呼吸功能障碍在脑卒中康复中的临床研究进展

doi:10.3969/j.issn.1004-583X.2022.12.015

摘要/Abstract

摘要：

呼吸功能障碍是脑卒中患者临床康复中的常见并发症之一,通常表现为肺功能减退、呼吸肌萎缩和肌力下降、呼吸模式异常以及呼吸性碱中毒等,对患者机体各项功能和生活质量产生了广泛而深远的影响。本文主要对脑卒中患者呼吸功能障碍临床表现、发生机制、呼吸功能评估以及呼吸训练方法进行综述,旨在为脑卒中呼吸功能障碍领域的研究提供理论参考。

中图分类号:

R743.3

余一夫, 袁春华. 呼吸功能障碍在脑卒中康复中的临床研究进展[J]. 临床荟萃, 2022, 37(12): 1142-1147.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.12.015

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I12/1142

参考文献 57

[1]	Wu S, Wu B, Liu M, et al. Stroke in China: Advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4):394-405. doi: S1474-4422(18)30500-3 pmid: 30878104
[2]	Lanini B, Bianchi R, Romagnoli I, et al. Chest wall kinematics in patients with hemiplegia[J]. Am J Respir Crit Care Med, 2003, 168(1):109-113. doi: 10.1164/rccm.200207-745OC URL
[3]	Menezes KK, Nascimento LR, Avelino PR, et al. Efficacy of interventions to improve respiratory function after stroke[J]. Respir Care, 2018, 63(7):920-933. doi: 10.4187/respcare.06000 pmid: 29844210
[4]	Menezes KK, Nascimento LR, Ada L, et al. Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: A systematic review[J]. J Physiother, 2016, 62(3):138-144. doi: 10.1016/j.jphys.2016.05.014 pmid: 27320833
[5]	Jung KM, Bang DH. Effect of inspiratory muscle training on respiratory capacity and walking ability with subacute stroke patients: A randomized controlled pilot trial[J]. J Phys Ther Sci, 2017, 29(2):336-339. doi: 10.1589/jpts.29.336 URL
[6]	Lee K, Park D, Lee G. Progressive respiratory muscle training for improving trunk stability in chronic stroke survivors: A pilot randomized controlled trial[J]. J Stroke Cerebrovasc Dis, 2019, 28(5):1200-1211. doi: S1052-3057(19)30008-4 pmid: 30712955
[7]	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. doi: 10.1589/jpts.29.1954 URL
[8]	Nogués MA, Benarroch E. Abnormalities of respiratory control and the respiratory motor unit[J]. Neurologist, 2008, 14(5):273-288. doi: 10.1097/NRL.0b013e318173e830 pmid: 18784597
[9]	Robba C, Bonatti G, Battaglini D, et al. Mechanical ventilation in patients with acute ischaemic stroke: From pathophysiology to clinical practice[J]. Crit Care, 2019, 23(1):388. doi: 10.1186/s13054-019-2662-8 URL
[10]	Bösel J. Use and timing of tracheostomy after severe stroke[J]. Stroke, 2017, 48(9):2638-2643. doi: 10.1161/STROKEAHA.117.017794 pmid: 28733479
[11]	Popat C, Ruthirago D, Shehabeldin M, et al. Outcomes in patients with acute stroke requiring mechanical ventilation: Predictors of mortality and successful extubation[J]. Am J Med Sci, 2018, 356(1):3-9. doi: S0002-9629(18)30099-5 pmid: 30049327
[12]	Woischneck D, Kapapa T, Heissler HE, et al. Respiratory function after lesions in medulla oblongata[J]. Neurol Res, 2009, 31(10):1019-1022. doi: 10.1179/174313209X385608 pmid: 19215659
[13]	Khedr EM, El Shinawy O, Khedr T, et al. Assessment of corticodiaphragmatic pathway and pulmonary function in acute ischemic stroke patients[J]. Eur J Neurol, 2000, 7(3):323-330. pmid: 10886317
[14]	Tyml K, Mathieu-Costello O. Structural and functional changes in the microvasculature of disused skeletal muscle[J]. Front Biosci, 2001, 6:D45-D52. doi: 10.2741/Tyml URL
[15]	Scherbakov N, von Haehling S, Anker SD, et al. Stroke induced sarcopenia: Muscle wasting and disability after stroke[J]. Int J Cardiol, 2013, 170(2):89-94. doi: 10.1016/j.ijcard.2013.10.031 pmid: 24231058
[16]	Kim M, Lee K, Cho J, et al. Diaphragm thickness and inspiratory muscle functions in chronic stroke patients[J]. Med Sci Monit, 2017, 23:1247-1253. doi: 10.12659/MSM.900529 URL
[17]	Jung KJ, Park JY, Hwang DW, et al. Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients[J]. Ann Rehabil Med, 2014, 38(1):29-37. doi: 10.5535/arm.2014.38.1.29 URL
[18]	Pinheiro MB, Polese JC, Faria CD, et al. Inspiratory muscular weakness is most evident in chronic stroke survivors with lower walking speeds[J]. Eur J Phys Rehabil Med, 2014, 50(3):301-307.
