[1]林夏妃,吴海霞,史静琴,等.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[J].卒中与神经疾病杂志,2022,29(05):442-447.[doi:10.3969/j.issn.1007-0478.2022.05.009]
　Lin Xiafei,Wu Haixia,Shi Jingqin,et al.Mechanism of respiratory muscle training via cortical diaphragm pathway in patients with ischemic stroke[J].Stroke and Nervous Diseases,2022,29(05):442-447.[doi:10.3969/j.issn.1007-0478.2022.05.009]
点击复制

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()
分享到：

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第29卷
期数:
2022年05期
页码:
442-447
栏目:
论著
出版日期:
2022-10-10

文章信息/Info

Title:
Mechanism of respiratory muscle training via cortical diaphragm pathway in patients with ischemic stroke
文章编号:
1007-0478(2022)05-0442-06
作者:
林夏妃; 吴海霞; 史静琴; 宋振华
570206 海口市人民医院康复医学科
Author(s):
Lin Xiafei;  Wu Haixia;  Shi Jingqin;  et al.
Department of Rehabilitation Medicine, Haikou People's Hospital, Haikou 570206
关键词:
缺血性脑卒中; 呼吸肌训练; 经皮质-膈肌通路; 作用机制; 呼吸肌
Keywords:
Stroke; Respiratory muscle training; Transcortical-diaphragmatic pathway; Mechanism of action; Respiratory muscle
分类号:
R743.3
DOI:
10.3969/j.issn.1007-0478.2022.05.009
文献标志码:
A
摘要:
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。
Abstract:
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.

参考文献/References:

[1] Rabinstein AA. Update on treatment of acute ischemic stroke[J]. Continuum(Minneap Minn), 2020, 26(2): 268-286.
[2] Tang L, Tang X, Yang Q. The application of tirofiban in the endovascular treatment of acute ischemic stroke: a Meta-Analysis[J]. Cerebrovasc Dis, 2021, 50(2): 121-131.
[3] Wang Q, Wang F, Fu F, et al. Diagnostic and prognostic value of serum miR-9-5p and miR-128-3p levels in early-stage acute ischemic stroke[J]. Clinics(Sao Paulo), 2021, 76(1): e2958.
[4] Slupska L, Halski T,Z·ytkiewicz M, et al. Proprioceptive neuromuscular facilitation for accessory respiratory muscles training in patients after ischemic stroke[J]. Adv Exp Med Biol, 2019, 1160(1): 81-91.
[5] 冯慧,付娟娟,开绍江,等.Breath-link呼吸功能评估在老年卒中病人吸气肌功能评价中的应用研究[J].实用老年医学,2019,33(5):433-436.
[6] 中华医学会神经病学分会.中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志,2018,51(9):666-682.
[7] 吴丹丽,解东风,宋梅思,等.中文版躯干损伤量表评定脑卒中患者躯干功能的信度及效度研究[J].中国康复医学杂志,2020,35(1):40-44.
[8] 陈丹凤,燕铁斌,黎冠东,等.三种平衡评定量表在脑卒中早期患者中的应用及其相关性研究[J].中国康复,2018,33(2):133-135.
[9] 曹丽辉,黄富表.徐筱婧媛.中国人简易上肢功能检查测试结果分析[J].中国康复理论与实践,2021,27(6):730-736.
[10] 张嗣敏,毕胜,赵海红,等.扩展Barthel指数量表应用于脑卒中患者康复评定的信度研究[J].中国康复,2019,34(2):75-77.
[11] 唐宝丽,易雅玮,和晓莉,等.简版脑卒中患者专门生存质量量表的汉化及信度、效度检验[J].现代临床护理,2021,20(2):33-39.
[12] Li H, Long D, Li B, et al. A clinical study to assess the influence of acupuncture at "Wang's Jiaji" acupoints on limb spasticity in patients in convalescent stage of ischemic stroke: study protocol for a randomized controlled trial[J]. Trials, 2019, 20(1): 419.
[13] Ptaszkowska L, Ptaszkowski K, Halski T, et al. Immediate effects of the respiratory stimulation on ventilation parameters in ischemic stroke survivors: A randomized interventional study(CONSORT)[J]. Medicine(Baltimore), 2019, 98(38): e17128.
[14] 韩亮,李惠琳,欧贻斌,等.呼吸肌训练对脑卒中后躯干控制和平衡功能的影响[J].海南医学院学报,2019,25(7):538-542.
[15] 李卫卫,周停,王红星.脑卒中慢性期吸气肌肌力的改变[J].中国康复理论与实践,2018,24(7):843-845.
[16] 张玮凇,邢艳丽,范星月.脑卒中患者吸气肌力量训练理论依据及临床研究进展[J].中国康复医学杂志,2017,32(11):1317-1320.
[17] Jung NJ, Na SS, Kim SK, et al. The effect of the inspiratory muscle training on functional ability in stroke patients[J]. J Phys Ther Sci, 2017, 29(11): 1954-1956.
[18] Geltser BI, Kurpatov IG, Dei AA, et al. Otsenka sily dykhatel'nykh myshts na razlichnykh stadiiakh ishemicheskogo insul'ta(Assessment of the respiratory muscles strength at various stages of ischemic stroke)[J]. Zh Nevrol Psikhiatr Im S S Korsakova, 2019, 119(2): 83-88.
[19] Aydogˇan AS, Ugˇurlu K, Sakizli EE, et al. Effects of inspiratory muscle training on respiratory muscle strength, trunk control, balance and functional capacity in stroke patients: a single-blinded randomized controlled study[J]. Top Stroke Rehabil, 2022, 29(1): 40-48.
[20] 邹盛国,吴建贤.脑卒中患者呼吸肌训练的临床研究进展[J].中华物理医学与康复杂志,2019,41(9):708-711.
[21] 王渝,张哲成,朱炬,等.机械通气慢性阻塞性肺疾病患者皮质-膈肌通路的电生理评价[J].天津医药,2010,38(2):105-108.

