| 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. |
