unit, and equipped with intensive care physicians, nurses, and rehabilitation treatment teams to be on standby. In terms of clinical treatment, the use of antibiotics combined with bedside airway dissection to promote sputum excretion was first used, and lung infection was controlled in a timely and effective manner. After 2 months of treatment, the patient's glycosylated hemoglobin decreased from 10.07% to 6.0%. After the patient was admitted to the hospital, he developed acute coronary syndrome with acute heart failure, and was immediately given comprehensive treatment such as anticoagulation, tube expansion, and diuresis, and the patient's condition gradually improved. In addition, a comprehensive nutritional assessment was conducted, and after individualized and meticulous treatment, the patient's weight increased from 20 kg to 27 kg, which included the cooperation of the patient and the hard work of medical care.
In terms of rehabilitation, after the lung infection and heart failure of the patient were basically controlled, ultra-early discharge rehabilitation training was started immediately. From the initial turning, long sitting training in bed, sitting up training with bedside under invasive ventilators, standing training, and then short-distance walking training assisted by walkers, it has played an important role in weaning patients and recovering the functions of various systems. In view of the characteristics of mitochondrial encephalomyopathy of patients, an integrated mode of neuroassessment and treatment was arranged for patients, and superior conditions were created for patients to recover neuromuscularly and ventilator through neurodevelopmental therapy, exercise learning, biofeedback therapy, forced induction of exercise therapy, transcranial magnetic stimulation technology and other technical means with the concept of ultra-early bed discharge.
Patients in our hospital are treated with transcranial magnetic stimulation
In terms of speech and swallowing training, from the initial breathing training, tongue muscle strength and range of motion training, laryngeal muscle strength and other comprehensive training, the patient can feel the happiness of normal communication from the beginning of monosyllabic vocalization to the completion of normal dialogue. In terms of swallowing training, from the initial nasogastric diet, to nasogastric feeding + oral feeding to the final removal of the nasogastric tube, all oral feeding was eaten, and there was no choking, and the medical staff, patients and accompanying nurses worked together to ensure that patients can enjoy the fun of food again.
In terms of psychotherapy, the patient was admitted to the hospital with severe deafness, and the medical staff communicated the specific details of the clinical and rehabilitation treatment process through written writing, and accumulated as many as 85 pages of communication records from the patient's admission to weaning. The font from the initial crooked to the gradual regularization, then to the gradual hope, the gradual self-confidence, and finally to the restoration of the independent individual words, witnessing the entire psychological reconstruction and rehabilitation process of the patient.
The multidisciplinary and whole-process management of the neurocritical early rehabilitation unit is the wings woven by our hospital for patients, so that patients can be weaned and free to breathe fresh air, regain weight, regain their appearance, enjoy the happiness brought by chewing food again, sing freely again, and finally return to their families and society, I think this is the temperature and power of medicine.
Text/Jishuitan Xiaotangshan Rehabilitation Center Jin Shasha
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