无创通气肺复膨技术和体外膈肌起搏技术对脑卒中偏瘫患者肺功能的改善作用

关键词：脑卒中  无创通气  体外膈肌起搏  呼吸训练

Keywords:stroke  non-invasive ventilation  external diaphragm pacer  breathing training

摘要：

      摘要 目的：比较无创通气肺复膨技术和体外膈肌起搏技术两种干预方式对脑卒中偏瘫患者肺功能的作用。 方法：选取南京医科大学附属逸夫医院康复医学科收治的脑卒中患者40例。采用2×2析因设计，因素1：无创通气肺复膨技术，2个水平分别为用、不用；因素2：体外膈肌起搏技术，2个水平分别为用、不用。将患者随机分为对照组（A组：行常规呼吸训练）；无创通气肺复膨组（B组：常规呼吸训练+无创通气肺复膨技术）；体外膈肌起搏组（C组：常规呼吸训练+体外膈肌起搏技术）；联合组（D组：常规呼吸训练+无创通气肺复膨技术+体外膈肌起搏技术）。分别在干预前、干预2周后对患者的肺功能进行评估。采用SPSS23.0软件对数据进行统计描述和分析，统计方法包括单因素方差分析、非参数秩和检验、χ2检验、LSD法和析因设计方差分析。 结果：FVC%pred和FEV1%pred在四组患者干预后较干预前有显著提高（P＜0.05）；干预前后差值组间比较具有显著性意义（P＜0.05），组间差值从高到低分别为：FVC%pred为D＞B＞C＞A，FEV1%pred为D=C＞B=A。FEV1/FVC在C组患者干预后较干预前显著提高（P＜0.05）；干预前后差值组间比较具有显著性意义（P＜0.05），从高到低为C＞D=B=A。PEF%pred在C组和D组患者干预后较干预前显著提高（P＜0.05）；干预前后差值组间比较具有显著性意义（P＜0.05），从高到低排序是C＞A=B=D。析因设计分析显示：无创通气肺复膨技术对FVC%pred差值、FEV1/FVC差值主效应显著（P＜0.001），体外膈肌起搏技术对FEV1%pred差值、FEV1/FVC差值及PEF%pred差值主效应显著（P＜0.001），两项技术对FVC%pred差值、FEV1%pred差值、FEV1/FVC差值及PEF%pred差值均无交互效应（P＞0.05）。 结论：采用无创通气肺复膨技术、体外膈肌起搏技术或者两者联合的干预措施均可改善卒中患者的呼吸功能。体外膈肌起搏技术对FEV1%pred、PEF%pred改善效果更显著，而无创通气肺复膨技术对FVC%pred改善效果更好。

Abstract:

      Abstract Objective： To compare the effects of non-invasive ventilation lung re-expansion and external diaphragm pacer on pulmonary function in patients after stroke with hemiplegia. Method： Forty stroke patients were recruited. A 2×2 factorial design was used, with two factors: (1) non-invasive ventilation lung re-expansion technique (used vs. not used) and (2) external diaphragm pacer technique (used vs. not used). Patients were randomly assigned to one of four groups： the control group （group A：routine respiratory training）， the non-invasive ventilation group （group B：routine respiratory training + non-invasive ventilation re-expansion technique）， the external diaphragm pacer group （group C： routine respiratory training + external diaphragm pacer technique）， and the combined group （group D： routine respiratory training + non-invasive ventilation re-expansion technique + external diaphragm pacer technique）. The pulmonary function were collected before the intervention and after two weeks of the intervention. SPSS23.0 software was used to describe and analyze the data. The main statistical methods included one-way ANOVA， nonparametric rank sum test， chi-square test， LSD method and factorial design analysis of variance. Result：After two weeks of intervention, all four groups showed significant improvements in FVC% pred and FEV1% pred compared to baseline（P＜0.05）. Between-group comparisons of changes in FVC%pred and FEV1%pred showed significant differences (P<0.05), ranked as follows, FVC% pred: D>B>C>A， FEV1% pred: D=C＞B=A. FEV1/FVC significantly improved in Group C compared to baseline (P<0.05), with between-group differences ranked as C>D=B=A. PEF% pred in group C and D significantly improved in Groups C and D compared to baseline（P<0.05）， with between-group differences ranked as C>D=B=A. Factorial design analysis showed that non-invasive ventilation had significant main effects on changes in FVC% pred and FEV1/FVC（P<0.001）, while external diaphragm pacing had significant main effects on changes in FEV1% pred difference， FEV1/FVC and PEF% pred（P<0.001）. No interaction effects were observed between two interventions on changes in FVC% pred， FEV1% pred， FEV1/FVC and PEF% pred（P>0.001）. Conclusion： Non-invasive ventilation lung re-expansion technique， external diaphragm pacer technique and their combination can effectively improve the respiratory function of patients after stroke. External diaphragm pacer technique has a better effect on FEV1%pred and PEF%pred， while Non-invasive ventilation lung re-expansion technique has a better effect on FVC%pred.