[19]	Wang JS, Cho KH, Park SJ. The immediate effect of diaphragm taping with breathing exercise on muscle tone and stiffness of respiratory muscles and SpO₂ in stroke patient[J]. J Phys Ther Sci, 2017, 29(6):970-973. doi: 10.1589/jpts.29.970 URL
[20]	Xu CY, Ye HW, Chen B, et al. Analysis of risk factors and prognosis of post-stroke pulmonary infection in integrated ICU[J]. Eur Rev Med Pharmacol Sci, 2021, 25(2):856-865.
[21]	Powers SK, Wiggs MP, Sollanek KJ, et al. Ventilator-induced diaphragm dysfunction: Cause and effect[J]. Am J Physiol Regul Integr Comp Physiol, 2013, 305(5):R464-R477. doi: 10.1152/ajpregu.00231.2013 URL
[22]	Grosu HB, Lee YI, Lee J, et al. Diaphragm muscle thinning in patients who are mechanically ventilated[J]. Chest, 2012, 142(6):1455-1460. doi: S0012-3692(12)60677-1 pmid: 23364680
[23]	Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans[J]. N Engl J Med, 2008, 358(13):1327-1335. doi: 10.1056/NEJMoa070447 URL
[24]	Hermans G, Agten A, Testelmans D, et al. Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: A prospective observational study[J]. Crit Care, 2010, 14(4):R127. doi: 10.1186/cc9094 URL
[25]	Choi HE, Jo GY, Do HK, et al. Comprehensive respiratory muscle training improves pulmonary function and respiratory muscle strength in acute stroke patients[J]. J Cardiopulm Rehabil Prev, 2021, 41(3):166-171. doi: 10.1097/HCR.0000000000000526 URL
[26]	Santos RSD, Dall'alba SCF, Forgiarini SGI, et al. Relationship between pulmonary function, functional independence, and trunk control in patients with stroke[J]. Arq Neuropsiquiatr, 2019, 77(6):387-392. doi: 10.1590/0004-282x20190048 URL
[27]	Billinger SA, Coughenour E, Mackay-Lyons MJ, et al. Reduced cardiorespiratory fitness after stroke: Biological consequences and exercise-induced adaptations[J]. Stroke Res Treat, 2012, 2012:959120.
[28]	Nakanishi N, Okura K, Okamura M, et al. Measuring and monitoring skeletal muscle mass after stroke: A review of current methods and clinical applications[J]. J Stroke Cerebrovasc Dis, 2021, 30(6):105736. doi: 10.1016/j.jstrokecerebrovasdis.2021.105736 URL
[29]	Jung JH, Kim NS. The effect of progressive high-intensity inspiratory muscle training and fixed high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients[J]. J Phys Ther Sci, 2015, 27(10):3267-3269. doi: 10.1589/jpts.27.3267 pmid: 26644689
[30]	Pollock RD, Rafferty GF, Moxham J, et al. Respiratory muscle strength and training in stroke and neurology: A systematic review[J]. Int J Stroke, 2013, 8(2):124-130. doi: 10.1111/j.1747-4949.2012.00811.x pmid: 22568454
[31]	Sutbeyaz ST, Koseoglu F, Inan L, et al. Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: A randomized controlled trial[J]. Clin Rehabil, 2010, 24(3):240-250. doi: 10.1177/0269215509358932 pmid: 20156979
[32]	Lee HJ, Kang TW, Kim BR. Effects of diaphragm and deep abdominal muscle exercise on walking and balance ability in patients with hemiplegia due to stroke[J]. J Exerc Rehabil, 2018, 14(4):648-653. doi: 10.12965/jer.1836252.126 URL
[33]	Rochester CL, Mohsenin V. Respiratory complications of stroke[J]. Semin Respir Crit Care Med, 2002, 23(3):248-260. pmid: 16088617
[34]	Ha SM, Kwon OY, Kim SJ, et al. The importance of a normal breathing pattern for an effective abdominal-hollowing maneuver in healthy people: An experimental study[J]. J Sport Rehabil, 2014, 23(1):12-17. doi: 10.1123/JSR.2012-0059 URL
[35]	Kocjan J, Gzik-Zroska B, Nowakowska K, et al. Impact of diaphragm function parameters on balance maintenance[J]. PLoS One, 2018, 13(12):e0208697. doi: 10.1371/journal.pone.0208697 URL
[36]	Muppidi V, Kolli S, Dandu V, et al. Severe respiratory alkalosis in acute ischemic stroke: A rare presentation[J]. Cureus, 2020, 12(4):e7747.
[37]	Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation[J]. Int J Sports Phys Ther, 2013, 8(1):62-73.
[38]	Singh V, Khatana S, Gupta P. Blood gas analysis for bedside diagnosis[J]. Natl J Maxillofac Surg, 2013, 4(2):136-141. doi: 10.4103/0975-5950.127641 URL
