吸气肌训练对脑卒中后偏瘫患者吸气肌功能及心肺适能的影响  

Effects of inspiratory muscle training on inspiratory muscle function and cardiopulmonary fitness in stroke survivors with hemiplegia

作　　者：胡树罡 朱二秋 龚雪 笪儒娴 马婷婷 Hu Shugang;Zhu Erqiu;Gong Xue;Da ruxian;Ma Tingting(The Department of Rehabilitation Medicine of Jiangning Hospital Affiliated to Nanjing Medical University,Nanjing 211100,China;The Department of Rehabilitation Medicine of Nanjing Dongshan Hospital,Nanjing 211100,China)

机构地区：[1]南京医科大学附属江宁医院康复医学科,南京211100 [2]南京市东山医院康复医学科,南京211100

出　　处：《中国运动医学杂志》2024年第9期699-706,共8页Chinese Journal of Sports Medicine

基　　金：南京医科大学康达学院科研发展基金项目(KD2020KYJJZD007);南京市江宁区科技惠民计划项目(2022085S)。

摘　　要：目的:观察吸气肌训练(inspiratory muscle training,IMT)对脑卒中后偏瘫患者吸气肌功能及心肺适能的影响。方法:从2021年1月至2023年1月南京市医科大学附属江宁医院康复医学科就诊的患者中纳入58例脑卒中后偏瘫患者,随机分为IMT组和对照组,每组各29例。两组患者均予12周健康指导和常规脑卒中后康复治疗(含:物理治疗及有氧训练),IMT组在此基础上予以IMT。分别于12周干预前后,采用Powerbreathe K5呼吸训练测试系统获取两组患者最大口腔吸气压(maximal inspiratory pressure,MIP)和吸气肌肌力指数;通过6分钟步行试验(6-minute walk test,6MWT)获得步行距离(6-minute walk distance,6MWD)和干预前后6MWD差值(6MWDd-value),并在6MWT期间使用Cosmed K4b2无线遥测气体分析仪动态采集患者呼吸气体参数,获得峰值摄氧量(VO_(2peak))和峰值通气量(VE_(peak)),观察比较上述指标的变化,评估和对比患者吸气肌功能和心肺适能的变化,并评估6MWD分别与VO_(2peak)和VE_(peak)的相关性。结果:12周干预后,两组患者MIP和吸气肌肌力指数、6MWD、VO_(2peak)、VE_(peak)均较干预前显著提高(P<0.05);IMT组MIP、吸气肌肌力指数、6MWDd、VO_(2peak)、VE_(peak)显著高于对照组(P<0.05);而6MWD两组差异不具统计学意义(P>0.05);6MWD与VO_(2peak)(r=0.298,P<0.05)和VE_(peak)(r=0.813,P<0.01)呈显著正相关;6MWDd-value与6MWD、VO_(2peak)和VE_(peak)相关均不显著(P>0.05);6MWD和IMT可正向预测VO_(2peak)(6MWD:B=0.023,P<0.01;IMT:B=0.341,P<0.01)和VE_(peak)(6MWD:B=0.503,P<0.01;IMT:B=7.486,P<0.01)。结论:(1)IMT可提高脑卒中后偏瘫患者吸气肌功能和心肺适能,建议可与常规康复治疗联合应用;(2)6分钟步行试验可能适用于间接评估脑卒中患者摄氧量的改善。Objective To explore the impact of inspiratory muscle training(IMT)on enhancing cardio-pulmonary fitness and inspiratory muscle performance among hemiplegic stroke survivors.Methods A total of 58 hemiplegic stroke survivors treated at the Affiliated Jiangning Hospital of Nanjing Medical University between January 2012 and January 2023 were enrolled,and randomly divided into an IMT group and a control group,each of 29.Both groups were given a 12-week health education and rou-tine rehabilitation including physiotherapy and aerobic exercise,while the IMT group was additionally provided with IMT.Before and after intervention,both groups were assessed the maximal inspiratory pressure(MIP)and the inspiratory muscle strength index(IMSI)using the Power breathe K5 system,the 6-minute walk distance(6MWD)using the 6-minute walk test(6MWT),as well as the difference value between baseline and post-intervention 6MWD(6MWDd-value).During the process of 6MWT,gas exchange data were recorded using Cosmed K4b2 wirless telemetry gas analyzer,and the peak oxy-gen uptake(VO_(2peak))and peak ventilation(VE_(peak))were determined.Meanwhile,the cardiopulmonary fit-ness and inspiratory muscle performance were compared,and the correlations of 6MWD to VO_(2peak) and VE_(peak) were assessed,respectively.Results After intervention,a significant increase was observed in MIP,IMSI,6MWD,VO_(2peak),and VE_(peak) in both groups(P<0.05).Moreover,the IMT group demonstrat-ed more significant increases in MIP,IMSI,6MWDd-value,VO_(2peak),and VE_(peak) compared to the con-trol group(P<0.05).However,no significant difference was found in 6MWD between the two groups af-ter the intervention(P>0.05).Although 6MWD was positively correlated with VO_(2peak)(r=0.298,P<0.05)and VE_(peak)(r=0.813,P<0.01),the 6MWDd-value was not significantly correlated with 6MWD,VO_(2peak) or VE_(peak)(P>0.05).Meanwhile,6MWD and IMT can positively predict VO_(2peak)(6MWD:B=0.023,P<0.01;IMT:B=0.341,P<0.01)and VE_(peak)(6MWD:B=0.503,P<0.01;IMT:B=7.486,P<0.01).Conclusion IMT can enhan

关 键 词：脑卒中 偏瘫 心肺适能 吸气肌 6分钟步行试验 

分 类 号：R743.3[医药卫生—神经病学与精神病学]