基于超声的脑卒中患者膈肌功能的特征分析

doi:10.3969/j.issn.1006-9771.2026.07.003

摘要/Abstract

摘要：

目的采用超声技术评估脑卒中对患者膈肌功能的影响。

方法 2024年4月至2025年6月，于首都医科大学宣武医院招募脑卒中患者40例(卒中组)，不定向招募性别和年龄匹配的健康受试者40例(对照组)，采用超声评估两组平静呼吸和深呼吸时膈肌移动度、膈肌厚度，并计算膈肌增厚比。将卒中组按病程分为≤ 30 d组和> 30 d组进行亚组分析。

结果无论平静呼吸还是深呼吸时，卒中组患侧膈肌移动度小于健侧和对照组(P < 0.05)。平静呼吸时，卒中组患侧膈肌增厚比小于健侧和对照组(P < 0.05)，健侧膈肌增厚比明显小于对照组(P < 0.01)；深呼吸时，卒中组双侧膈肌增厚比显著小于对照组(P < 0.001)；深呼吸时，双侧吸气末膈肌厚度显著小于对照组(P < 0.001)。平静呼吸时，≤ 30 d组和> 30 d组的膈肌移动度小于对照组(P < 0.05)；深呼吸时，≤ 30 d组的膈肌移动度小于对照组(P < 0.05)；无论在平静呼吸还是深呼吸时，≤ 30 d组和> 30 d组膈肌增厚比均小于对照组(P < 0.05)。深呼吸时，≤ 30 d组和 > 30 d组的吸气末膈肌厚度均明显小于对照组(P < 0.01)。

结论超声可以有效识别脑卒中对患者膈肌功能的影响；脑卒中患者患侧膈肌移动度和收缩性能同时下降，而健侧膈肌收缩性能下降。

关键词: 脑卒中, 膈肌功能障碍, 超声

Abstract:

Objective To evaluate the impact of stroke on diaphragmatic function by ultrasound.

Methods From April, 2024 to June, 2025, 40 stroke patients (stroke group) were recruited in Xuanwu Hospital Capital Medical University. Additionally, 40 sex- and age-matched healthy subjects (control group) were recruited without directional selection. Diaphragmatic excursion and diaphragmatic thickness during quiet breathing and deep breathing were assessed using ultrasound in both groups, and the diaphragmatic thickening fraction was calculated. The stroke group was further divided into two subgroups according to disease course: ≤ 30 days group and > 30 days group, for subgroup analysis.

Results During both quiet and deep breathing, diaphragmatic excursion on the affected side in the stroke group was smaller than that on the unaffected side and in the control group (P < 0.05). During quiet breathing, diaphragmatic thickening fraction on the affected side in the stroke group was smaller than that on the unaffected side and in the control group (P < 0.05), while the diaphragmatic thickening fraction on the unaffected side was significantly smaller than that in the control group (P < 0.01). During deep breathing, the bilateral diaphragmatic thickening fraction in the stroke group was significantly smaller than that in the control group (P < 0.001), and the bilateral end-inspiratory diaphragmatic thickness was significantly smaller than that in the control group (P < 0.001). During quiet breathing, diaphragmatic excursion in both the ≤ 30 d group and the > 30 d group was smaller than that in the control group (P < 0.05); during deep breathing, diaphragmatic excursion in the ≤ 30 d group was smaller than that in the control group (P < 0.05). In both quiet breathing and deep breathing, the diaphragmatic thickening fraction in the ≤ 30 d group and the >30 d group were lower than those in the control group (P < 0.05). During deep breathing, end-inspiratory diaphragmatic thickness in both the ≤ 30 d group and the > 30 d group was significantly smaller than that in the control group (P < 0.01).

Conclusion Ultrasound can effectively identify the impact of stroke on patients' diaphragmatic function. In stroke patients, both diaphragmatic excursion and contractile performance are reduced on the affected side, while contractile performance is also reduced on the unaffected side.

