体外膈肌起搏治疗联合腹肌电刺激对脑卒中患者呼吸功能的效果

doi:10.3969/j.issn.1006-9771.2023.01.016

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (1): 104-109.doi: 10.3969/j.issn.1006-9771.2023.01.016

体外膈肌起搏治疗联合腹肌电刺激对脑卒中患者呼吸功能的效果

乔魏¹^,², 刘苏¹(), 王莹¹, 侯婷婷¹^,², 宋思瑾¹^,², 王司晔¹, 孙丽¹, 张莹莹¹

1.南通大学附属医院康复医学科，江苏南通市 226001
2.大连医科大学，辽宁大连市 116044

收稿日期:2022-10-13 修回日期:2022-11-14 出版日期:2023-01-25 发布日期:2023-02-17
通讯作者: 刘苏(1977-)，女，汉族，江苏扬州市人，博士，副教授、副主任医师，硕士研究生导师，主要研究方向：中枢神经系统损伤与修复， E-mail： 327202278@qq.com。
作者简介:乔魏(1996-)，女，汉族，河南长垣县人，硕士研究生，主要研究方向：肺康复，神经康复。
基金资助:
南通市科技计划项目(MSZ2022116);南通市科技计划项目(MSZ19240)

Effect of external diaphragm pacing therapy combined with abdominal functional electrical stimulation on respiratory function for stroke patients

QIAO Wei¹^,², LIU Su¹(), WANG Ying¹, HOU Tingting¹^,², SONG Sijin¹^,², WANG Siye¹, SUN Li¹, ZHANG Yingying¹

1. Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
2. Dalian Medical University, Dalian, Liaoning 116044, China

Received:2022-10-13 Revised:2022-11-14 Published:2023-01-25 Online:2023-02-17
Contact: LIU Su, E-mail: 327202278@qq.com
Supported by:
Nantong Science and Technology Program(MSZ2022116);Nantong Science and Technology Program(MSZ19240)

摘要/Abstract

摘要：

目的探讨体外膈肌起搏治疗联合腹肌电刺激对脑卒中患者呼吸功能的疗效。

方法选取2020年10月至2022年9月南通大学附属医院康复医学科脑卒中患者54例，随机分为对照组(n = 18)、体外膈肌起搏组(n = 18)和联合治疗组(n = 18)。3组均接受常规呼吸训练，体外膈肌起搏组增加体外膈肌起搏治疗，联合治疗组联合应用体外膈肌起搏和腹肌电刺激治疗，共2周。治疗前后采用肺功能检测仪检测用力肺活量(FVC)、第1秒用力呼气容积(FEV₁)、第1秒用力呼气容积占用力肺活量的百分比(FEV₁/FVC)、呼气峰流速(PEF)、最大吸气压(MIP)和最大呼气压(MEP)，超声检测膈肌活动度和膈肌厚度。

结果对照组3例、体外膈肌起搏组2例、联合治疗组1例脱落。治疗后，3组FVC、FEV₁、PEF、MIP、MEP和膈肌活动度均有明显改善(|t| > 3.366, P < 0.01)，联合治疗组和体外膈肌起搏组FVC、FEV₁、MIP和膈肌活动度优于对照组(P < 0.05)，联合治疗组FVC和FEV₁高于体外膈肌起搏组(P < 0.05)。

结论体外膈肌起搏治疗可以改善脑卒中患者的肺通气和吸气肌肌力，膈肌运动增强；联合腹肌电刺激后肺通气功能改善更为显著。

关键词: 脑卒中, 体外膈肌起搏, 腹肌, 电刺激, 呼吸功能

Abstract:

Objective To explore the effect of external diaphragm pacing therapy combined with abdominal functional electrical stimulation on respiratory function for stroke patients.

Methods From October, 2020 to September, 2022, 54 stroke patients were randomly divided into control group (n= 18), external diaphragm pacing group (n= 18) and combined treatment group (n= 18). All the groups received breathing training, while the external diaphragm pacing group received external diaphragm pacing therapy, and the combined treatment group received external diaphragm pacing and abdominal functional electrical stimulation therapy, for two weeks. They were measured forced vital capacity (FVC), forced expiratory volume in first second (FEV₁), ratio of forced expiratory volume in first second in forced vital capacity (FEV₁/FVC), peak expiratory flow (PEF), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) with pulmonary function instrument; measured diaphragmatic excursion (DE) and diaphragmatic thickness (DT) with ultrasound, before and after treatment.

Results Three cases in the control group, two cases in the external diaphragm pacing group and one case in the combined treatment group dropped off. The FVC, FEV₁, PEF, MIP, MEP and DE improved in all the groups (|t| > 3.366, P< 0.01) after treatment; and the FVC, FEV₁, MIP and DE increased more in the combined treatment group and the external diaphragm pacing group than in the control group (P< 0.05); the FVC and FEV₁ increased more in the combined treatment group than in the external diaphragm pacing group (P< 0.05).

