膈肌电刺激联合阈值压力负荷呼吸训练对亚急性期颈段脊髓损伤患者肺功能的影响

黄乐乐; 刘孟

doi:10.16766/j.cnki.issn.1674-4152.003578

膈肌电刺激联合阈值压力负荷呼吸训练对亚急性期颈段脊髓损伤患者肺功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.003578

黄乐乐¹,
刘孟^2, ,

1.
蚌埠医科大学第一附属医院重症医学科，安徽蚌埠 233004
2.
中国科技大学附属第一医院康复医学科，安徽合肥 230001

基金项目:

安徽省临床医学研究转化专项基金项目 202304295107020073

详细信息

通讯作者:
刘孟，E-mail: liumeng5238@126.com

中图分类号: R651.2 R454
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- 被引次数: 0
出版历程
- 收稿日期: 2023-10-19
- 网络出版日期: 2024-09-05

Effects of low frequency electric stimulation on diaphragmatic muscle combined with threshold inspiratory muscle training on lung function in patients with sub-acute traumatic cervical spinal cord injury

HUANG Lele¹,
LIU Meng^{2
, ,}

1.
Department of Critical Care Medicine, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的观察亚急性期创伤性颈段脊髓损伤患者进行膈肌低频脉冲电刺激联合阈值压力负荷呼吸训练对患者肺功能和肺部感染发生率的影响。方法采用随机数字表法将2020年7月—2022年6月蚌埠医科大学第一附属医院收治住院的亚急性期创伤性颈段脊髓损伤患者40例分为对照组(20例)和实验组(20例)，对照组在常规治疗的基础上接受阈值压力负荷呼吸功能训练，实验组在对照组的基础上给予膈肌低频脉冲电刺激。分别于治疗前及治疗3周后评估患者肺功能[用力肺活量(FVC)、FVC占预计值的百分比(FVC%pred)、第一秒用力呼气容积(FEV₁)及FEV₁占预计值的百分比(FEV₁%pred)]的变化；治疗后随访3个月，统计肺部感染的发生率。结果与治疗前比较，2组患者治疗3周后的FVC、FVC%pred、FEV₁及FEV₁%pred均有明显提高(P < 0.01)；治疗3周后，实验组患者FVC、FVC%pred、FEV₁及FEV₁%pred均高于对照组，差异有统计学意义(P < 0.01)。治疗3个月后，实验组患者的肺部感染发生率为50.0%(10/20)，对照组为80.0%(16/20)，实验组患者肺部感染发生率显著低于对照组(χ²=3.956, P=0.047)。结论膈肌低频脉冲电刺激联合阈值压力负荷呼吸训练能有效改善亚急性期创伤性颈段脊髓损伤患者的肺功能，降低肺部感染的发生率。
- 低频脉冲电刺激 /
- 阈值压力负荷呼吸训练 /
- 颈段脊髓损伤 /
- 肺功能
Abstract: Objective To observe the effectiveness of low frequency electric stimulation on diaphragmatic muscle combined with threshold inspiratory muscle training on lung function and incidence of lung infections in patients with sub-acute traumatic cervical spinal cord injury. Methods A total of 40 patients with sub-acute traumatic cervical spinal cord injury in Department of Critical Care Medicine of the First Affiliated Hospital of Bengbu Medical University from July 2020 to June 2022 were assigned to the control and experimental groups (20 for each group) by the random number table. The control group received threshold inspiratory muscle training on the basis of conventional treatment, and the experimental group was given low frequency electric stimulation on diaphragmatic muscle on the basis of the control group. The patients' lung functions [forceful lung volume (FVC), FVC as a percentage of the predicted value (FVC%pred), first-second forceful expiratory volume (FEV₁), and FEV₁ as a percentage of the predicted value (FEV₁%pred)] were evaluated before and after 3 weeks of treatment. The incidence of pulmonary infections was followed up at 3 months after treatment. Results After three-week training, compared with before the training, FVC, FVC%pred, FEV_l and FEV₁%pred in two groups obviously improved (P < 0.01). Comparing with the control group, FVC, FVC%pred, FEV_l and FEV₁%pred in experimental group were significantly high (P < 0.01). After 3 months of treatment, the incidence of lung infection was significantly lower in the experimental group than in the control group [50.0% (10/20) vs. 80.0% (16/20), χ²=3.956, P=0.047]. Conclusion Low frequency electric stimulation on diaphragmatic muscle combined with threshold inspiratory muscle training can significantly improve on lung function in patients with sub-acute traumatic cervical spinal cord injury, and its effect is better than the simple respiratory training.
- Low frequency pulse electrical stimulation /
- Threshold inspiratory muscle training /
- Cervical spinal cord injury /
- Lung function

