体表膈神经电刺激对脑卒中恢复期呼吸功能的效果
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摘要
目的探讨体表膈神经电刺激对恢复期脑卒中患者呼吸功能的影响。方法 2017年10月至2018年7月,恢复期脑卒中患者27例随机分为对照组(n=14)和观察组(n=13)。两组均予常规康复,观察组在此基础上增加体表膈神经电刺激。分别于治疗前和治疗4周后,对患者进行肺通气功能和呼吸肌肌力测定。结果治疗后,两组用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、峰值呼气流速(PEF)、最大吸气压(MIP)、最大呼气压(MEP)均显著提高(t> 5.075,Z=-3.366,P <0.001),观察组FVC、FEV1、PEF和MIP较对照组提高更多(t> 0.921,Z=-2.746, P <0.05)。结论体表膈神经电刺激可改善恢复期脑卒中患者肺通气功能及吸气肌肌力。
Objective To observe the effect of external phrenic nerve electrical stimulation on respiratory function for convalescent stroke patients.Methods From October, 2017 to July, 2018, 27 convalescent stroke patients were randomly divided into control group(n = 14) and observation group(n = 13). Both groups received routine rehabilitation, while the observation group accepted external phrenic nerve electrical stimulation additionaly. Their ventilation and respiratory muscle strength were measured before and four weeks after treatment.Results The forced vital capacity(FVC), forced expiratory volume in 1 st second(FEV1), peak expiratory flow(PEF),maximal inspiratory pressure(MIP) and maximal expiratory pressure(MEP) improved in both groups after treatment(t > 5.075, Z =-3.366, P < 0.001), and improved more in FVC, FEV1, PEF and MIP in the observation group than in the control group(t > 0.921, Z =-2.746, P < 0.05).Conclusion External phrenic nerve electrical stimulation can improve ventilation and inspiratory muscle strength for convalescent stroke patients.
Objective To observe the effect of external phrenic nerve electrical stimulation on respiratory function for convalescent stroke patients.Methods From October, 2017 to July, 2018, 27 convalescent stroke patients were randomly divided into control group(n = 14) and observation group(n = 13). Both groups received routine rehabilitation, while the observation group accepted external phrenic nerve electrical stimulation additionaly. Their ventilation and respiratory muscle strength were measured before and four weeks after treatment.Results The forced vital capacity(FVC), forced expiratory volume in 1 st second(FEV1), peak expiratory flow(PEF),maximal inspiratory pressure(MIP) and maximal expiratory pressure(MEP) improved in both groups after treatment(t > 5.075, Z =-3.366, P < 0.001), and improved more in FVC, FEV1, PEF and MIP in the observation group than in the control group(t > 0.921, Z =-2.746, P < 0.05).Conclusion External phrenic nerve electrical stimulation can improve ventilation and inspiratory muscle strength for convalescent stroke patients.
引文
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[7]王志威,黄怀.体外膈肌起搏器在脑卒中后肺康复中的应用进展[J].中华生物医学工程杂志,2017,23(1):80-84.
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[12]俞长君,李雪萍,林强,等.呼吸肌训练对亚急性期脑卒中患者呼吸功能的影响[J].中华物理医学与康复杂志,2016,38(10):735-739.
[13]Similowski T,Catala M,Rancurel G,et al.Impairment of central motor conduction to the diaphragm in stroke[J].Am JRespir Crit Care Med,1996,154(1):436-441.
[14]Lanini B,Bianchi R,Romagnoli I,et al.Chest wall kinematics in patients with hemiplegia[J].Am J Respir Crit Care Med,2003,168(1):109-113.
[15]Khedr E M,El Shinawy O,Khedr T,et al.Assessment of corticodiaphragmatic pathway and pulmonary function in acute ischemic stroke patients[J].Eur J Neurol,2000,7(5):509-516.
[16]Jung K J,Park J Y,Hwang D W,et al.Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients[J].Ann Rehabil Med,2014,38(1):29-37.
[17]Teixeira-Salmela L F,Parreira V F,Britto R R,et al.Respiratory pressures and thoracoabdominal motion in communitydwelling chronic stroke survivors[J].Arch Phys Med Rehabil,2005,86(10):1974-1978.
[18]Tenório L H,Santos A C,Camara Neto J B,et al.The influence of inspiratory muscle training on diaphragmatic mobility,pulmonary function and maximum respiratory pressures in morbidly obese individuals:a pilot study[J].Disabil Rehabil,2013,35(22):1915-1920.
[19]Hazenberg A,Hofker S S,van der Aa J G,et al.Diaphragm pacemaker:alternative for chronic ventilatory support[J].Ned Tijdschr Geneeskd,2013,157(5):A5572.
[20]Gaissert H,Wilcox S R.Diaphragmatic dysfunction after thoracic operations[J].Thorac Cardiovasc Surg,2016,64(8):621-630.
[21]曾娟利,胡瑞成.体外膈肌起搏的临床应用及研究进展[J].临床与病理杂志,2017,37(9):1978-1984.
[22]Reynolds S C,Meyyappan R,Thakkar V,et al.Mitigation of ventilator-induced diaphragm atrophy by transvenous phrenic nerve stimulation[J].Am J Respir Crit Care Med,2017,195(3):339-348.
