呼吸肌训练联合膈神经电刺激对脑卒中肺部感染患者咳嗽能力及肺功能的影响

关键词：脑卒中  肺部感染  呼吸肌训练  膈神经电刺激  咳嗽能力  肺功能

Keywords:stroke  lung infection  respiratory muscle training  electrical stimulation of phrenic nerve  cough ability  lung function

摘要：

      摘要 目的：探讨呼吸肌训练联合膈神经电刺激对脑卒中肺部感染患者咳嗽能力及肺功能的影响。 方法：收集2022年1月—2024年1月本院收治的脑卒中后合并肺部感染患者66例，随机分为观察组和对照组，每组33例，在治疗期间观察组和对照组各有3例患者脱落。两组患者均给予常规药物和康复治疗，观察组在此基础上增加呼吸肌训练和膈神经电刺激，治疗频次为每日1次，每周治疗5天，治疗4周。在治疗前、1周、2周、4周后收集咳嗽峰流速（CPF）、临床肺部感染评分（CPIS）和Borg呼吸困难评分，在治疗前、治疗4周后收集最大吸气压（MIP）、最大呼气压（MEP）、用力肺活量（FVC）、第一秒用力呼气量（FEV1）、每分钟最大通气量（MVV）等肺功能指标并计算FVC%、FEV1%、MVV%，比较脑卒中肺部感染患者的咳嗽能力及肺功能。 结果：治疗前与治疗1周后2组患者的CPF、CPIS、Borg呼吸困难评分组间差异无显著性意义（P>0.05），在治疗2周、4周后，观察组的CPF、CPIS、Borg呼吸困难评分改善程度显著优于对照组，差异具有显著性意义（P<0.05）；同时治疗4周后观察组肺功能指标改善程度显著优于对照组，差异具有显著性意义（P<0.05）。 结论：呼吸肌训练联合膈神经电刺激能在短期内提高脑卒中患者咳嗽能力，减轻肺部感染并改善肺功能，可在早期脑卒中肺部感染的治疗中应用。

Abstract:

      Abstract Objective：To explore the effects of respiratory muscle training (RMT) combined with phrenic nerve electrical stimulation (PNES) on coughing ability and lung function in stroke patients with pulmonary infection. Method： A total of 66 patients with pulmonary infection after stroke, admitted to our hospital from January 2022 to January 2024, were randomly assigned to either an observation group or a control group， with 33 cases in each group. During the study, three patients from each group dropped out. Both groups received conventional pharmacological and rehabilitation treatment. Additionally, the observation group received combined RMT and PNES , administered once a day， 5 days per week， for 4 weeks. Outcome measures included: Cough peak flow rate （CPF），Clinical Pulmonary Infection Score (CPIS), and Borg Dyspnea Scale scores, assessed at baseline, 1 week, 2 weeks, and 4 weeks. Pulmonary function tests were performed at baseline and after 4 weeks, including maximum inspiratory pressure （MIP），maximum expiratory pressure （MEP）， forced vital capacity （FVC）， forced expiratory volume in the first second （FEV1），maximum volume per minute （MVV）. The percentages of predicted values (FVC%， FEV1%， MVV%) were calculated. Coughing ability and pulmonary function were compared between the groups. Result: At baseline and after 1 week of treatment, there were no significant between-group differences in CPF, CPIS, or Borg Dyspnea scores (P>0.05). However, after 2 and 4 weeks of treatment, the observation group showed significantly greater improvements in CPF, CPIS, and Borg Dyspnea scores compared to the control group（P<0.05）. Furthermore, after 4 weeks of treatment， the improvement in all pulmonary function parameters (MIP, MEP, FVC%, FEV1%, MVV%) was significantly greater in the observation group than in the control group（P<0.05）. Conclusion: Respiratory muscle training combined with phrenic nerve electrical stimulation can effectively improve the coughing ability, alleviate pulmonary infection, and enhance lung function in stroke patients within a short period of time， which is worthy of promotion and application in the treatment of lung infection in early stroke.