膈神经电刺激联合呼吸训练对脑卒中患者肺功能、躯干稳定性及平衡功能的影响

The effect of phrenic nerve electrical stimulation combined with respiratory training on lung function and on the trunk stability and balance of stroke survivors

目的观察膈神经电刺激联合呼吸训练对脑卒中患者肺功能、躯干稳定性及平衡功能的影响。方法采用随机数字表法将56例脑卒中患者分为观察组及对照组，每组28例。对照组患者给予常规康复干预（包括物理因子治疗及肢体综合训练），观察组患者在此基础上辅以膈神经电刺激及呼吸训练，每天治疗1次。于治疗前、治疗6周后分别采用用力肺活量（FVC）、1秒用力呼气量（FEV1）及呼气峰流速（PEF）评估患者肺功能，采用Sheikh躯干控制评分量表（TCT）、Berg平衡功能量表（BBS）评估患者躯干功能及平衡功能改善情况。结果治疗6周后观察组FVC[（4．21±0．49）L]、FEV1[（3．78±0．49）L／s]及PEF[（6．44±0．69）L／s]均较治疗前及对照组明显增高（P〈0．05）。治疗后2组患者TCT评分、BBS评分均较治疗前明显提高（P〈0．05）；并且治疗后观察组患者TCT评分[（71．88±14．86）分]、BBS评分[（50．44±4．72）分]亦显著优于对照组水平（P〈0．05）。结论在传统康复干预基础上辅以膈神经电刺激及呼吸训练，能进一步改善脑卒中患者肺功能及平衡功能，该联合疗法值得临床推广、应用。

Objective To observe the effect of phrenic nerve electrical stimulation combined with respirato- ry training on the pulmonary function, trunk stability and balance of stroke survivors. Methods Thirty-six stroke survivors were randomly divided into a control group and a training group, each of 28. Both groups were given routine rehabilitation treatment （including physical agent therapy and combined training of the limbs） , while the training group was additionally provided with phrenic nerve electrical stimulation combined with respiratory training once a day for six weeks. Before and after the treatment, the forced vital capacity （FVC） , forced expiratory volume in one second （FEV1 ） and peak expiratory flow （PEF） of both groups were recorded. The Sheikh trunk control scale （TCT） was used to quantify their trunk stability, and balance was quantified using the Berg balance function scale （BBS）. Results After six weeks of treatment the average FVC, FEV1 and PEF values of the training group were significantly higher than before the treatment, and significantly better than those of the control group after the treatment. Moreover, significant improvement was observed in the average TCT and BBS scores of both groups after the intervention, with the training group＇s average significantly higher than that of the control group. Conclusion Phrenic nerve electrical stimulation combined with respiratory training can further improve the pulmonary function and balance function of stroke survivors as a supplement to routine rehabilitation treatment. Therefore, it is worth popularizing in clinical practice.