[39]	Goligher EC, Laghi F, Detsky ME, et al. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: Feasibility, reproducibility and validity[J]. Intensive Care Med, 2015, 41(4):642-649. doi: 10.1007/s00134-015-3687-3 pmid: 25693448
[40]	Laghi F, Shaikh HS, Morales D, et al. Diaphragmatic neuromechanical coupling and mechanisms of hypercapnia during inspiratory loading[J]. Respir Physiol Neurobiol, 2014, 198:32-41. doi: 10.1016/j.resp.2014.03.004 pmid: 24747754
[41]	宋征宇, 张鹏, 赵红梅, 等. 不同呼吸训练方式在脑卒中后疲劳治疗中的效果及对患者膈肌功能的影响[J]. 中国临床医生杂志, 2018, 46(12):1450-1453.
[42]	Lee HY, Cheon SH, Yong MS. Effect of diaphragm breathing exercise applied on the basis of overload principle[J]. J Phys Ther Sci, 2017, 29(6):1054-1056. doi: 10.1589/jpts.29.1054 URL
[43]	Cabral LF, D'Elia Tda C, Marins Dde S, et al. Pursed lip breathing improves exercise tolerance in COPD: A randomized crossover study[J]. Eur J Phys Rehabil Med, 2015, 51(1):79-88.
[44]	Seo K, Hwan PS, Park K. The effects of inspiratory diaphragm breathing exercise and expiratory pursed-lip breathing exercise on chronic stroke patients' respiratory muscle activation[J]. J Phys Ther Sci, 2017, 29(3):465-469. doi: 10.1589/jpts.29.465 pmid: 28356632
[45]	Vatwani A. Pursed lip breathing exercise to reduce shortness of breath[J]. Arch Phys Med Rehabil, 2019, 100(1):189-190. doi: 10.1016/j.apmr.2018.05.005 URL
[46]	Kido S, Nakajima Y, Miyasaka T, et al. Effects of combined training with breathing resistance and sustained physical exertion to improve endurance capacity and respiratory muscle function in healthy young adults[J]. J Phys Ther Sci, 2013, 25(5):605-610. doi: 10.1589/jpts.25.605 pmid: 24259812
[47]	Molassiotis A, Charalambous A, Taylor P, et al. The effect of resistance inspiratory muscle training in the management of breathlessness in patients with thoracic malignancies: A feasibility randomised trial[J]. Support Care Cancer, 2015, 23(6):1637-1645. doi: 10.1007/s00520-014-2511-x pmid: 25417042
[48]	Derrickson J, Ciesla N, Simpson N, et al. A comparison of two breathing exercise programs for patients with quadriplegia[J]. Phys Ther, 1992, 72(11):763-769. doi: 10.1093/ptj/72.11.763 pmid: 1409873
[49]	Kigin CM. Breathing exercises for the medical patient: The art and the science[J]. Phys Ther, 1990, 70(11):700-706. pmid: 2236213
[50]	Kim CB, Yang JM, Choi JD. The effects of chest expansion resistance exercise on chest expansion and maximal respiratory pressure in elderly with inspiratory muscle weakness[J]. J Phys Ther Sci, 2015, 27(4):1121-1124. doi: 10.1589/jpts.27.1121 URL
[51]	Rocha T, Souza H, Brandão DC, et al. The manual diaphragm release technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: A randomised trial[J]. J Physiother, 2015, 61(4):182-189. doi: 10.1016/j.jphys.2015.08.009 pmid: 26386894
[52]	李琳琳, 郝世杰, 王万宏, 等. 膈肌松解技术联合吸气肌训练对脑卒中患者肺功能的影响[J]. 康复学报, 2018, 28(1):19-23.
[53]	Zheng Y, Zhang Y, Li H, et al. Comparative effect of Liuzijue Qigong and conventional respiratory training on trunk control ability and respiratory muscle function in patients at an early recovery stage from stroke: A randomized controlled trial[J]. Arch Phys Med Rehabil, 2021, 102(3):423-430. doi: 10.1016/j.apmr.2020.07.007 URL
[54]	Wu W, Liu X, Liu J, et al. Effectiveness of water-based Liuzijue exercise on respiratory muscle strength and peripheral skeletal muscle function in patients with COPD[J]. Int J Chron Obstruct Pulmon Dis, 2018, 13:1713-1726. doi: 10.2147/COPD.S165593 URL
[55]	Tang Y, Jiang J, Shen P, et al. Liuzijue is a promising exercise option for rehabilitating discharged COVID-19 patients[J]. Medicine (Baltimore), 2021, 100(6):e24564. doi: 10.1097/MD.0000000000024564 URL
[56]	陈妙玲, 查甫兵, 李华, 等. 体外膈肌起搏联合体位改变对脑卒中气管切开卧床者肺部感染的影响[J]. 深圳中西医结合杂志, 2021, 31(3):4-7.
[57]	闫斌, 陈峰, 刘永飞, 等. 体外膈肌起搏器联合经鼻高流量氧疗在重症脑出血术后患者脱机中的临床应用[J]. 中华医学杂志, 2020, 100(14):1091-1094.