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表 1 2组创伤性颈段脊髓损伤患者一般情况比较

Table 1. Comparison of general conditions between two groups in patients with traumatic cervical spinal cord injury

组别	例数	性别(例)		年龄 (x±s, 岁)	BMI (x±s)	病程 (x±s, d)	ASIA分级(例)				损伤平面(例)
组别	例数	男性	女性	年龄 (x±s, 岁)	BMI (x±s)	病程 (x±s, d)	A	B	C	D	C₄	C₅	C₆	C₇	C₈
对照组	20	16	4	38.23±9.56	20.95±2.04	16.33±2.14	2	9	5	4	1	3	10	5	1
实验组	20	15	5	39.55±10.58	20.75±1.99	16.51±2.35	3	10	4	3	1	4	9	4	2
统计量		<0.001^a		0.414^b	0.314^b	0.253^b	0.694^c				0.640^a
P值		0.999		0.681	0.755	0.801	0.488				0.959
注：^a为χ²值，^b为t值, ^c为Z值。

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表 2 2组创伤性颈段脊髓损伤患者治疗前后FVC比较(x±s)

Table 2. Comparison of FVC before and after treatment in two groups of patients with traumatic cervical spinal cord injury (x±s)

组别	例数	FVC(L)		t值	P值	FVC%pred(%)		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
实验组	20	1.78±0.12	3.00±0.13	35.211	<0.001	41.32±6.39	68.7±10.38	10.536	<0.001
对照组	20	1.77±0.12	2.23±0.11	13.987	<0.001	41.17±6.12	58.7±7.03	6.651	<0.001
统计量		0.264^a	1 601.500^b			0.076^a	57.793^b
P值		0.794	<0.001			0.940	<0.001
注: ^a为t值，^b为F值。

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表 3 2组创伤性颈段脊髓损伤患者治疗前后FEV₁比较(x±s)

Table 3. Comparison of FEV1 before and after treatment in two groups of patients with traumatic cervical spinal cord injury (x±s)

组别	例数	FEV₁(L)		t值	P值	FEV₁%pred(%)		t值	P值
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
实验组	20	1.66±0.10	2.52±0.18	35.211	<0.001	45.73±7.55	68.79±17.85	10.536	<0.001
对照组	20	1.64±0.07	1.93±0.16	13.987	<0.001	46.22±6.86	56.71±14.12	6.651	<0.001
统计量		0.733^a	115.284^b			0.215^a	22.216^b
P值		0.468	<0.001			0.831	<0.001
注: ^a为t值，^b为F值。

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表 4 2组创伤性颈段脊髓损伤患者治疗前后肺功能参数变化量比较(x±s)

Table 4. Comparison of pulmonary function parameters before and after treatment in patients with traumatic cervical spinal >cord injury between two groups (x±s)

组别	例数	FVC		FEV₁
组别	例数	ΔFVC(L)	ΔFVC%pred(%)	ΔFEV₁(L)	ΔFEV₁%pred(%)
实验组	20	1.22±0.07	27.38±3.65	0.86±0.19	23.06±3.41
对照组	20	0.46±0.05	17.53±4.45	0.29±0.18	10.49±2.32
t值		39.511	7.654	9.740	13.630
P值		<0.001	<0.001	<0.001	<0.001
注：Δ为各项指标治疗前后的变化值。

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