神经肌肉电刺激联合踏车训练在呼吸机撤机中的应用研究

Clinical efficacy of neuromuscular electrical stimulation and lower limb treadmill training on patients with respiratory failure

目的探讨早期神经肌肉电刺激联合踏车训练在慢性阻塞性肺疾病(简称慢阻肺)合并呼吸衰竭患者呼吸机撤机中的疗效。方法选取2017年1月至2019年1月宁波市第七医院重症医学科收治的慢阻肺合并呼吸衰竭患者60例,随机分为对照组、研究组各30例。对照组采用常规治疗,研究组在此基础上,开展早期渐进性肺康复训练,主要包括神经肌肉电刺激和踏车训练。比较两组患者的撤机成功率、机械通气时间以及超声下膈肌增厚率的变化。结果与对照组相比,研究组机械通气时间明显缩短(6.22±0.78 vs 10.56±1.89),差异有显著统计学意义(P<0.01)。康复训练后第24小时、第3天两组患者的膈肌增厚率无统计学差异,康复训练后第7天研究组膈肌增厚率明显高于对照组(35.58±2.73 vs 23.79±2.26),差异有显著统计学意义(P<0.01)。结论神经肌肉电刺激联合踏车训练在慢阻肺合并呼吸衰竭患者撤机中应用效果良好,有助于改善慢阻肺合并呼吸衰竭患者的膈肌功能,缩短机械通气时间。

Objective To explore the clinical effect of neuromuscular electrical stimulation and lower limb treadmill training on patients with chronic obstructive pulmonary disease complicated with respiratory failure.Methods 60 patients with chronic obstructive pulmonary disease and respiratory failure admitted to the Department of Intensive Medicine of Ningbo Seventh Hospital from January 2017 to January 2019 were randomly divided into the control group(n=30)and the study group(n=30).The control group was treated with conventional medicine,and the study group adopted stepwise pulmonary rehabilitation training,mainly including early neuromuscular electrical stimulation,late lower limb treadmill training on the basis of conventional treatment.The changes of diaphragmatic thickening rate under ultrasound in the two groups were observed,and the success rate of weaning and mechanical ventilation time were compared.Results In comparison with the control group,the mechanical ventilation time of the study group was significantly shorter(6.22±0.78 vs 10.56±1.89,P<0.01).The rate of diaphragmatic thickening of the study group was significantly higher than that of the control group on the 7th day of treatment(35.58±2.73 vs 23.79±2.26,P<0.01).Conclusion Neuromuscular electrical stimulation combined with lower limb treadmill training is effective in weaning patients with chronic obstructive pulmonary disease,it can improve the diaphragm function of patients with chronic obstructive pulmonary disease complicated with respiratory failure,and shorten the time of mechanical ventilation.