呼吸神经肌肉双相同步刺激对神经重症气管切开呼吸机依赖患者脱机的效果

doi:10.3969/j.issn.1006-9771.2026.08.007

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (8): 938-945.doi: 10.3969/j.issn.1006-9771.2026.08.007

呼吸神经肌肉双相同步刺激对神经重症气管切开呼吸机依赖患者脱机的效果

王亚静, 孙玉景, 石莹, 王宝玉()

郑州大学附属郑州中心医院，河南郑州市 450000

收稿日期:2025-10-15 修回日期:2026-06-28 接受日期:2026-06-29 出版日期:2026-08-25 发布日期:2026-08-25
通讯作者: 王宝玉，E-mail： Wby70@126.com
作者简介:王亚静(1975-)，女，汉族，河南洛阳市人，主任医师，主要研究方向：呼吸危重症及重症康复。
王宝玉，男，主任医师，主要研究方向：急危重症救治及高级生命支持。
基金资助:
河南省医学科技攻关计划联合共建项目(LHGJ20220861)

Effect of respiratory neuromuscular biphasic synchronous stimulation on weaning from ventilator dependence in patients with severe neurological disorders undergoing tracheotomy

Wang Yajing, Sun Yujing, Shi Ying, Wang Baoyu()

Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, China

Received:2025-10-15 Revised:2026-06-28 Accepted:2026-06-29 Published:2026-08-25 Online:2026-08-25
Contact: Wang Baoyu，E-mail： Wby70@126.com
Supported by:
Henan Provincial Medical Science and Technology Breakthrough Program Joint Construction Project(LHGJ20220861)

摘要/Abstract

摘要：

目的探讨呼吸神经肌肉双相同步刺激对神经重症气管切开呼吸机依赖患者脱机的影响。

方法 2023年5月至2025年3月郑州大学附属郑州中心医院收治的神经重症气管切开呼吸机依赖患者94例，随机分为对照组(n = 47)和观察组(n = 47)。对照组采用常规治疗和综合康复，观察组在此基础上，联合呼吸神经肌肉双相同步刺激治疗。治疗前及治疗2周、4周后，比较两组氧合指数(PaO₂/FiO₂)、膈肌移动度、膈肌增厚率、最大吸气压(MIP)、最大呼气压(MEP)、机械通气时间和脱机成功率。

结果对照组2例死亡，1例失访；观察组1例死亡。治疗前两组各项指标无显著性差异(P > 0.05)；治疗2周、4周后，两组PaO₂/FiO₂、膈肌移动度、膈肌增厚率、MIP和MEP均随时间延长显著改善(F > 23.632, P < 0.001)，且观察组优于对照组(P < 0.05)。观察组机械通气时间低于对照组(t = 2.287, P < 0.05)，脱机成功率高于对照组(χ² = 4.622, P < 0.05)。

结论呼吸神经肌肉双相同步刺激可能有助于促进神经重症气管切开呼吸机依赖患者呼吸肌肌力恢复，缩短机械通气时间，提高脱机成功率。

关键词: 呼吸神经肌肉双相同步刺激, 机械通气, 神经重症, 呼吸机依赖

Abstract:

Objective To explore the effect of respiratory neuromuscular biphasic synchronous stimulation on weaning from ventilator dependence in patients with severe neurological disorders undergoing tracheotomy.

Methods From May, 2023 to March, 2025, 94 critically ill patients with nerve related tracheostomy and ventilator dependence admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University were randomly divided into control group (n = 47) and observation group (n = 47). The control group received conventional treatment and comprehensive rehabilitation, while the observation group received respiratory nerve and muscle biphasic synchronous stimulation therapy on this basis. The oxygenation index (PaO₂/FiO₂), diaphragm mobility, diaphragm thickening rate, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), mechanical ventilation time and weaning success rate were compared before, and two and four weeks after treatment.

Results Three cases in the control group and one in the observation group were dropped out. There was no significant difference in various indicators between two groups before treatment (P > 0.05). Two and four weeks after treatment, PaO₂/FiO₂, diaphragm movement, diaphragm thickening rate, MIP and MEP improved with the prolongation of time in both groups (F > 23.632,P < 0.001), and they were better in the observation group than in the control group (P < 0.05). The mechanical ventilation time was shorter (t = 2.287, P < 0.05) and the success rate of weaning was higher (χ² = 4.622, P < 0.05) in the observation group than in the control group.

Conclusion The respiratory neuromuscular biphasic synchronous stimulation can be applied to patients with severe neurological conditions who are dependent on tracheotomy ventilators, to accelerate the recovery of respiratory muscle strength, shorten the duration of mechanical ventilation, and increase the success rate of weaning from the ventilator.

