腹部电刺激联合高频胸壁振荡对气管切开重症患者气道廓清能力的效果

doi:10.3969/j.issn.1006-9771.2022.02.015

Abstract

Abstract:

Objective To observe the effect of abdominal electrical stimulation combined with high-frequency chest wall oscillation on airway clearance ability in critical ill patients with tracheostomy. Methods From January to June, 2021, a total of 84 critical ill patients with tracheostomy in the department of Critical Care Medicine, Zhongda Hospital, Southeast University, were randomly divided into control group (n = 28),experimental group A (n = 28) and experimental group B (n = 28). All the groups received routine therapy and early activities; while high-frequency chest wall oscillation was added to experimental group A, and abdominal electrical stimulation combined with high-frequency chest wall oscillation were added to experimental group B, for two weeks. Their involuntary cough peak flow (ICPF), Clinical Pulmonary Infection Score (CPIS), diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and thickness of abdominal muscle (Tab) were measured before and after treatment. Results The improvement of CPIS, ICPF and Tab were better in the experimental group B than in the other two groups (P < 0.05). The improvement of DE and DTF were slightly better in experimental group B, however, there was no significant difference among groups (F_DE = 0.514, F_DTF = 1.582, P > 0.05). The thickness d-values of rectus abdominis, musculi obliquus internus abdominis and musculus transversus abdominis were positively correlated with the d-value of ICPF in the exprimental group B (r > 0.415, P < 0.05). ICPF was highly negatively correlated with CPIS before treatment for all the patients (r = -0.702, P < 0.001). No adverse events occurred during the intervention period. Conclusion Abdominal electrical stimulation combined with high-frequency chest wall oscillation could improve airway clearance ability in critical ill patients with tracheostomy.

Key words: tracheostomy, abdominal electrical stimulation, high-frequency chest wall oscillation, critical ill, airway clearance

CLC Number:

R562

HU Zhengyong,MA Ming,YANG Xi,YIN Jinxia,SHI Jinjun. Effect of abdominal electrical stimulation combined with high-frequency chest wall oscillation on airway clearance ability for critical ill patients with tracheostomy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(2): 232-241.

Figures/Tables 12

References 40

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项目	对照组(n = 28)	试验A组(n = 28)	试验B组(n = 28)	F/χ²值	P值
性别(男/女)/n	19/9	21/7	18/10	0.780	0.677
年龄/岁	53.11±8.53	53.21±11.17	51.18±7.56	0.433	0.650
BMI/kg•m^-2	20.95±2.43	22.29±2.50	22.38±2.50	2.929	0.059
机械通气时间/d	15.5(12,18)	11(8.25,16.5)	15(11.25,18)	4.091	0.129
APACHEII评分	11.5(9,18)	13.5(11,18)	11(10,16)	1.495	0.474
SOFA评分	6.50±1.92	6.64±1.83	7.32±2.33	1.302	0.278
GCS评分^a	6.86±2.07	6.54±2.13	6.89±1.95	0.257	0.774
病因/n
重症肺炎	10	13	14	1.256	0.534
脑出血	5	6	7	0.424	0.809
多发性创伤	6	4	4	0.686	0.710
AECOPD	7	5	3	1.948	0.378
影响呼吸功能因素/n				1.449	0.836
吸烟	7	5	5
支气管扩张	1	0	1
慢性阻塞性肺疾病	7	5	3

组别	n	治疗前	治疗后	差值(95%CI)	t值^a	P值^a
对照组	28	97.94±23.70	180.73±45.64	82.79(67.81~97.77)	-11.339	< 0.001
试验A组	28	102.59±24.33	192.24±44.76	89.65(77.40~101.90)^b	-15.108	< 0.001
试验B组	28	97.26±18.80	224.45±58.02	127.19(108.36~146.01)^c,d	-13.864	< 0.001
F值		0.469	5.789	9.899
P值		0.627	0.004	< 0.001

组别	n	治疗前	治疗后	差值(95%CI)	t值^a	P值^a
对照组	28	6.32±1.31	3.46±1.91	-2.86(-3.53~-2.18)	8.706	< 0.001
试验A组	28	6.89±1.17	2.96±1.62	-3.93(-4.57~-3.29)^b	12.569	< 0.001
试验B组	28	7.11±1.10	2.11±1.29	-5(-5.56~-4.44)^c,d	18.371	< 0.001
F值		3.240	4.979	12.323
P值		0.044	0.009	< 0.001

