常规呼吸训练结合发音视觉反馈训练对脑卒中患者呼吸功能的影响  

Effects of conventional respiratory training combined with articulatory visual feedback training on respiratory function in stroke patients

作　　者：郭和杰 石明芳 刘光华 刘圆圆 刘邦忠 KUO Ho-chieh;SHI Ming-fang;LIU Guang-hua;LIU Yuan-yuan;LIU Bang-zhong(Department of Rehabilitation Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院康复医学科,上海200032 [2]上海市中西医结合康复医学研究所,上海200032

出　　处：《复旦学报（医学版）》2024年第6期990-996,共7页Fudan University Journal of Medical Sciences

摘　　要：目的探讨常规呼吸训练与发音视觉反馈训练相结合对改善卒中患者的呼吸功能和膈肌功能的影响。方法本研究招募2022年11月至2023年8月于复旦大学附属中山医院康复医学科住院的脑卒中患者共30名,随机分为试验组和对照组,每组各15例。试验组接受常规呼吸训练结合发音视觉反馈的综合训练,对照组接受常规呼吸训练,治疗每周5次、为期4周。结果两组的最大吸气压、吸气峰值流量、最长声时、最大数数能力、呼气峰值流量评估在训练后各自均有明显改善(P<0.05)。与对照组相比,试验组在训练后最大吸气压[(46.04±13.58)cmH2O vs.(63.46±16.96)cmH2O;P=0.004;95%CI:-28.91,-5.93;效应值大小(effect size,ES)=1.13]、吸气峰值流量[(144.00±43.81)L/min vs.(190.20±75.01)L/min;P=0.049;95%CI:-1.54,0;ES=0.75]、最大数数能力[(7.06±3.25)s vs.(10.30±4.89)s;P=0.041;95%CI:-6.34,-0.13;ES=0.77]、用力肺活量[(1.74±0.76)L vs.(2.26±0.57)L;P=0.04;95%CI:-1.03,-0.03;ES=0.77]、第1秒用力呼气容积[(1.10±0.40)L vs.(1.60±0.50)L;P=0.004;95%CI:-0.85,-0.18;ES=1.1]、呼气峰值流量[83.40(55.80)L/min vs.171.12(94.80)L/min;P=0.012]的差异均有统计学意义。两组间在最长声时、肺活量、最大通气量,以及健侧和偏瘫侧膈肌移动度、膈肌增厚率的差异均无统计学意义。结论与单独进行常规呼吸训练相比,发音视觉反馈训练与常规呼吸训练相结合能更有效地提高卒中患者的呼吸和肺功能。Objective To investigate whether the combination of conventional respiratory training and articulatory visual feedback training can improve respiratory function and diaphragmatic function in stroke patients.Methods This single-blind randomized controlled trial recruited a total of 30 stroke patients who were admitted to Department of Rehabilitation Medicine,Zhongshan Hospital,Fudan University,from Nov 2022 to Aug 2023,and divided them into two groups:a experimental group(n=15)and a control group(n=15).The experimental group received conventional respiratory training combined with articulatory visual feedback training,and the control group received conventional respiratory training.The training in the 2 groups was conducted 5 times per week for 4 weeks.Results Both groups significantly improved in maximum inspiratory pressure(MIP),peak inspiratory flow(PIF),maximum phonation time(MPT),maximum counting ability(MCA),and peak expiratory flow(PEF)in each of the two groups improved significantly after training(P<0.05).After training,compared with the control group,the experimental group showed significant differences in MIP[(46.04±13.58)cmH2O vs(.63.46±16.96)cmH2O;P=0.004;95%CI:-28.91,-5.93;effect size(ES)=1.13],PIF[(144.00±43.81)L/min vs.(190.20±75.01)L/min;P=0.049;95%CI:-1.54,0;ES=0.75],MCA[(7.06±3.25)s vs.(10.30±4.89)s;P=0.041;95%CI:-6.34,-0.13;ES=0.77],forced vital capacity(FVC)[(1.74±0.76)L vs.(2.26±0.57)L;P=0.04;95%CI:-1.03,-0.03;ES=0.77],forced expiratory volume in one second(FEV1)[(1.10±0.40)L vs.(1.60±0.50)L;P=0.004;95%CI:-0.85,-0.18;ES=1.1],and PEF[(83.40(55.80)L/min vs.171.12(94.80)L/min;P=0.012)].However,there were no statistically significant differences after training between the two groups in the maximum phonation time(MPT),vital capacity(VC),maximum voluntary ventilation(MVV),diaphragm mobility of the nonparetic side and paretic side,thickening fraction of the nonparetic side and paretic side.Conclusion Compared with conventional respiratory training alone,the combination of articulatory visua

关 键 词：呼吸训练 脑卒中康复 发音视觉反馈 肺功能 膈肌功能 

分 类 号：R493[医药卫生—康复医学]