Key words: respiratory neuromuscular biphasic synchronous stimulation, mechanical ventilation, neurological critical illness, ventilators dependence

中图分类号:

R742

王亚静, 孙玉景, 石莹, 王宝玉. 呼吸神经肌肉双相同步刺激对神经重症气管切开呼吸机依赖患者脱机的效果[J]. 《中国康复理论与实践》, 2026, 32(8): 938-945.

Wang Yajing, Sun Yujing, Shi Ying, Wang Baoyu. Effect of respiratory neuromuscular biphasic synchronous stimulation on weaning from ventilator dependence in patients with severe neurological disorders undergoing tracheotomy[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(8): 938-945.

图/表 11

表1

表2

表3

表4

表5

表6

表7

表8

表9

表10

表11

参考文献 29

[1]	Rea Á, Bern R S, Oliver M C, et al. Epidemiology and disease burden of patients requiring neurocritical care: a brazilian multicentre cohort study[J]. Sci Rep, 2023, 13(1): 18595. doi: 10.1038/s41598-023-44261-w
[2]	Valery L, Feigin T. Global burden of neurological disorders: from global burden of disease estimates to actions[J]. Neuroepidemiology, 2019, 52: 1-2. doi: 10.1159/000495197 pmid: 30472717
[3]	Pu L, Zhu B, Jing L, et al. Weaning critically ill patients from mechanical ventilation: a prospective cohort study[J]. J Crit Care, 2015, 30(4): 7-13. doi: 10.1016/j.jcrc.2014.08.013
[4]	Burns K E A, Rizvi L, Cook D J, et al. Ventilator weaning and discontinuation practices for critically ill patients[J]. JAMA, 2021, 325(12): 1173-1184. doi: 10.1001/jama.2021.2384 pmid: 33755077
[5]	Schreiber A F, Ceriana P, Ambrosino N. Physiotherapy and weaning from prolonged mechanical ventilation[J]. Respir Care, 2019, 64(1): 17-25. doi: 10.4187/respcare.06280 pmid: 30206129
[6]	Devaraja K, Majitha C S, Pujary K. A simplified protocol for tracheostomy decannulation in patients weaned off prolonged mechanical ventilation[J]. Int Arch Otorhinolaryngol, 2024, 28(2): 211-218.
[7]	Dolinay T, Hsu L, Maller A, et al. Ventilator weaning in prolonged mechanical ventilation: a narrative review[J]. J Clin Med, 2024, 13(7): 1909. doi: 10.3390/jcm13071909
[8]	Huang C. The survival outcomes of patients requiring prolonged mechanical ventilation[J]. Medicina, 2023, 59(3): 614. doi: 10.3390/medicina59030614
[9]	David B, Seder A, Jagoda B. Emergency neurological life support: airway, ventilation, and sedation[J]. Neurocrit Care, 2015, 12(4): S5-S22.
[10]	Powers S K, Wiggs M P, Sollaner K J, et al. Ventilator induced diaphragm dysfunction: cause and effect[J]. Am J Physiol Regul Integr Comp Physiol, 2013, 30(5): 464-477.
[11]	Evans D, Shure D, Clark L, et al. Temporary transvenous diaphragm pacing vs. standard of care for weaning from mechanical ventilation: study protocol for a randomized trial[J]. Trials, 2019, 20(1): 1-13. doi: 10.1186/s13063-018-3101-x
[12]	Sieck G C, Fogarty M J. Diaphragm muscle: a pump that can not fail[J]. Physiol Rev, 2025, 105(4): 2589-2656. doi: 10.1152/physrev.00043.2024 pmid: 40643074
[13]	Tuinman P R, et al. Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients: a narrative review[J]. Intensive Care Med, 2020, 46(4): 594-605. doi: 10.1007/s00134-019-05892-8 pmid: 31938825
[14]	Verges Y, Sager C, Erni S. Expiratory muscle fatigue impairs exercise performance[J]. Eur J Appl Physiol, 2007, 101: 225-232. pmid: 17546459
[15]	Coiffard B, Dianti J, Telias I, et al. Dyssynchronous diaphragm contractions impair diaphragm function in mechanically ventilated patients[J]. Crit Care, 2024, 28(1): 107. doi: 10.1186/s13054-024-04894-3
[16]	Xu C, Yang F, Wang Q, et al. Effect of respiratory neuromuscular electrical stimulation in critically ill adults with mechanical ventilation: a systematic review and network meta-analysis[J]. BMC Pulm Med, 2024, 24(1): 56. doi: 10.1186/s12890-024-02854-9
