立位被动平衡功能训练对慢性意识障碍患者膈肌功能的影响研究

Effect of balance training relying on tilted table on diaphragmatic function in patients with prolonged disorder of consciousness

目的探讨立位被动平衡功能训练对慢性意识障碍(pDoC)患者膈肌功能的康复效果。方法前瞻性选取自2023年5月至12月于解放军南部战区总医院高压氧康复科接受康复治疗的30例pDoC患者为研究对象,并按治疗方式不同分为研究组(15例)与对照组(15例)。对照组采用常规康复方式治疗,研究组在常规康复方式治疗的基础上依托电动病床进行立位被动平衡功能训练。分别于治疗前及治疗4周、8周后行膈肌超声检查,测量膈肌移动度(DE)、吸气末膈肌厚度(DTei)、呼气末膈肌厚度(DTee)和膈肌增厚分数(DTF),以评估患者的膈肌功能。结果治疗过程中研究组脱落2例,最终13例研究组患者和15例对照组患者完成试验。(1)组间比较:治疗4周后,研究组患者的DE、DTei、DTee、DTF与对照组差异无统计学意义(P>0.05)。治疗8周后,研究组患者的DE、DTei、DTF均较对照组明显升高[(1.65±0.32)cmvs.(1.21±0.22)cm;(2.07±0.26)cmvs.(1.83±0.26)cm;(24.39±3.19)%vs.(18.93±2.50)%],差异均有统计学意义(P<0.05)。(2)组内比较:2组患者治疗4周及8周后的DE均较治疗前明显升高,差异均有统计学意义(P<0.05)。研究组患者治疗8周后的DE较治疗4周后明显升高,差异有统计学意义(P<0.05)。2组患者治疗4周后的DTei、DTee、DTF与治疗前差异均无统计学意义(P>0.05)。研究组患者治疗8周后的DTei、DTee、DTF均较治疗前、治疗4周后明显升高,差异均有统计学意义(P<0.05)。结论依托电动病床的立位被动平衡训练对pDoC患者具有改善其膈肌功能的作用,且一定时间内治疗时间越长治疗效果越好。

Objective To observe the rehabilitation effect of balance training relying on tilted table on diaphragmatic function of patients with prolonged disorder of consciousness(pDoC).Methods A prospective study was performed.Thirty patients with pDoC were enrolled from Department of Hyperbaric Oxygen Medicine and Rehabilitation,General Hospital of Southern Theater Command of PLA from May to December 2023.The pateints were divided into study group(n=15)and control group(n=15)according to different rehabilitation.Patients from the control group received conventional rehabilitation,while those in the study group received passive balance training relying on tilted table in addition to conventional rehabilitation.Diaphragmatic ultrasound examination was performed before treatment,and 4 and 8 weeks after treatment to measure diaphragm excursion(DE),diaphragm thickening inspiration(DTei),diaphragm thickening expiration(DTee)and diaphragm thickening fraction(DTF)so as to assess the diaphragmatic functions of patients with pDoC.Results During treatment,2 patients dropped out from the study group resulting from the willing of the family members,ultimately including 13 and 15 patients in the study and control groups,respectively.(1)Between-group comparison:no significant difference in DE,DTei,DTee or DTF was noted between the study group and control group 4 weeks after treatment(P>0.05).However,8 weeks after treatment,the study group had statistically increased DE,DTei and DTF compared with the control group([1.65±0.32]cm vs.[1.21±0.22]cm;[2.07±0.26]cm vs.[1.83±0.26]cm;and[24.39±3.19]%vs.[18.93±2.50]%).(2)Within-group comparison:both group had significantly increased DE 4 and 8 weeks after treatment compared with those before treatment(P<0.05);in the study group,DE 8 weeks after treatment was significantly increased compared with that 4 weeks after treatment(P<0.05).No significant difference in DTei,DTee or DTF was noted in both groups between 4 weeks after treatment and before treatment(P>0.05).In the study group,DTei,DTee and DTF 8 weeks after treatment were significantly higher than those before treatment and 4 weeks after treatment(P<0.05).Conclusion Balance training relying on tilted table is feasible and effective in improving diaphragmatic function in patients with pDoC,and the effect is positively correlated with treatment time within a certain time.