| 高世爱,贾文萍,陈金慧,曹新燕,冷晓轩,刘西花.膈肌电刺激联合呼吸肌训练对脑卒中假性球麻痹患者肺通气功能、膈肌功能和吞咽功能的影响[J].中国康复,2025,40(10):599-605 |
| 膈肌电刺激联合呼吸肌训练对脑卒中假性球麻痹患者肺通气功能、膈肌功能和吞咽功能的影响 |
| Effect of diaphragmatic electrical stimulation combined with respiratory muscle training on pulmonary ventilation, diaphragm function and swallowing function in patients with pseudobulbar palsy after stroke |
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| DOI：10.3870/zgkf.2025.10.004 |
| 中文关键词: 脑卒中后假性球麻痹 膈肌电刺激 呼吸肌训练 呼吸功能 吞咽功能 |
| 英文关键词: pseudobulbar palsy after stroke diaphragmatic electrical stimulation respiratory muscle training respiratory function swallowing function |
| 基金项目:国家自然科学基金青年基金项目（81802239）；山东省中医药科技项目（M-2023142）；山东省医务职工科技创新计划项目（SDYWZGKCJH2022024） |
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| 中文摘要: |
| 目的：探究膈肌电刺激联合呼吸肌训练对脑卒中后假性球麻痹患者肺通气功能、膈肌功能和吞咽功能的影响。方法：纳入脑卒中后假性球麻痹患者60例，采用随机数字表法分为对照组与观察组各30例。所有患者均接受常规康复治疗，对照组在此基础上增加呼吸肌训练，观察组则在对照组的基础上联合膈肌电刺激干预。治疗周期为3周。分别在治疗前和治疗3周后，采用便携式肺功能检测仪评估患者肺通气功能，主要检测指标包括最大吸气压（MIP）、最大呼气压（MEP）、用力肺活量（FVC）、第1秒用力呼气量（FEV1）和峰值呼气流速（PEF）；同时运用超声技术评估膈肌移动度和膈肌增厚率，以客观反映膈肌功能状态；此外，通过超声评估舌运动功能，并结合吞咽功能量表（SSA）和吞咽生存质量量表（SWAL-QOL）评分，综合评价患者的吞咽功能改善情况。结果：治疗3周后，2组患者的肺通气功能指标MIP、MEP、FVC、FEV1和PEF均较治疗前升高（P＜0.01）；2组患者的膈肌移动度和膈肌增厚率也均较治疗前升高（P＜0.01）。在吞咽功能评估方面，SSA评分降低（P＜0.01），SWAL-QOL评分升高（P＜0.01）；舌运动幅度和速度增加（P＜0.01），舌运动时间减少（P＜0.01）。组间比较结果显示，观察组在上述各项指标的改善程度均优于对照组（P＜0.01）。结论：膈肌电刺激联合呼吸肌训练可更好地改善脑卒中后假性球麻痹患者肺通气功能、膈肌功能与吞咽功能，值得在临床应用推广。 |
| 英文摘要: |
| Objective：To investigate the effects of diaphragmatic electrical stimulation combined with respiratory muscle training on pulmonary ventilation, diaphragm function and swallowing function in patients with pseudobulbar palsy after stroke. Methods：A prospective randomized controlled study was used to enroll 60 patients with post-stroke pseudobulbar palsy admitted to the Rehabilitation Center of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from July 2023 to December 2024, and the patients were divided into a control group and an experimental group with 30 cases in each group. All patients received conventional rehabilitation. The control group was supplemented with respiratory muscle training, and the experimental group was given diaphragmatic electrical stimulation in combination with respiratory muscle training. The duration of treatment was 3 weeks. Before and after 3 weeks of treatment, the pulmonary ventilation function of the patients was evaluated by a portable pulmonary function tester, and the main indicators included maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEF). At the same time, ultrasound technology was used to evaluate diaphragm mobility and diaphragm thickening rate to objectively reflect the functional status of diaphragm. In addition, tongue motor function was evaluated by ultrasound, and combined with the swallowing function scale (SSA) and swallowing-related quality of life scale (SWAL-QOL) scores, the improvement of swallowing function was comprehensively evaluated. Results：After 3 weeks of treatment, the pulmonary ventilation function indexes (MIP, MEP, FVC, FEV1 and PEF) in the two groups were significantly higher than those before treatment (P<0.01), and the diaphragm mobility and diaphragm thickening rate in the two groups were significantly higher than those before treatment (P<0.01). In the evaluation of swallowing function, the SSA score was significantly decreased, the SWAL-QOL score and the amplitude of tongue movement were significantly increased (P<0.01). The results showed that the improvement degree of the above indicators in the experimental group was significantly better than that in the control group, and the difference was statistically significant (P<0.01). Conclusion：The integrated therapeutic regimen combining diaphragmatic electrical stimulation with respiratory muscle rehabilitation exerts significant therapeutic effects on enhancing pulmonary ventilation capacity, diaphragmatic mobility, and swallowing coordination in post-stroke pseudobulbar palsy patients, thereby holding considerable value for widespread clinical implementation. |
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