Key words: stroke, diaphragmatic dysfunction, ultrasound

中图分类号:

R743.3

单桂香, 杜巨豹, 曹磊, 叶琳琳, 姜春静, 张晔, 马慧娟, 宋为群. 基于超声的脑卒中患者膈肌功能的特征分析[J]. 《中国康复理论与实践》, 2026, 32(7): 760-767.

Shan Guixiang, Du Jubao, Cao Lei, Ye Linlin, Jiang Chunjing, Zhang Ye, Ma Huijuan, Song Weiqun. Characteristics of diaphragmatic function in stroke patients based on ultrasound[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(7): 760-767.

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组别	n	性别(男/女)/n	年龄/岁	吸烟(是/否)/n	BMI/(kg·m^-2)
对照组	40	28/12	58.45±8.15	13/27	25.02±1.45
卒中组	40	26/14	60.25±9.45	15/25	24.82±3.05
χ²/t值		0.228	0.912	0.220	-0.391
P值		0.633	0.364	0.639	0.697

项目	组别		平均值差	P值	95%置信区间
项目	组别		平均值差	P值	下限	上限
平静呼吸膈肌移动度	患侧	健侧	-0.285	0.005	-0.499	-0.070
	患侧	对照组	-0.283	0.002	-0.473	-0.092
	健侧	对照组	0.002	1.000	-0.172	0.176
深呼吸膈肌移动度	患侧	健侧	-0.746	0.031	-1.439	-0.052
	患侧	对照组	-0.925	0.005	-1.619	-0.232
	健侧	对照组	-0.180	1.000	-0.873	0.514
平静呼吸膈肌增厚比	患侧	健侧	-0.076	0.017	-0.142	-0.011
	患侧	对照组	-0.164	< 0.001	-0.219	-0.108
	健侧	对照组	-0.087	0.001	-0.145	-0.030
深呼吸膈肌增厚比	患侧	健侧	-0.211	0.448	-0.591	0.170
	患侧	对照组	-1.011	< 0.001	-1.347	-0.674
	健侧	对照组	-0.800	< 0.001	-1.128	-0.472
深呼吸吸气末膈肌厚度	患侧	健侧	-0.018	0.770	-0.069	0.033
	患侧	对照组	-0.132	< 0.001	-0.175	-0.089
	健侧	对照组	-0.114	< 0.001	-0.154	-0.073

项目	组别		平均值差	P值	95%置信区间
项目	组别		平均值差	P值	下限	上限
平静呼吸膈肌移动度	≤ 30 d组	> 30 d组	0.148	0.655	-0.212	0.508
	≤ 30 d组	对照组	-0.232	0.039	-0.455	-0.010
	> 30 d组	对照组	-0.380	0.021	-0.708	-0.052
深呼吸膈肌移动度	≤ 30 d组	> 30 d组	-0.409	0.830	-1.778	0.961
	≤ 30 d组	对照组	-1.069	0.006	-1.874	-0.264
	> 30 d组	对照组	-0.660	0.412	-1.884	-0.052
平静呼吸膈肌增厚比	≤ 30 d组	> 30 d组	0.041	0.577	-0.048	0.130
	≤ 30 d组	对照组	-0.150	< 0.001	-0.220	-0.079
	> 30 d组	对照组	-0.191	< 0.001	-0.264	-0.117
深呼吸膈肌增厚比	≤ 30 d组	> 30 d组	-0.224	0.798	-0.937	0.490
	≤ 30 d组	对照组	-1.088	< 0.001	-1.426	-0.751
	> 30 d组	对照组	-0.865	0.013	-1.559	-0.170
平静呼吸吸气末膈肌厚度	≤ 30 d组	> 30 d组	0.005	0.667	-0.019	0.030
	≤ 30 d组	对照组	-0.019	0.050	-0.038	0.000
	> 30 d组	对照组	-0.024	0.041	-0.048	-0.001
深呼吸吸气末膈肌厚度	≤ 30 d组	> 30 d组	-0.001	1.000	-0.083	0.082
	≤ 30 d组	对照组	-0.133	< 0.001	-0.186	-0.080
	> 30 d组	对照组	-0.133	0.001	-0.205	-0.060