呼吸肌训练经皮质-膈肌通路对缺血性脑卒中患者的作用机制分析

目的 分析呼吸肌训练经皮质-膈肌通路对缺血性脑卒中患者的作用机制。方法 选取2019年6月-2021年6月本院收治的98例缺血性脑卒中患者作为研究对象,按照随机数字表法按1:1比例分为观察组、对照组,每组各49例; 对照组采用常规康复训练,观察组在对照组基础上加用呼吸肌训练; 比较2组治疗前、治疗8周后呼吸肌功能最大吸气压(Maximum inspiratory pressure,MIP)、最大呼气压(Maximal expiratory pressure,MEP)、胸廓活动度]、躯干损伤量表(Trunk impaiment scale,TIS)、Fugl-Meyer评定量表(Fugl-Meyer assessment,FMA)、简易上肢功能检查量表(Simple test for evaluating hand function,STEF)、三维步态、Barthel指数(Barthelindex,BI)、脑卒中专门化生活质量量表(Stroke specific quality of life scale,SS-QOL)评分、皮质-膈肌通路膈神经运动传导(Phrenic nerve conduction,PNC)潜伏期、PNC波幅对数、经C₇棘突磁刺激膈肌运动诱发电位(Diaphragmatic motor evoked potential,dMEP)潜伏期、经C₇棘突dMEP波幅对数]。结果 治疗8周后观察组MIP,MEP,胸廓活动度较对照组高(P<0.05); 治疗8周后观察组TIS,FMA,STEF评分较对照组高(P<0.05); 治疗8周后观察组步速、步频、跨步长比率较对照组高(P<0.05); 治疗8周后观察组BI,SS-QOL评分较对照组高(P<0.05); 治疗8周后观察组PNC潜伏期、经C₇棘突dMEP潜伏期较对照组短,PNC波幅对数、经C₇棘突dMEP波幅对数较对照组高(P<0.05)。结论 呼吸肌训练可能通过改善经皮质-膈肌通路来改善缺血性脑卒中患者呼吸肌功能,从而提高躯干控制力,恢复平衡步态,提升肢体运动功能、日常生活能力及生活质量。

Mechanism of respiratory muscle training via cortical diaphragm pathway in patients with ischemic stroke

ObjectiveTo analyze the mechanism of respiratory muscle training via a cortical-diaphragmatic pathway in stroke patients.Methods A total of 98 patients with ischemic stroke who were treated in our hospital from June 2019 to June 2021 were included. The patients were divided into the observation group and the control group using the random number table method in a ratio of 1:1, with 49 cases in each. The control group received routine rehabilitation training, while the observation group received additional respiratory muscle training. The following functional changes were compared between the two groups before treatment and after 8 weeks of treatment: respiratory muscle function maximum inspiratory pressure(MIP), maximum expiratory pressure(MEP), thoracic range of motion], trunk injury scale(TIS), Fugl-Meyer assessment scale(FMA), simple test for evaluating hand function(STEF), three-dimensional gait, Barthel index(BI), stroke-specific quality of life scale(SS-QOL)score, cortical-diaphragmatic pathway phrenic nerve motor conduction(PNC)latency, PNC amplitude pair number, magnetically stimulated diaphragm motor evoked potential(dMEP)latency via C₇ spinous process, logarithm of dMEP amplitude via C₇ spinous process].Results After treatment, MIP, MEP, and thoracic activity in the observation group were higher than those in the control group(P<0.05). After treatment, the TIS, FMA, and STEF scores in the observation group were higher than those in the control group(P<0.05). The frequency and stride length ratio of the observation group were higher than those of the control group(P<0.05). The BI and SS-QOL scores of the observation group after treatment were higher than those of the control group(P<0.05). The incubation period of PNC and dMEP via the C7 spinous process in the observation group were shorter than those in the control group. The logarithm of the amplitude of PNC and the logarithm of the amplitude of dMEP through the C7 spinous process were higher than those of the control group(P<0.05).Conclusion Respiratory muscle training may improve the respiratory muscle function of stroke patients by improving the transcortical-diaphragmatic pathway, thereby improving trunk control, restoring gait balance, and improving limb motor function, daily living ability, and quality of life.