联合刺激吸气和呼气肌群对COPD稳定期患者肺康复的价值

Combined stimulation of inspiratory and expiratory muscles for pulmonary rehabilitation in stable COPD patients

目的研究体外膈肌和腹肌联合刺激在稳定期慢性阻塞性肺疾病(COPD)患者中的应用效果。方法以“慢性阻塞性肺疾病全球倡议2017版(GOLD 2017)”标准确诊的COPD稳定期患者为研究对象,选取96例稳定期COPD患者,第一秒用力呼气量(FEV1)<50%预计值,以随机数字表法分为药物治疗组(n=32)、单独膈肌刺激组(膈肌刺激组,n=34)以及膈肌、腹肌联合刺激组(联合刺激组,n=30)。药物治疗组采用一般呼吸锻炼、健康教育及常规药物治疗,膈肌刺激组在常规药物治疗的同时进行体外膈肌起搏器刺激治疗,而联合刺激组在常规药物治疗同时进行对膈肌、腹肌的联合刺激治疗,电刺激强度为40 Hz,治疗时间30 min,治疗周期20 d。20 d后对患者肺功能FEV1、用力肺活量(FVC)、每分钟最大通气量(MVV)、呼气峰流速(PEF)、6分钟步行距离(6MWD)及双侧膈肌活动度等指标进行监测。结果联合刺激组双侧膈肌活动度大于其他2组(P<0.05),膈肌刺激组膈肌活动度亦大于药物治疗组(P<0.05)。联合刺激组患者FEV1、FVC、MVV、PEF和6MWD均优于其他2组(P<0.05),且膈肌刺激组患者此5项指标亦优于药物治疗组(P<0.05)。结论对COPD稳定期患者进行体外膈肌和腹肌联合刺激,可以作为一种改善COPD患者肺功能和生活质量的新方法。

Objective To study the effect of external diaphragm and abdominal muscle stimulation in patients with stable chronic obstructive pulmonary disease(COPD).Methods Ninety-six COPD patients with stable COPD diagnosed according to gold 2017 standard(FEV1<50%of the predicted value)were selected as the research objects.Patients were randomly divided into drug treatment group(n=32),diaphragm stimulation group(n=34),diaphragm and abdominal muscle stimulation group(n=30).The drug treatment group received general respiratory exercise,health education and conventional drug therapy.The diaphragm stimulation group received external diaphragm pacemaker intervention while receiving conventional medication.The diaphragm and abdominal muscle stimulation group received the diaphragm and abdominal muscle stimulation at the same time during the drug therapy.The electrical stimulation intensity was 40 Hz,treatment time was 30 minutes and the whole treatment time was 20 days.Data of lung function(FEV1,FVC,MVV,PEF),6MWD distance and bilateral diaphragm motion were monitored after 20 days.Results After 20 days of treatment,the activity of bilateral diaphragms was higher in the diaphragm and abdominal muscle stimulation group than that in the other two groups(P<0.05).The activity of diaphragms was also higher in the diaphragm stimulation group than that in the drug treatment group(P<0.05).Five lung function indexes of FEV1,FVC,MVV,PEF,and 6MWD were better in the diaphragm and abdominal muscle stimulation group than those in the other two groups(P<0.05),and these five indexes were also better in the diaphragm stimulation group than those in the drug treatment group(P<0.05).Conclusion Combined stimulation of diaphragm and abdominal muscles in vitro can be used as a new method to improve the lung function and quality of life of COPD patients.