侧俯卧位下应用体外膈肌起搏器对脑卒中气管切开患者肺功能康复的影响

Effect of external diaphragmatic pacemaker in lateral prone position on pulmonary function rehabilitation in stroke patients with tracheotomy

目的:分析侧俯卧位下应用体外膈肌起搏器对脑卒中气管切开患者肺功能康复的影响。方法:前瞻性纳入粤北人民医院在2022年1月至3月住院的卒中后气管切开患者共64例,随机分为观察组(n=32)和对照组(n=32),两组均予常规雾化、湿化、排痰等气道护理及呼吸功能训练,观察组在此基础上采用侧俯卧位下应用体外膈肌起搏器治疗。以患者咳嗽、咳痰、发热、湿啰音等症状缓解改善情况,最大吸气压及最大呼气压的肺功能指标进行评估,同时记录患者感染发生率和气管套管拔管成功率。结果:经过1个月治疗后,两组气管切开患者的临床症状情况、最大吸气压(maximal inspiratory pressure,MIP)、最大呼气压(motor evoked potential,MEP)指标均有显著改善(P<0.05),治疗后观察组临床症状改善总有效率、肺部感染发生率、气管套管拔管成功率、肺通气功能均显著优于对照组(P<0.05)。结论:侧俯卧位下应用体外膈肌起搏器可显著改善卒中后气管切开患者的咳嗽、咳痰、发热等临床症状,提升最大吸气压和最大呼气压,减小肺部感染发生几率,提高拔管的成功率。

Objective:To analyze the effect of external diaphragmatic pacemaker in lateral prone position on pulmonary function rehabilitation in stroke patients with tracheotomy.Methods:Patients with post-stroke tracheotomy hospitalized in Yuebei People’s Hospital from January to March 2022 were prospectively included.A total of 64 cases were randomly divided into observation group(n=32)and control group(n=32),two groups were given conventional atomization,humidification,expectoration drainage airway nursing and respiratory function training.On this basis,the observation group was treated with in vitro diaphragm pacemaker therapy in lateral prone position.The patients’ symptoms such as cough,expectoration,fever,damp rhones and other symptoms were alleviated,and the pulmonary function indexes of maximum inspiratory pressure and maximum expiratory pressure were evaluated.Meanwhile,the incidence of infection and the success rate of tracheal cannula extubation were recorded.Results:After one month of treatment,the clinical symptoms,MIP and MEP indexes of patients in the two groups were significantly improved(P<0.05).The total effective rate of clinical symptoms improvement,incidence of pulmonary infection,success rate of tracheal cannula extubation and pulmonary ventilation function in the observation group were significantly better than those in the control group(P<0.05).Conclusion:The application of external diaphragm pacemaker in lateral prone position can significantly improve the clinical symptoms of cough,expectoration,fever and other symptoms in patients with tracheotomy after stroke,increase the maximum inspiratory pressure and maximum expiratory pressure,reduce the incidence of pulmonary infection,and improve the success rate of extubation.