Conclusion External diaphragm pacing therapy may improve ventilation and inspiratory muscle strength, and increase diaphragm movement for stroke patients; while the ventilation improved more after combining with abdominal functional electrical stimulation.

Key words: stroke, external diaphragm pacing, abdominal muscles, electrical stimulation, respiratory function

中图分类号:

R743.3

乔魏, 刘苏, 王莹, 侯婷婷, 宋思瑾, 王司晔, 孙丽, 张莹莹. 体外膈肌起搏治疗联合腹肌电刺激对脑卒中患者呼吸功能的效果[J]. 《中国康复理论与实践》, 2023, 29(1): 104-109.

QIAO Wei, LIU Su, WANG Ying, HOU Tingting, SONG Sijin, WANG Siye, SUN Li, ZHANG Yingying. Effect of external diaphragm pacing therapy combined with abdominal functional electrical stimulation on respiratory function for stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(1): 104-109.

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项目	对照组(n = 15)	EDP组(n = 16)	联合治疗组(n = 17)	χ²/F值	P值
性别(男/女)/n	9/6	12/4	14/3	2.003	0.395
年龄/岁	61.47±3.00	59.31±3.45	56.41±3.36	0.594	0.556
BMI/(kg·m^-2) 病程/d 吸烟(无/有)/n 高血压(无/有)/n 糖尿病(无/有)/n 吞咽困难(无/有)/n	23.80±0.90 24.93±5.31 12/3 4/11 9/6 5/10	22.88±0.72 22.63±2.86 9/7 5/11 13/3 6/10	24.69±0.99 20.29±2.06 13/4 4/13 12/5 6/11	1.095 0.428 2.359 0.345 1.686 0.059	0.343 0.655 0.320 0.920 0.485 0.971

组别	n	治疗前	治疗后	t值	P值
对照组	15	1.57±0.16	1.89±0.14	-5.736	< 0.001
EDP组	15	1.76±0.15	2.39±0.15^a	-5.356	< 0.001
联合治疗组	16	1.99±0.17	2.91±0.18^a,b	-8.341	< 0.001
F值 P值		1.735 0.189	10.450 < 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	15	1.15±0.12	1.44±0.11	-4.257	0.001
EDP组	15	1.32±0.10	1.85±0.10^a	-9.075	< 0.001
联合治疗组	16	1.51±0.14	2.23±0.14^a,b	-7.435	< 0.001
F值 P值		2.144 0.130	11.414 < 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	15	0.75±0.04	0.77±0.04	-0.890	0.388
EDP组	15	0.76±0.03	0.80±0.04	-0.741	0.471
联合治疗组	16	0.77±0.04	0.79±0.04	-0.688	0.502
F值 P值		0.063 0.939	0.082 0.921

组别	n	治疗前	治疗后	t值	P值
对照组	15	1.70±0.19	2.23±0.24	-3.366	0.005
EDP组	15	1.87±0.15	2.80±0.23	-5.415	< 0.001
联合治疗组	16	2.23±0.23	3.03±0.30	-4.883	< 0.001
F值 P值		1.971 0.152	2.467 0.097

体外膈肌起搏治疗联合腹肌电刺激对脑卒中患者呼吸功能的效果

Effect of external diaphragm pacing therapy combined with abdominal functional electrical stimulation on respiratory function for stroke patients

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组别	n	治疗前	治疗后	t值	P值
对照组	15	21.20±1.98	27.07±2.26	-3.454	0.004
EDP组	15	23.07±2.76	39.07±2.92^a	-10.328	< 0.001
联合治疗组	16	21.94±1.93	41.50±2.55^a	-10.838	< 0.001
F值 P值		0.172 0.843	8.844 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	15	26.47±2.63	38.27±3.44	-7.172	< 0.001
EDP组	15	28.60±2.45	45.20±3.73	-6.642	< 0.001
联合治疗组	16	34.63±3.33	50.75±4.71	-7.681	< 0.001
F值 P值		2.235 0.119	2.425 0.100

组别	n	治疗前	治疗后	t值	P值
对照组	15	1.32±0.06	1.53±0.08	-4.101	0.001
EDP组	16	1.34±0.10	1.90±0.09^a	-6.049	< 0.001
联合治疗组	17	1.36±0.08	1.92±0.15^a	-5.343	< 0.001
F值 P值		0.056 0.945	3.787 0.030

组别	n	治疗前	治疗后	t值	P值
对照组	15	0.18±0.01	0.19±0.01	-1.408	0.181
EDP组	16	0.17±0.01	0.18±0.01	-1.040	0.315
联合治疗组	17	0.19±0.01	0.21±0.01	-1.892	0.077
F值 P值		1.185 0.315	1.431 0.250

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