阈值负荷吸气肌训练联合体外膈肌起搏对慢性阻塞性肺疾病患者肺功能和膈肌功能的影响

Effects of threshold load inspiratory muscle training combined with extracorporeal diaphragm pacing on pulmonary function and diaphragm function in patients with chronic obstructive pulmonary disease

目的探讨阈值负荷吸气肌训练联合体外膈肌起搏对急性加重期慢性阻塞性肺疾病(COPD)患者肺功能和膈肌功能的影响。方法选择2019年3月至2021年3月新乡市第一人民医院收治的78例中重度急性加重期COPD患者为研究对象,随机分为对照组和观察组,每组39例。对照组患者给予吸氧、抗感染、平喘、祛痰等常规治疗;观察组患者在常规治疗基础上给予阈值负荷吸气肌训练和体外膈肌起搏治疗;治疗周期为2周。分别于治疗前及治疗2周后,应用超声检测2组患者膈肌功能指标膈肌位移(DE)、深吸气末膈肌厚度(DTei)及平静呼气末膈肌厚度(DTee),计算膈肌厚度分数(DTF);应用肺功能检测仪测定2组患者治疗前后第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、第1秒用力呼气容积占预计值百分比(FEV_(1)%pred),计算FEV_(1)/FVC;观察2组患者治疗前后的活动耐力指标6 min步行距离(6MWD)和呼吸劳累感觉(POD)评分。结果2组患者治疗前DE、DTei、DTee、DTF、FEV_(1)%pred、FEV_(1)/FVC、MIP、6MWT和POD评分比较差异均无统计学意义(P>0.05)。对照组患者治疗前后DE、DTei、DTee、DTF、FEV_(1)%pred、FEV_(1)/FVC、MIP、6MWT比较差异均无统计学意义(P>0.05),治疗后POD评分显著低于治疗前(P<0.05)。治疗后,观察组患者的DE、DTei、DTF、FEV_(1)%pred、FEV_(1)/FVC、MIP、6MWT显著大于治疗前,DTee、POD评分显著小于治疗前(P<0.05)。治疗后,观察组患者的DE、DTei、DTF、FEV_(1)%pred、FEV1/FVC、MIP、6MWT显著大于对照组,DTee、POD评分显著小于对照组(P<0.05)。结论阈值负荷吸气肌训练联合体外膈肌起搏治疗能有效改善COPD患者的膈肌功能,有利于患者肺功能的康复。

Objective To investigate the effect of threshold load inspiratory muscle training combined with extracorporeal diaphragm pacing on pulmonary function and diaphragm function in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods A total of 78 patients with moderate to severe acute exacerbation of COPD admitted to the Xinxiang First People's Hospital from March 2019 to March 2021 were randomly divided into the control group and the observation group,with 39 cases in each group.The patients in the control group were given the routine treatment such as oxygen inhalation,anti-infection,anti-asthma and expectoration;the patients in the observation group were given threshold load inspiratory muscle training and extracorporeal diaphragm pacing therapy on the basis of routine treatment;the treatment period was two weeks.Before and two weeks after treatment,the diaphragmatic function indexes such as diaphragmatic excursion(DE),diaphragmatic thickness at the end of deep inhalation(DTei)and diaphragmatic thickness at the end of calm exhalation(DTee)were measured by ultrasonography,and the diaphragmatic thickness fraction(DTF)was calculated;the forced expiratory volume in one second(FEV_(1)),forced vital capacity(FVC),the first second and the percentage of forced expiratory volume in the predicted value(FEV_(1)%pred)of patients in the two groups were measured by pulmonary function tester before and after treatment,and FEV_(1)/FVC were calculated;the activity endurance indexes of 6-minute walking distance(6MWD)and perception of dyspnea(POD)score of patients in the two groups before and after treatment were observed.Results There was no significant difference in DE,DTei,DTee,DTF,FEV_(1)%pred,FEV_(1)/FVC,MIP,6MWT and POD scores of patients between the two groups before treatment(P>0.05).There was no significant difference in DE,DTei,DTee,DTF,FEV_(1)%pred,FEV_(1)/FVC,MIP and 6MWT of patients in the control group after treatment compared with before treatment(P>0.05).The POD score of patients in the control group after treatment was significantly lower than that before treatment(P<0.05).The DE,DTei,DTF,FEV_(1)%pred,FEV_(1)/FVC,MIP and 6MWT of patients in the observation group after treatment were significantly higher than those before treatment(P<0.05),the DTee and the POD scores were significantly lower than those before treatment(P<0.05).After treatment,the DE,DTei,DTF,FEV_(1)%pred,FEV_(1)/FVC,MIP and 6MWT of patients in the observation group were significantly higher than those in the control group(P<0.05),and the DTee,POD scores were significantly lower than those in the control group(P<0.05).Conclusion The inspiratory muscle training combined with extracorporeal diaphragm pacing therapy can effectively improve the diaphragm function of patients with COPD,which is beneficial to the rehabilitation of patients'lung function.