主动循环呼吸技术联合高流量湿化氧疗对脑卒中气管切开患者呼吸肌功能及误吸的影响

Effects of active circulatory breathing technique combined with humidified high-flow oxygen therapy on respiratory muscle function and pulmonary aspiration in stroke patients undergoing tracheotomy

目的 探讨主动循环呼吸技术联合高流量湿化氧疗对脑卒中气管切开患者呼吸肌功能及误吸的影响。方法 招募2022年5月至2023年5月在沧州市人民医院接受治疗的脑卒中气管切开患者70例,采用随机数字表法将其分为观察组和对照组,各35例。对照组予高流量湿化氧疗,观察组予主动循环呼吸技术联合高流量湿化氧疗。对比两组痰液黏稠度、呼吸肌功能、肺功能、渗漏-误吸量表(PAS)评分以及功能独立性量表(FIM)评分。结果 两组治疗2周后痰液黏稠度均较治疗前显著改善(P<0.05),且观察组痰液黏稠度为Ⅰ~Ⅱ度的人数比例较对照组更高,差异有统计学意义(P<0.05)。在治疗后,两组最大吸气压(MIP)、最大呼气压(MEP)、第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC水平均较治疗前显著提高(P<0.05),且观察组水平较对照组更高,差异有统计学意义(P<0.05)。与治疗前相比,两组治疗后PAS评分和误吸发生率均显著降低(P<0.05),FIM评分显著升高(P<0.05)。观察组治疗后的PAS评分和误吸发生率较对照组更低,FIM评分较对照组更高,差异有统计学意义(P<0.05)。在治疗期间,两组均未观察到与治疗措施相关的不良事件发生。结论 主动循环呼吸技术联合高流量湿化氧疗可改善呼吸肌功能和肺功能,降低痰液黏稠度,减少误吸发生,改善患者生活质量。

Objective To explore the effects of active circulatory breathing technique combined with humidified high-flow oxygen therapy on respiratory muscle function and pulmonary aspiration in stroke patients undergoing tracheotomy.Methods A total of 70 stroke patients receiving tracheotomy in Cangzhou People′s Hospital from May 2022 to May 2023 were recruited and divided into observation group and control group by random number table method,with 35 cases in each group.The control group received humidified high-flow oxygen therapy,while the observation group received active circulatory breathing technique combined with humidified high-flow oxygen therapy.The sputum viscosity,respiratory muscle function,lung function,Penetration-Aspiration Scale(PAS)scores and Functional Independence Measurement(FIM)scores were compared between the two groups.Results After the treatment of 2 weeks,the sputum viscosity was significantly improved compared with that before treatment in both groups(P<0.05),and the proportion of the patients with sputum viscosity ofⅠ-Ⅱdegrees in the observation group was higher than that in the control group,and the differences were statistically significant(P<0.05).After treatment,the levels of maximum inspiratory pressure(MIP),maximum expiratory pressure(MEP),forced expiratory volume in 1 second(FEV 1),forced vital capacity(FVC)and FEV 1/FVC in both groups were significantly increased compared with those before treatment(P<0.05),and the levels of MIP,MEP,FEV 1,FVC and FEV 1/FVC in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Compared with those in both groups before treatment,the PAS scores and the incidence of pulmonary aspiration in both groups after treatment were significantly decreased(P<0.05),and the FIM scores in both groups after treatment were significantly increased(P<0.05).After treatment,the PAS scores and the incidence of pulmonary aspiration in the observation group were lower than those in the control group,and the FIM scores in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).During the treatment period,no adverse events related to the treatment measures were observed in both groups.Conclusion Active circulatory breathing technique combined with humidified high-flow oxygen therapy can improve respiratory muscle function and lung function,reduce sputum viscosity and the incidence of pulmonary aspiration,and improve the patients′quality of life.