Passy-Muir说话瓣膜对脑卒中气管切开患者呼吸功能影响的超声影像研究

关键词：脑卒中  气管切开  说话瓣膜  膈肌

Keywords:stroke  tracheotomy  Passy-Muir speaking valve  diaphragm

摘要：

      摘要 目的：应用超声检测Passy-Muir说话瓣膜（PMV）对脑卒中气管切开患者呼吸功能的影响并探讨利用膈肌的超声影像学参数评估PMV改善呼吸功能的应用价值。 方法：选取90例符合纳入标准的脑卒中气管切开患者随机分为PMV组（45例）和对照组（45例），对照组给予常规呼吸康复治疗，PMV组在常规呼吸治疗的基础上佩戴PMV。两组治疗方案为60min/d，6天/周，共2周。两组分别在治疗前和治疗后进行呼吸症状临床评估和膈肌超声影像学参数的测定。评定指标包括：Borg呼吸困难评定量表、呼气末膈肌厚度（EDT）、吸气末膈肌厚度（IDT）、膈肌厚度分数（DTF）和膈肌移动度。比较两组的临床疗效。将PMV组治疗后的Borg评分与膈肌的超声影像学参数行相关性分析。 结果：治疗前两组Borg评分、EDT值、IDT值、DTF值及膈肌移动度均未见显著性差异（P＞0.05）。通过2周治疗，组内对比显示：治疗后两组Borg评分比治疗前降低（P＜0.05）；EDT值、IDT值、DTF值及膈肌移动度均比治疗前提高（P＜0.05）。组间比较显示：两组治疗后Borg评分，PMV组低于对照组（P＜0.05）；EDT值、IDT值、DTF值及膈肌移动度，PMV组均高于对照组（P＜0.05）。相关性分析显示：治疗后PMV组EDT值（r=﹣0.962，P＜0.01）、IDT值（r=﹣0.948，P＜0.01）、DTF值（r=﹣0.972，P＜0.01）及膈肌移动度（r=﹣0.960，P＜0.01）与Borg评分之间存在负的线性相关。 结论：佩戴PMV能显著改善脑卒中气管切开患者的呼吸困难症状，提高膈肌的运动功能，进而改善患者的肺功能。膈肌的超声影像学参数可预测卒中气切患者呼吸困难的程度，从而为后续的康复治疗提供超声影像学证据。

Abstract:

      Abstract Objective：To explore the influence of Passy-Muir speaking valve （PMV） on diaphragm function by using ultrasound in stroke patients with tracheotomy and to evaluate the application value of improving respiratory function by using ultrasonography parameters of diaphragm in PMV therapy. Method：Ninety stroke patients with tracheotomy meeting the inclusion criteria were randomly divided into PMV group（n=45） and control group（n=45）. The control group received traditional respiratory therapy. The PMV group underwent PMV therapy based on traditional respiratory therapy. The procedure was 60min/day，6days/week for 2 weeks. The scores of Borg scale， end-expiratory diaphragm thickness（EDT），end-inspiration diaphragm thickness（IDT），diaphragm thickening fraction（DTF） and diaphragm mobility were assessed before and after treatment. The correlation of the scores of Borg scale and diaphragm ultrasonographic parameters were analyzed. Result：After two weeks of treatment, significant improvements were observed within both groups: Borg scores decreased (P<0.05), while EDT, IDT, DTF, and diaphragm mobility increased (P<0.05). Compared with control group， FMV group had significantly greater improvement on the scores of Borg（P＜0.05）， EDT（P＜0.05）， IDT（P＜0.05）， DTF（P＜0.05） and diaphragm mobility（P＜0.05）. In the PMV group, post-treatment Borg scores were significantly negatively correlated with EDT（r=﹣0.962，P＜0.01）、IDT（r=﹣0.948，P＜0.01）、DTF（r=﹣0.972，P＜0.01） and diaphragm mobility（r=﹣0.960，P＜0.01）. Conclusion：PMV can improve respiratory function， increase the mobility of diaphragm and improve pulmonary function in stroke tracheotomy patients. Diaphragm ultrasonographic parameters can predict the degree of dyspnea to provide the following rehabilitation with ultrasonography evidence.