[23]Ahn B,Beaver T,Martin T,et al.Phrenic nerve stimulation increases human diaphragm fiber force after cardiothoracic surgery[J].Am J Respir Crit Care Med,2014,190(7):837-839.
[24]Hamada T,Usami A,Kishi A,et al.Anatomical study of phrenic nerve course in relation to neck dissection[J].Surg Radio Anat,2015,37(3):255-258.
[25]唐文庆,张瑞媞,殷稚飞,等.体外膈肌起搏在膈肌功能障碍中的应用[J].中华物理医学与康复杂志,2018,40(11):871-874.
[2]Britto R R,Rezende N R,Marinho K C,et al.Inspiratory muscular training in chronic stroke survivors:a randomized controlled trial[J].Arch Phys Med Rehabil,2011,92(2):184-190.
[3]Ezeugwu V E,Olaogun M,Mbada C E,et al.Comparative lung function performance of stroke survivors and age-matched and sex-matched controls[J].Physiother Res Int,2013,18(4):212-219.
[4]Messaggi-Sartor M,Guillen-SolàA,Depolo M,et al.Inspiratory and expiratory muscle training in subacute stroke:a randomized clinical trial[J].Neurology,2015,85(7):564-572.
[5]Menezes K K,Nascimento L R,Ada L,et al.Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke:a systematic review[J].J Physiother,2016,62(3):138-144.
[6]时惠,刘玲,祖菲娅·吐尔迪.阈值压力负荷呼吸肌训练对脑卒中患者康复疗效的Meta分析[J].中国康复理论与实践,2016,22(9):1069-1074.
[7]王志威,黄怀.体外膈肌起搏器在脑卒中后肺康复中的应用进展[J].中华生物医学工程杂志,2017,23(1):80-84.
[8]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[9]周丽娜,李庆云,黄绍光.膈肌功能障碍综合评估方法的研究进展[J].中华结核和呼吸杂志,2014,37(2):115-118.
[10]De Troyre A,Boriek A M.Mechanics of the respiratory muscles[J].Compr Physiol,2011,1(3):1273-1300.
[11]Lista Paz A,González Doniz L,Ortigueira García S,et al.Respiratory muscle strength in chronic stroke survivors and its relation with the 6-minute walk test[J].Arch Phys Med Rehabil,2016,97(2):266-272.
[12]俞长君,李雪萍,林强,等.呼吸肌训练对亚急性期脑卒中患者呼吸功能的影响[J].中华物理医学与康复杂志,2016,38(10):735-739.
[13]Similowski T,Catala M,Rancurel G,et al.Impairment of central motor conduction to the diaphragm in stroke[J].Am JRespir Crit Care Med,1996,154(1):436-441.
[14]Lanini B,Bianchi R,Romagnoli I,et al.Chest wall kinematics in patients with hemiplegia[J].Am J Respir Crit Care Med,2003,168(1):109-113.
[15]Khedr E M,El Shinawy O,Khedr T,et al.Assessment of corticodiaphragmatic pathway and pulmonary function in acute ischemic stroke patients[J].Eur J Neurol,2000,7(5):509-516.
[16]Jung K J,Park J Y,Hwang D W,et al.Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients[J].Ann Rehabil Med,2014,38(1):29-37.
[17]Teixeira-Salmela L F,Parreira V F,Britto R R,et al.Respiratory pressures and thoracoabdominal motion in communitydwelling chronic stroke survivors[J].Arch Phys Med Rehabil,2005,86(10):1974-1978.
[18]Tenório L H,Santos A C,Camara Neto J B,et al.The influence of inspiratory muscle training on diaphragmatic mobility,pulmonary function and maximum respiratory pressures in morbidly obese individuals:a pilot study[J].Disabil Rehabil,2013,35(22):1915-1920.
[19]Hazenberg A,Hofker S S,van der Aa J G,et al.Diaphragm pacemaker:alternative for chronic ventilatory support[J].Ned Tijdschr Geneeskd,2013,157(5):A5572.
[20]Gaissert H,Wilcox S R.Diaphragmatic dysfunction after thoracic operations[J].Thorac Cardiovasc Surg,2016,64(8):621-630.
[21]曾娟利,胡瑞成.体外膈肌起搏的临床应用及研究进展[J].临床与病理杂志,2017,37(9):1978-1984.
[22]Reynolds S C,Meyyappan R,Thakkar V,et al.Mitigation of ventilator-induced diaphragm atrophy by transvenous phrenic nerve stimulation[J].Am J Respir Crit Care Med,2017,195(3):339-348.
[23]Ahn B,Beaver T,Martin T,et al.Phrenic nerve stimulation increases human diaphragm fiber force after cardiothoracic surgery[J].Am J Respir Crit Care Med,2014,190(7):837-839.
[24]Hamada T,Usami A,Kishi A,et al.Anatomical study of phrenic nerve course in relation to neck dissection[J].Surg Radio Anat,2015,37(3):255-258.
[25]唐文庆,张瑞媞,殷稚飞,等.体外膈肌起搏在膈肌功能障碍中的应用[J].中华物理医学与康复杂志,2018,40(11):871-874.