组别	n	治疗前	治疗后	差值	Z值^a	P值^a
对照组	28	2.00(1.25, 2.00)	0(0, 1.00)	-1.00(-2.00, -1.00)	-4.681	< 0.001
试验A组	28	2.00(1.25, 2.00)	0(0, 1.00)	-1.00(-2.00, -1.00)^b	-4.686	< 0.001
试验B组	28	2.00(1.00, 2.00)	0(0, 1.00)	-1.50(-2.00, -1.00)^c,d	-4.512	< 0.001
χ²值		0.122	0.106	0.069
P值		0.941	0.948	0.966

组别	n	治疗前	治疗后	差值(95%CI)	t值^a	P值^a
对照组	28	1.09±0.13	1.44±0.15	0.35(0.28~0.42)	-10.194	< 0.001
试验A组	28	1.06±0.13	1.44±0.14	0.38(0.30~0.46)^b	-10.188	< 0.001
试验B组	28	1.07±0.13	1.47±0.13	0.40(0.33~0.47)^c,d	-11.699	< 0.001
F值		0.405	0.552	0.514
P值		0.688	0.578	0.600

Effect of abdominal electrical stimulation combined with high-frequency chest wall oscillation on airway clearance ability for critical ill patients with tracheostomy

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组别	n	治疗前	治疗后	差值(95%CI)	t值^a	P值^a
对照组	28	30.60±3.36	36.64±3.33	6.04(4.26~7.82)	-6.970	< 0.001
试验A组	28	29.54±3.27	37.56±4.10	8.02(5.90~10.14)^b	-7.761	< 0.001
试验B组	28	30.78±3.15	38.90±4.07	8.13(6.30~9.95)^c,d	-9.140	< 0.001
F值		1.175	2.452	1.582
P值		0.314	0.092	0.212

组别	n	治疗前	治疗后	差值(95%CI)	t值^a	P值^a
对照组	28	0.54±0.11	0.59±0.12	0.05(0.04~0.07)	-6.735	< 0.001
试验A组	28	0.52±0.12	0.59±0.14	0.07(0.05~0.08)^b	-8.145	< 0.001
试验B组	28	0.49±0.12	0.59±0.13	0.11(0.09~0.12)^c,d	-12.412	< 0.001
F值		1.317	0.017	10.273
P值		0.274	0.983	< 0.001

组别	n	治疗前	治疗后	差值(95%CI)	t值^a	P值^a
对照组	28	0.38±0.07	0.40±0.07	0.02(0.01~0.03)	-3.000	0.006
试验A组	28	0.36±0.06	0.39±0.06	0.03(0.02~0.03)^b	-12.540	< 0.001
试验B组	28	0.35±0.06	0.39±0.06	0.04(0.03~0.05)^c,d	-9.441	< 0.001
F值		2.089	0.249	7.855
P值		0.130	0.780	0.001

组别	n	治疗前	治疗后	差值(95%CI)	t值^a	P值^a
对照组	28	0.48±0.11	0.49±0.12	0.01(0~0.03)	-1.872	0.072
试验A组	28	0.47±0.12	0.49±0.12	0.03(0.01~0.04)^b	-4.455	< 0.001
试验B组	28	0.45±0.11	0.50±0.12	0.06(0.04~0.07)^c,d	-8.865	< 0.001
F值		0.601	0.041	10.676
P值		0.551	0.960	< 0.001

组别	n	治疗前	治疗后	差值(95%CI)	t值^a	P值^a
对照组	28	0.23±0.04	0.26±0.04	0.03(0.03~0.04)	-13.899	< 0.001
试验A组	28	0.22±0.05	0.27±0.04	0.04(0.03~0.05)^b	-9.266	< 0.001
试验B组	28	0.22±0.04	0.28±0.04	0.06(0.06~0.07)^c,d	-19.065	< 0.001
F值		0.672	0.929	16.028
P值		0.513	0.399	< 0.001

项目	r	P值
腹直肌	0.495	0.007
腹内斜肌	0.415	0.028
腹外斜肌	0.139	0.481
腹横肌	0.597	0.001

项目	B	OR(95%CI)	P值
BMI	0.320	1.378(0.899~2.111)	0.141
APACHE II	-0.085	0.918(0.611~1.381)	0.683
SOFA	-0.140	0.869(0.557~1.355)	0.535
机械通气天数	-0.151	0.860(0.593~1.246)	0.424

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