呼吸肌训练对亚急性期脑卒中患者呼吸功能的影响  

Effect of respiratory muscle training on respiratory function in subacute stroke patients

作　　者：俞长君[1] 李雪萍[1] 林强[1] 程凯[1] 蔡雨星 张会慧[1] 赵秋云[1] 夏鹏[1] Yu Changjun Li Xueping Lin Qiang Cheng Kai Cai Yuxing Zhang Huihui Zhao Qiuyun Xia Peng.(Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)康复医学科,南京210006

出　　处：《中华物理医学与康复杂志》2016年第10期735-739,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：南京市科技计划项目,脑卒中急性期康复治疗技术规范化应用与评估研究（20110401F）

摘　　要：目的探讨呼吸肌训练对亚急性期脑卒中患者呼吸功能的影响。方法选取50例首次发病亚急性期脑卒中患者，按随机数字表法分为对照组和观察组，每组25例。由于患者失去康复治疗的积极性、出院等原因，有5例患者退出（其中对照组2例，观察组3例），最终有45例患者完成本研究。2组患者均根据自身功能障碍情况给予相应的常规康复功能治疗，观察组在此基础上增加呼吸肌训练。每日2次，每周6d，康复治疗共3周。分别于治疗前和治疗3周后（治疗后），对2组患者进行血气分析、肺通气功能测定和呼吸肌肌力测定，并采用Fugl-Meyer运动功能评定量表（FMA）上肢及下肢部分对2组患者的上下肢运动功能进行评定，采用Barthel指数（BI）对2组患者的日常生活活动（ADL）能力进行评分；然后随访观察3个月，分析和比较2组患者肺部感染和再发脑卒中的发生率。结果治疗后，2组患者动脉氧分压（PaO2）、用力肺活量（FCV）、一秒用力呼气容积（FEV1）、每分钟最大通气量占预计值的百分比（MVV％）、峰值呼气流速（PEF）、最大静止吸气压（Plmax）、最大静止呼气压（PEmax）、上肢及下肢Fugl-Meyer运动功能评分、Barthel指数评分均较组内治疗前有明显提高，且差异有统计学意义（P〈0．05）；且治疗后除FMA和BI评分外，观察组其余各项指标均高于对照组，组间差异有统计学意义（P〈0．05）。随访3个月发现，2组患者肺部感染率组间比较，观察组低于对照组，差异亦有统计学意义（P〈0．05）；而2组患者再发脑卒中的发生率组间比较，差异无统计学意义（P〉0．05）。结论亚急性期脑卒中患者通过呼吸肌训练能有效增加呼吸肌肌力，提高动脉氧分压，改善肺通气功能，降低肺部感染率。Objective To investigate the effect of respiratory muscle training on respiratory function in stroke patients at subacute stage. Methods Fifty subaeute stroke patients with a first ever ischemic eerebrovascular accident were randomly allocated to a training group （ n = 25） and a control group （ n = 25）. All of the subjects re- ceived routine therapy for stroke rehabilitation twice daily, 6 days weekly for 3 weeks. In addition, the training group received respiratory muscle training besides the conventional stroke rehabilitation. Arterial blood gases, lung ventila- tion, respiratory muscle strength, the scores of Fugl-Meyer assessment （FMA） of the upper and lower limbs, and Barthel index were measured in two groups. In addition, pulmonary infection and stroke recurrence at 3 months follow- up were also recorded. Results After three months of intervention, PaO2 , forced vital capacity （FVC） , force ex- piratory volume in 1 second （ FEV1 ）, peak expiratory flow （ PEF）, maximum voluntary ventilation （ MVV）, maxi- mal inspiratory pressure （PImax）, maximal expiratory pressure （PEmax） , the scores of FMA and BI in two groups were significantly increased （P〈0.05）. The training group had significantly improved in terms of PaO2, FVC, FEV1, MVV, PEF, Plmax and PEmax compared with the control group （P〈0.05）, although there was no significant differ- ence in FMA and BI scores between groups （P〉0.05）. Moreover, the pulmonary infection as shown by 3 months fol- low-up occurred more frequently in the control group （P〈0.05） , but no significant difference was observed at the rate of stroke recurrence between two groups （P〉0.05）. Conclusion The respiratory muscle training effectively im- proved the respiratory muscle strength, the arterial oxygen pressure and pulmonary function, and reduced pulmonaryinfection at 3 months follow-up in subacute stroke patients.

关 键 词：脑卒中 呼吸肌 呼吸功能 肺通气 

分 类 号：R743.3[医药卫生—神经病学与精神病学]