复合频率体外膈肌起搏治疗对脑卒中恢复期患者呼吸功能及抗疲劳能力的疗效探究

To Explore the Effect of Compound Frequency External Diaphragm Pacing on Respiratory Function and Anti-Fatigue Ability in Patients with Stroke at Recovery Stage

摘要: 目的：观察复合频率体外膈肌起搏器(EDP)治疗对脑卒中恢复期患者呼吸功能的疗效。方法：收集2022年12月至2023年10月期间安徽医科大学第一附属医院康复医学科收治的45位脑卒中恢复期患者，通过抛硬币法分为(10 40 Hz)复合频率EDP组15例、(40 Hz)生理频率EDP组15例和对照组15例。对照组采用常规康复训练，两EDP组分别在对照组的基础上增加生理频率和复合频率体外膈肌起搏治疗。所有治疗组治疗时间均为4周，比较3组治疗前后肺功能、膈肌功能、抗疲劳程度指标变化情况。结果：1) 4周治疗后，3组一秒用力呼气容积(FEV1)、用力肺活量(FVC)数值均较前升高，差异具有统计学意义(P < 0.05)，且3组FEV1、FVC治疗后组间比较差异性明显(P < 0.05)，具体表现为两EDP组治疗后较对照组升高(P < 0.05)，而两EDP组组间无明显差异(P < 0.05)；同时治疗4周后两EDP组一秒率(FEV1/FVC)较前改善(P < 0.001)，对照组亦较前有所提高，但无统计学差异(P > 0.05)，且治疗后3组间比较差异不明显(P > 0.05)。2) 经4周治疗后，两EDP组平静呼吸膈肌移动度(DE-QB)、深呼吸膈肌移动度(DE-DB)、深呼吸膈肌厚度(DT)的数值较前明显升高，具有统计学差异(P < 0.001)，组间比较显示两EDP组DT、DE-DB数值较对照组升高明显(P < 0.05)，而两EDP组之间无显著差异(P > 0.05)。3) 治疗4周后3组患者Borg呼吸困难指数评分均较前降低，具有统计学差异(P < 0.05)；3组间比较显示两EDP组较对照组下降明显(P < 0.05)，而复合频率EDP组较生理频率EDP组下降更为明显(P < 0.05)。结论：生理频率和复合频率EDP治疗都能改善脑卒中恢复期患者的呼吸功能，而复合频率EDP治疗在改善患者抗疲劳程度方面较生理频率更加有效。

Abstract: Objective: To observe the effect of combined frequency extracorporeal diaphragm pacemaker (EDP) on respiratory function in convalescent stroke patients. Methods: A total of 45 stroke convalescent patients admitted to the Department of Rehabilitation Medicine of the First Affiliated Hospital of Anhui Medical University from December 2022 to October 2023 were collected and divided into (10 40 Hz) compound frequency EDP group (15 cases), (40 Hz) physiological frequency EDP group (15 cases) and control group (15 cases) by coin toss method. The control group was treated with routine rehabilitation training, and the two EDP groups were treated with physiologic frequency and compound frequency external diaphragm pacing respectively. All the treatment groups were treated for 4 weeks. The changes of lung function, diaphragm function and anti-fatigue degree before and after treatment were compared in the 3 groups. Results: 1) After 4 weeks of treatment, the values of forced expiratory volume (FEV1) in one second and forced vital capacity (FVC) in the 3 groups were higher than before, and the differences were statistically significant (P < 0.05), and there were significant differences among the 3 groups after FEV1 and FVC treatment (P < 0.05). After treatment, the two EDP groups were higher than the control group (P < 0.05), but there was no significant difference between the two EDP groups (P < 0.05). At the same time, after 4 weeks of treatment, the one-second rate (FEV1/FVC) in the two EDP groups was improved compared with that before (P < 0.001), and the control group was also increased, but there was no statistical difference (P > 0.05), and there was no significant difference between the three groups after treatment (P > 0.05). 2) After 4 weeks of treatment, the values of calm breathing diaphragm movement (DE-QB), deep breathing diaphragm movement (DE-DB) and deep breathing diaphragm thickness (DT) in the two EDP groups were significantly higher than before, with statistical differences (P < 0.001). The DT and DE-DB values in EDP and EDP groups were significantly higher than those in control group (P < 0.05), but there was no significant difference between EDP and EDP groups (P > 0.05). 3) After 4 weeks of treatment, Borg dyspnea index scores of 3 groups were lower than before, with statistical difference (P < 0.05). Comparison among the three groups showed that the EDP group decreased significantly compared with the control group (P < 0.05), and the compound frequency EDP group decreased more significantly than the physiological frequency EDP group (P < 0.05). Conclusion: Both physiological frequency and combined frequency EDP treatment can improve the respiratory function of patients recovering from stroke, and the combined frequency EDP treatment is more effective than the physiological frequency in improving the anti-fatigue degree of patients.