相似文献/References:

[1]高敏,张亚琼,芮海杰,等.内蒙古地区蒙古族与汉族血浆同型半胱氨酸水平差异及分析[J].卒中与神经疾病杂志,2015,22(01):47.
[2]杨新林,李月春,李锐铭,等.脑血管储备功能的临床应用进展[J].卒中与神经疾病杂志,2015,22(01):50.
[3]王本孝.脑微出血的研究进展[J].卒中与神经疾病杂志,2015,22(01):52.
[4]曹阳月,朱雨岚.脑缺血后处理与PI3K/Akt信号转导通路的研究进展[J].卒中与神经疾病杂志,2015,22(03):192.
[5]解晓睿,刘煜敏,和珂莉,等.中国人群脂联素+45位点基因单核苷酸多态性与缺血性脑卒中易感性的Meta分析[J].卒中与神经疾病杂志,2014,21(06):361.
[6]冯庆琪,李昂,王巍.κ阿片受体激动剂（U50488H）对缺血性脑卒中大鼠神经元自噬、迟发性神经元损伤及NOTCH表达水平的影响[J].卒中与神经疾病杂志,2022,29(04):311.[doi:10.3969/j.issn.1007-0478.2022.04.002]
　Feng Qingqi*,Li Ang*,Wang Wei.*.Effects of κ opioid receptor agonist(U50488H)on autophagy, delayed nerve injury and NOTCH expression in ischemic stroke rats[J].Stroke and Nervous Diseases,2022,29(05):311.[doi:10.3969/j.issn.1007-0478.2022.04.002]
[7]曹炳华,乔振虎.缺血性脑卒中患者血清SIRT1水平与早期神经功能恶化的相关性研究[J].卒中与神经疾病杂志,2022,29(04):330.[doi:10.3969/j.issn.1007-0478.2022.04.005]
　Cao Binghua,Qiao Zhenhu..Correlation between serum SIRT1 and early neurological deterioration of patients with ischemic stroke[J].Stroke and Nervous Diseases,2022,29(05):330.[doi:10.3969/j.issn.1007-0478.2022.04.005]
[8]何妮,易兴阳.CYP2C8,GPIIIa和P2Y12变异体之间的相互作用增加了缺血性脑卒中的易感性[J].卒中与神经疾病杂志,2022,29(04):359.[doi:10.3969/j.issn.1007-0478.2022.04.011]
[9]何涛,索志超,孔德强,等.术前血清CTRP3,CTRP9水平与缺血性脑卒中患者颈动脉支架成形术后再狭窄的相关性研究[J].卒中与神经疾病杂志,2022,29(05):427.[doi:10.3969/j.issn.1007-0478.2022.05.006]
　e Tao*,Suo Zhichao,Kong Deqiang*,et al.Correlation between preoperative serum CTRP3, CTRP9 levels and restenosis after carotid artery stenting in patients with cerebral ischemic stroke[J].Stroke and Nervous Diseases,2022,29(05):427.[doi:10.3969/j.issn.1007-0478.2022.05.006]
[10]宋秀威 杨月君 王伟.五味子乙素调节MAPK/NF-κB/AP-1信号通路对缺血性脑卒中大鼠神经元损伤的影响[J].卒中与神经疾病杂志,2023,30(03):242.[doi:10.3969/j.issn.1007-0478.2023.03.002]
　Song Xiuwei*,Yang Yuejun,Wang Wei..Schisandrin B attenuates neuronal damage in rats with ischemic stroke by regulating MAPK/NF-κB/AP-1 signaling pathway[J].Stroke and Nervous Diseases,2023,30(05):242.[doi:10.3969/j.issn.1007-0478.2023.03.002]

备注/Memo

备注/Memo:
基金项目:海南省卫生健康行业科研项目(编号为20A200061)
更新日期/Last Update: 2022-10-10