| 祖丽皮努尔·阿卜杜萨迪克,刘玲,帕提曼·吾斯曼,陈祢.呼吸神经肌肉电刺激联合肺康复对慢阻肺急性加重期机械通气患者呼吸功能和运动能力的影响[J].中国康复,2025,40(5):271-278 |
| 呼吸神经肌肉电刺激联合肺康复对慢阻肺急性加重期机械通气患者呼吸功能和运动能力的影响 |
| Effect of respiratory neuromuscular electrical stimulation combined with pulmonary rehabilitation on respiratory function and motor function in mechanically ventilated AECOPD |
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| DOI：10.3870/zgkf.2025.05.003 |
| 中文关键词: 呼吸神经肌肉电刺激 慢性阻塞性肺疾病急性加重期 膈肌功能 腹肌功能 外周骨骼肌功能 |
| 英文关键词: respiratory neuromuscular electrical stimulation acute exacerbation of COPD diaphragm function abdominal muscle function peripheral skeletal muscle function |
| 基金项目:新疆维吾尔自治区自然科学基金（2020D01C262）；新疆维吾尔自治区自然科学基金项目（2015211C036） |
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| 中文摘要: |
| 目的：采用骨骼肌定量超声法，观察呼吸神经肌肉电刺激（RNMES）联合肺康复对慢性阻塞性肺疾病急性加重期（AECOPD）机械通气患者呼吸功能、运动功能和活动能力的影响，并探究呼吸肌结构-功能变化与外周骨骼肌功能、运动功能、活动能力的相关关系。方法：选取90例AECOPD机械通气患者，按随机数字表法随机分为对照组、观察组1、观察组2，每组各30例。对照组行常规肺康复，观察组1患者行RNMES+常规肺康复，观察组2患者行体外膈肌起搏(EDP)治疗+常规肺康复，治疗时间均为2周。比较3组患者治疗前后膈肌活动度(DE)、膈肌增厚分数(DTF)、腹横肌收缩率(TrACR)、咳嗽峰流速(CPF)、动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、屈肘肌群厚度(EFMT）、伸膝肌群厚度（KEMT）、医学研究理事会（MRC）评分、莫顿活动指数(DEMMI)、机械通气(MV)和ICU入住时间，使用Spearman相关性和分位数回归分析探讨呼吸肌与外周肌肉功能、运动功能和活动能力的相关性。结果：治疗2周后，3组患者DE、DTF、TrACR、CPF、PaO2、EFMT、KEMT、MRC评分、DEMMI均较治疗前提高(P<0.05)，且提高水平均呈观察组1＞观察组2＞对照组趋势(P<0.05)；治疗后，3组患者PaCO2均较治疗前降低(P<0.05)，且降低水平均呈观察组1＞观察组2＞对照组趋势(P<0.05)；治疗后，3组患者MV和ICU入住时间呈观察组1＜观察组2＜对照组趋势(P<0.05)。Sperman 相关性分析显示，DE、DTF的提高与EFMT、KEMT、MRC、DEMMI的提高正相关（P＜0.01）；TrACR的提高与DEMMI的提高正相关（P＜0.01）。以DE、DTF、TrACR、CPF为因变量的分位数回归显示：①在0.25和0.75分位点，EFMT与DE正相关(P<0.05)，且相关性随着DE的回归系数和分位数的增大而增大(P<0.05)；②在0.05分位点，KEMT与DE正相关(P<0.05)；在0.5分位点，KEMT与TrACR正相关(P<0.05)；在0.75分位点，KEMT与DE正相关(P<0.05)；③在0.05分位点，MRC与DE、DTF正相关(P<0.05)；在0.25分位点，MRC与DE正相关(P<0.05)；在0.75分位点，MRC与CPF正相关(P<0.05)；在0.95分位点，MRC与DTF正相关(P<0.05)；④在0.75分位点，DEMMI与DE正相关。结论：RNMES联合肺康复能够提高AECOPD机械通气患者的呼吸肌和外周骨骼肌功能，改善患者呼吸和运动功能，缩短机械通气和ICU入住时间，且膈肌活动度和收缩力、腹肌收缩力以及呼吸肌肌力的提高可明显改善屈肘肌群和伸膝肌群厚度、力量和DEMMI。 |
| 英文摘要: |
| Objective: Quantitative skeletal muscle ultrasound was used to observe the effects of respiratory nerve muscle electrical stimulation (RNMES) combined with pulmonary rehabilitation on respiratory function, motor function, and activity capacity in patients with mechanical ventilation, and correlation between structure-function changes in respiratory muscle and peripheral skeletal muscle function, respiratory function, motor function, and activity capacity. Methods: A total of 90 patients with AECOPD were randomly divided into control group, observation group 1 and observation group 2, each of 30. Control group was given pulmonary rehabilitation. Observation group 1 was given RNMES + pulmonary rehabilitation, and observation group 2 was given external diaphragm pacing (EDP) + pulmonary rehabilitation. The treatment duration was 2 weeks. Before and after 2 weeks of treatment, diaphragm excursion (DE), diaphragm thickening fraction (DTF), transversus abdominis contraction rate (TrACR), cough peak flow (CPF), partial pressure of oxygen (PaO2), partial pressure of carbon dioxide in artery (PaCO2), elbow flexor muscle group thickness (EFMT), knee extensor muscle group thickness (KEMT), Medical research council (MRC) score, the Morton mobility index (DEMMI), duration of MV and ICU stay were evaluated. Results: After 2 weeks of treatment, the indexes of DE, DTF, TrACR, CPF, PaO2, EFMT, KEMT, MRC score, DEMMI in all groups were improved as compared with those before the treatment (P<0.05), and the improvement level were observation group 1 > observation group 2 > control group (P<0.05); PaCO2 in all groups was lower than pre-treatment (P<0.05), and the decrease level was observation group 1 > observation group 2 > control group (P<0.05); the MV and ICU stay time was shorter in observation group 1 followed by observation group 2 and control group (P<0.05). Spearman correlation analysis indicated the improvement of DE and DTF was positively correlated with the improvement of EFMT, KEMT, MRC score and DEMMI (P<0.01); the improvement of TrACR was positively correlated with the improvement of DEMMI (P<0.01). In the quantile regression analysis with DE, DTF, TrACR and CPF as dependent variables, at the 0.25 and 0.75 point, EFMT was positively associated with DE and the correlation increased with the regression coefficient and quantile of DE; At the 0.05 point, KEMT was positively associated with DE; At the 0.5 point, KEMT was positively correlated with TrACR (P<0.05); At the 0.75 point, KEMT was positively correlated with DE (P<0.05). At the 0.05 point, MRC was positively correlated with DE and DTF (P<0.05); At the 0.25 point, MRC was positively associated with DE (P<0.05); At the 0.75 point, MRC was positively associated with CPF (P<0.05). At the 0.95 point，MRC was positively associated with DTF (P<0.05)；At the 0.75 point, DEMMI was positively associated with DE (P<0.05). Conclusion: RNMES combined with pulmonary rehabilitation can improve respiratory muscle and peripheral skeletal muscle function, respiratory function and mobility of AECOPD patients with MV. Improvement of DE, DTF, TrACR and CPF enhanced EFMT, KEMT, MRC score, DEMMI to varying degrees. |
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