[17]	Zhao Z, Sun W, Zhao X Y, et al. Stimulation of both inspiratory and expiratory muscles versus diaphragm-only paradigm for rehabilitation in severe chronic obstructive pulmonary disease patients: a randomized controlled pilot study[J]. Eur J Phys Rehabil Med, 2022, 58(3): 487-496.
[18]	中华医学会神经外科学分会, 中国神经外科重症管理协作组. 中国神经外科重症管理专家共识(2020版)[J]. 中华医学杂志, 2020, 100(19): 1443-1458.
[19]	Kaut A, Sharma S, Singh V P, et al. Sonographic assessment of diaphragmatic thickening and excursion as predictors of weaning success in the intensive care unit: a prospective observational study[J]. Indian J Anaesth, 2022, 66(11): 776-782. doi: 10.4103/ija.ija_312_22 pmid: 36590197
[20]	Boussuges A, Rives S, Finance J, et al. Ultrasound assessment of diaphragm thickness and thickening: reference values and limits of normality when in a seated position[J]. Front Med, 2021, 8(10): 742-750.
[21]	王明. 呼吸神经肌肉刺激仪联合正压机械通气应用于呼吸衰竭患者的疗效及对其动脉血气指标水平的影响状况分析[J]. 中国医疗器械信息, 2024, 30(7): 129-131.
	Wang M. Effect of respiratory neuromuscular stimulator combined with positive pressure mechanical ventilation on patients with respiratory failure and its influence on arterial blood gas index level[J]. Chin Med Dev Inf, 2024, 30(7): 129-131.
[22]	Gollee H, Hunt K J, Allan D B, et al. Automatic electrical stimulation of abdominal wall muscles increases tidal volume and cough peak flow in tetraplegia[J]. Technol Health Care, 2008, 16(4): 273-281. pmid: 18776604
[23]	Miller S N, Mueller M, Nichols M, et al. RESP-FIT: a technology-enhanced combined inspiratory and expiratory muscle strength training intervention for adults with COPD[J]. Chronic Obstr Pulm Dis, 2024, 11(6): 569-581. doi: 10.15326/jcopdf.2024.0523 pmid: 39357505
[24]	Chen Y J, Li P J, Wang J, et al. Assessments and targeted rehabilitation therapies for diaphragmatic dysfunction in patients with chronic obstructive pulmonary disease: a narrative review[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17(1): 457-473. doi: 10.2147/COPD.S338583
[25]	Yamamoto T, Mori T, Yamaguchi S, et al. Relationship between diaphragm thickness, thickening fraction, dome excursion, and respiratory pressures in healthy subjects: an ultrasound study[J]. Lung, 2024, 202(2): 171-178. doi: 10.1007/s00408-024-00686-2 pmid: 38520532
[26]	Fristh S J, Siemer A G. Diaphragm ultrasound in patients with prolonged weaning from mechanical ventilation[J]. Quant Imaging Med Surg, 2024, 14(5): 3248-3263. doi: 10.21037/qims
[27]	Al-Husinat L, Joryyeh B, Rawashdeh A, et al. The role of ultrasonography in the process of weaning from mechanical ventilation in critically ill patients[J]. Diagnostics, 2024, 14(3): 1-19. doi: 10.3390/diagnostics14010001
[28]	Nakai H, Hirata Y, Furue H, et al. Electrical stimulation mitigates muscle degradation shift in gene expressions during 12-h mechanical ventilation[J]. Sci Rep, 2023, 13(5): 1123-1132. doi: 10.1038/s41598-023-28032-1
[29]	Kumru H, Garcia L, Ros A, et al. Transcutaneous spinal cord stimulation improves respiratory muscle strength and function in subjects with cervical spinal cord injury: original research[J]. Biomedicines, 2023, 11(8): 2121. doi: 10.3390/biomedicines11082121

组别	n	性别(男/女)/n	年龄/岁	体质量指数/(kg·m^-2)	CPIS	机械通气时间/d
对照组	47	30/17	69.23±11.44	24.43±2.50	9.32±1.32	14.49±4.48
观察组	47	32/15	70.91±14.17	24.34±1.98	9.04±1.27	13.91±3.23
t/χ²值		0.190	-0.633	0.183	1.036	0.713
P值		0.828	0.528	0.855	0.303	0.478

组别	n	干预前		干预后2周		干预后4周
组别	n	均值	标准差	均值	标准差	均值	标准差
对照组	44	231.77	74.50	252.86	71.89	290.91	51.70
观察组	46	238.39	85.86	304.41	97.94	337.04	135.69

