脑卒中患者躯干平衡与呼吸功能的体外膈肌起搏及相关性研究

关键词：脑卒中  体外膈肌起搏  躯干平衡  呼吸功能  膈肌功能

Keywords:stroke  external diaphragm pacing  trunk balance  respiratory function  diaphragm function

摘要：

      摘要 目的：应用体外膈肌起搏（EDP）治疗脑卒中患者，观察卒中后患者躯干平衡、肺功能及膈肌功能的改善情况，分析躯干平衡与呼吸功能指标间的相关性。 方法：选取2023年1月—2023年8月安徽医科大学第一附属医院康复医学科收治的符合纳入标准的脑卒中患者共30例，采用随机数字表法分为观察组（n=15例）和对照组（n=15例）。对照组采用常规康复治疗，观察组在常规康复治疗基础上增加EDP治疗，共治疗4周。采用独立样本t检验和秩和检验比较两组患者的改良版躯干损伤量表（mTIS）评分、用力肺活量（FVC）、1秒用力呼气容积（FEV1）、FEV1/FVC（%）、立位到仰卧位肺活量的变化百分比[ΔVC（%）]、平静呼吸膈肌移动度（DE-QB）、用力呼吸膈肌移动度（DE-DB）、膈肌增厚率（TF），并采用Pearson相关性分析探究各指标间的相关性。 结果：治疗4周后对照组mTIS、FVC、FEV1、DE-DB较治疗前明显改善（P＜0.05），观察组mTIS、FVC、FEV1、FEV1/FVC、DE-QB、DE-DB、TF较治疗前明显改善（P＜0.05）；除DE-QB外，观察组治疗前后各指标的差值均明显大于对照组（P＜0.05）；30例患者治疗前和治疗后的mTIS评分与DE-QB、DE-DB、TF均呈正相关（P＜0.05），ΔVC与mTIS、DE-DB均呈负相关（P＜0.05）。 结论：EDP治疗可促进脑卒中患者的呼吸功能及躯干平衡功能的恢复；卒中后患者的躯干平衡能力与膈肌功能有关，而与肺功能无相关性。

Abstract:

      Abstract　 Objective：To observe the enhancement of trunk balance ability， pulmonary function， and diaphragm function in stroke patients after treatment of external diaphragm pacing（EDP）， and analyze the potential correlation between trunk balance ability and respiratory function metrics. Method：Thirty stroke patients meeting the inclusion criteria were selected from the department of rehabilitation medicine at the first affiliated hospital of Anhui medical university from January 2023 to August 2023. They were randomly divided into the observation group （n=15） and the control group （n=15）. The control group received conventional rehabilitation therapy， while the observation group received EDP treatment in addition to conventional rehabilitation therapy for 4 weeks. Independent sample t-tests and rank-sum tests were used to compare the modified trunk impairment scale （mTIS） scores， forced vital capacity （FVC）， forced expiratory volume in 1 second （FEV1）， FEV1/FVC change in percentage of vital capacity from sitting to supine position （ΔVC）， diaphragmatic excursion of quiet breath（DE-QB）， diaphragmatic excursion of deep breath （DE-DB）， and thickening fraction （TF） between the two groups of patients. Pearson correlation analysis was employed to explore the correlations among these indicators. Result：After 4 weeks of treatment， the mTIS， FVC， FEV1， and DE-DB of the control group were significantly improved than before（P<0.05）. The mTIS， FVC， FEV1， FEV1/FVC， DE-QB， DE-DB， and TF of the observation group were significantly improved than before（P<0.05）； Except for DE-QB， the differences in the indicators before and after treatment in the observation group were significantly greater than those in the control group （P<0.05）.The mTIS scores of all 30 patients both before and after treatment were positively correlated with DE-QB，DE-DB，and TF（P<0.05）,while ΔVC was negatively correlated with mTIS and DE-DB（P<0.05）. Conclusion：EDP treatment can promote the recovery of respiratory function and trunk balance in stroke patients. Additionally，the trunk balance ability in stroke patients displays a correlation with diaphragm function， but not with pulmonary function.