脑卒中患者自主咳嗽声学特征分析:呼吸肌训练的影响  

Analysis of acoustic features of voluntary cough in stroke patients:the impact of respiratory muscle training

作　　者：左亚南 吕倩倩 许维 江钟立 林枫[1,4,5] ZUO Ya'nan;LYU Qianqian;XU Wei(Department of Rehabilitation College,Nanjing Medical University,Jiangsu,Nanjing,210029)

机构地区：[1]南京医科大学康复医学院,江苏省南京市210029 [2]江苏省苏北人民医院 [3]杭州市儿童医院 [4]南京医科大学附属逸夫医院 [5]南京医科大学第一附属医院

出　　处：《中国康复医学杂志》2022年第5期623-629,共7页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:使用咳嗽声学检测技术辅助评估呼吸肌训练前后的咳嗽动作,为卒中后咳嗽能力测评提供除咳嗽峰流速(cough peak flow,CPF)检测以外的新思路。方法:卒中组(20例)进行6周的呼吸肌训练,对照组(25例)不接受训练。训练前后,在端坐位下根据随机视觉指令执行5次自主咳嗽,同时进行声音录制和CPF检测。计算每次咳嗽在时域、频域、时频域和信息域的声学参数。对卒中组训练前、训练后和对照组的声学参数进行比较,并分析其与CPF之间的相关性。结果:训练前咳嗽音峰值幅度和总耗能显著低于对照组(P<0.05)。CPF、峰值幅度、总耗能、声压均方根、峰值功率、峰强度最高频率和聚合熵,训练后都显著高于训练前(P<0.05)。对照组CPF分别与峰值幅度(r=0.67,P<0.01)和总耗能(r=0.70,P<0.01)显著正相关,卒中组训练前后CPF均与峰值幅度和总耗能无明显相关(P>0.05)。结论:呼吸肌训练6周虽可提高患者肺功能和CPF,但其声学参数提示训练未能改善咳嗽模式。咳嗽声学检测可为卒中后呼吸康复提供辅助手段。Objective:Using cough acoustic detection technology to assist in the assessment of cough movements before and after respiratory muscle training(RMT),so that to provide a new method for the assessment of cough ability after stroke except the cough peak flow(CPF)detection.Method:Twenty-five healthy persons and 20 stroke patients participated this study.The stroke group received6 weeks of RMT,while the control group received no training.Before and after training,in the sitting position the participants performed 5 voluntary coughs according to random visual instructions,and performed acoustic recording and CPF detection.Acoustic parameters of each cough were calculated in the time domain,frequency domain,time-frequency domain,and information domain.The acoustic parameters of the control group and the stroke group before and after training were compared,and the correlations between them and CPF were analyzed.Result:For the acoustic features,the peak amplitude and energy of the patient group before training were significantly lower than those of the control group(P<0.05).The CPF,peak amplitude,energy,the root-meansquare amplitude,peak power,peak max frequency and aggregate entropy of the patient group after training are all significantly higher than the patient group before training(P<0.05).The CPF of the control group was significantly positively correlated with the peak amplitude(r=0.67,P<0.01)and energy(r=0.70,P<0.01).The CPF of the patient group before and after training had no correlation with the peak amplitude and energy(P>0.05).Conclusion:Although RMT for 6 weeks can increase the CPF and pulmonary function of stroke patients,the acoustic parameters suggest that the training failed to improve the action pattern of voluntary cough.Cough auscultation offers a promising supplementary tool for post-stroke pulmonary rehabilitation.

关 键 词：脑卒中 声学分析技术 咳嗽音 咳嗽峰流速 呼吸肌训练 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]