体外膈肌起搏联合四点跪位训练对缺血性脑卒中患者肺功能的影响

Effect of Extracorporeal Diaphragmatic Pacing Combined with Four-Point Kneeling Position Training on Pulmonary Function in Patients with Ischemic Stroke

目的观察体外膈肌起搏联合四点跪位训练对缺血性脑卒中患者肺功能的影响。方法选择2023年1月1日—6月30日在苏州市独墅湖医院康复科收治的60例缺血性脑卒中患者,按照随机数字表法分为对照组和治疗组,每组30例。2组均接受常规的基础训练,对照组予体外膈肌起搏器治疗,治疗组给予体外膈肌起搏器联合四点跪位训练治疗。连续治疗8周后,评估治疗前后患者健侧及患侧平静呼气末膈肌厚度(CEEDT)、最大吸气末膈肌厚度(MEIDT)、平静呼吸膈肌移动度(QBDM)、深呼吸膈肌移动度(DBDM)、用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)/FVC、最大呼气流量(PEF)、6分钟步行距离(6MWD)和Borg评分。结果2组一般资料及治疗前各项评估结果比较,差异均无统计学意义(P>0.05)。与治疗前相比,对照组治疗8周后健侧CEEDT提高(P<0.05),治疗4、8周后患侧CEEDT均提高(P<0.05),治疗组治疗4、8周后健侧和患侧的CEEDT均提高(P<0.05);与对照组相比,治疗组治疗8周后健侧和患侧的CEEDT均提高(P<0.05)。治疗4、8周后2组健侧和患侧的MEIDT、QBDM和DBDM,以及患者FEV_(1)、FVC、PEF、6MWD均优于治疗前,Borg评分低于治疗前(P<0.05);且治疗组治疗4、8周后健侧和患侧的MEIDT、QB⁃DM、DBDM,以及患者的FEV_(1)、FVC和PEF明显高于对照组(P<0.05);治疗组治疗8周后FEV_(1)/FVC、6MWD均提高,Borg评分降低(P<0.05)。结论体外膈肌起搏联合四点跪位训练能够改善缺血性脑卒中患者的肺功能。

Objective To observe the clinical effect of extracorporeal diaphragmatic pacing combined with four-point kneeling position training on pulmonary function in patients with ischemic stroke.Methods A total of 60 patients with ischemic stroke admitted to the Rehabilitation Department of the Fourth Affiliated Hospital of Soochow University from January 1,2023 to June 30,2023 were enrolled and randomly divided into control group and treatment group,with 30 cases in each group.Both groups received regular basic training.The control group was treated with extracorporeal diaphragmatic pacing,and the treatment group was treated with extracorporeal diaphragmatic pacing,while combined with four-point kneeling training.After 8 weeks of continuous treatment,the patients were evaluated for changes of clam endexpiratory diaphragmatic thickness(CEEDT),maximum end-inspiratory diaphragm thickness(MEIDT),quiet breathing diaphragm mobility(QBDM),deep breathing diaphragm mobility(DBDM),forced vital capacity(FVC),forced expiratory volume in 1 second(FEV_(1)),FEV_(1)/FVC,peak expiratory flow(PEF),6-minute walking distance(6MWD)and Borg score of patients were detected and evaluated in both groups.Results There were no significant differences in the pre-treatment general data and baseline evaluation results at baseline,before treatment between the two groups(P>0.05).Compared with the pre-treatment,CEEDT of the unaffected side increased after 8 weeks of treatment in the control group(P<0.05),and CEEDT on the affected side significantly increased after 4 and 8 weeks of treatment(P<0.05);in the treatment group,CEEDT of both the unaffected and affected sides significantly increased after 4 and 8 weeks of treatment(P<0.05).Compared with the control group,the CEEDT of both the unaffected and affected sides increased in the treatment group after 8 weeks of treatment(P<0.05).After 4 and 8 weeks of treatment,the MEIDT,QBDM,DBDM on both the unaffected and affected sides,as well as the patients'FEV_(1),FVC,PEF,6MWD were all higher than those before treatment,and Borg score were lower than those before treatment(P<0.05).After 4 and 8 weeks of treatment,the MEIDT,QBDM,and DBDM of the unaffected and affected sides,and FEV_(1),FVC and PEF in the treatment group were significantly higher than those in the control group(P<0.05).Compared with the control group,FEV_(1)/FVC and 6MWD increased and Borg score decreased in the treatment group after 8 weeks of treatment(P<0.05).Conclusion Extracorporeal diaphragmatic pacing combined with four-point kneeling position training can improve pulmonary function in patients with ischemic stroke.