效应	平方和	自由度	均方	F值	P值
组内	280968.06	1.775	158318.27	23.632	< 0.001
组间	81552.09	1.000	81552.09	6.728	0.011
组内×组间	27058.64	1.775	15246.85	3.158	0.047

组别	组别	平均差值	P值	95%CI
组别	组别	平均差值	P值	下限	上限
对照组干预前	观察组干预前	-6.619	0.698	-40.355	27.118
对照组干预后2周	观察组干预后2周	-51.549	0.006	-87.672	-15.427
对照组干预后4周	观察组干预后4周	-46.134	0.037	-89.525	-2.744

变量	组别	n	干预前		干预后2周		干预后4周
变量	组别	n	均值	标准差	均值	标准差	均值	标准差
膈肌移动度/cm	对照组	44	1.52	0.27	1.58	0.27	1.72	0.25
	观察组	46	1.60	0.30	1.80	0.30	1.89	0.33
膈肌增厚率/%	对照组	44	38.27	7.18	43.30	8.44	51.20	7.81
	观察组	46	38.80	10.95	48.89	9.90	57.43	9.23

呼吸神经肌肉双相同步刺激对神经重症气管切开呼吸机依赖患者脱机的效果

Effect of respiratory neuromuscular biphasic synchronous stimulation on weaning from ventilator dependence in patients with severe neurological disorders undergoing tracheotomy

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 11

参考文献 29

相关文章 6

Metrics

本文评价

推荐阅读 0

变量	效应	平方和	自由度	均方	F值	P值
膈肌移动度	组内	2.697	1.571	1.716	25.213	< 0.001
	组间	1.681	1.000	1.681	9.484	0.003
	组内×组间	0.196	1.568	0.125	3.559	0.033
膈肌增厚率	组内	1.121	1.805	0.621	164.342	< 0.001
	组间	0.114	1.000	0.114	6.103	0.015
	组内×组间	0.044	1.833	0.024	5.739	0.005

变量	效应	平方和	自由度	均方	F值	P值
MIP	组内	3978.48	1.625	2448.59	80.269	< 0.001
	组间	406.26	1.000	406.26	4.550	0.036
	组内×组间	262.93	1.625	161.82	9.649	< 0.001
MEP	组内	6448.69	1.599	4031.71	122.873	< 0.001
	组间	1002.83	1.000	1002.83	6.642	0.012
	组内×组间	241.14	1.599	150.76	4.512	0.014

组别	n	机械通气时间/d	脱机成功率/%
对照组	44	35.50±18.37	54.55
观察组	46	25.02±12.15	76.09
t/χ²值		2.287	4.622
P值		0.025	0.032

[1]	中国残疾人康复协会神经康复专业委员会, 中国康复研究中心. 神经重症气管切开患者气道功能康复与管理专家共识(2024)[J]. 《中国康复理论与实践》, 2024, 30(8): 869-881.
[2]	毛晶,唐晓晓,郑瑶,张金牛,阚秀丽,吴建贤. 重症机械通气患者早期个体化康复的效果[J]. 《中国康复理论与实践》, 2022, 28(6): 710-715.
[3]	吴雨晨, 丁楠楠, 姜变通, 张志刚, 张彩云, 岳伟岗, 田金徽. 阈值负荷吸气肌训练对呼吸肌功能影响的Meta分析[J]. 《中国康复理论与实践》, 2019, 25(10): 1150-1161.
[4]	孙宝君;赵红梅;邹琳;刘长庭;俞森洋. 慢性阻塞性肺疾病长期机械通气患者血清睾酮、CD₄⁺/CD₈⁺ T细胞的变化 [J]. 《中国康复理论与实践》, 2005, 11(07): 568-569.
[5]	李培兰;王勇 . 43例心肌梗死患者机械通气疗效观察 [J]. 《中国康复理论与实践》, 2004, 10(02): 96-97.
[6]	李培兰;孟申综述;田汨审校. 心脏疾患与机械通气 [J]. 《中国康复理论与实践》, 2004, 10(01): 46-47.

变量	组别	n	干预前		干预后2周		干预后4周
变量	组别	n	均值	标准差	均值	标准差	均值	标准差
MIP	对照组	44	31.82	6.55	34.55	6.54	39.82	5.60
	观察组	46	31.75	7.45	39.28	5.82	42.52	6.37
MEP	对照组	44	37.09	5.33	40.73	6.55	46.66	8.76
	观察组	46	38.78	5.59	44.30	8.52	52.96	10.97