呼吸功能障碍在脑卒中康复中的临床研究进展

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 57

相关文章 15

编辑推荐

Metrics

本文评价

[1]	黄赛虎, 龙中洁, 吴水燕, 柏振江. 新冠疫情前后重症肺炎合并急性呼吸衰竭患儿的临床特点与病原学分析[J]. 临床荟萃, 2024, 39(2): 140-143.
[2]	肖煌怡, 袁建坤, 严梓予, 曾雯姝, 鲁兰莫, 王峻. 认知干预对遗忘型轻度认知障碍老年患者干预效果的meta分析[J]. 临床荟萃, 2024, 39(1): 12-19.
[3]	王海婷, 张丽平, 武雪瑞, 包利红, 李维燕, 闫进琳, 宋淑华, 卢珊珊. 远程康复在脊髓损伤患者居家康复护理中的研究进展[J]. 临床荟萃, 2023, 38(9): 851-854.
[4]	高玉叶, 徐海, 孙妍. 肥胖对呼吸功能的影响及机制[J]. 临床荟萃, 2023, 38(4): 381-384.
[5]	徐文灯, 沈懿, 张小峰. 心电图非特异性ST-T异常与急性缺血性脑卒中复发的相关性[J]. 临床荟萃, 2023, 38(10): 883-886.
[6]	王会新, 赵芳晴, 张馨妍, 侯晓雯. 中国人尿酸水平与急性缺血性脑卒中患者预后关系的meta分析[J]. 临床荟萃, 2022, 37(9): 785-790.
[7]	乔庆哲, 张新, 贺向红, 席素雅. 河北省涞源县40岁以上人群肺功能流行病学调查[J]. 临床荟萃, 2022, 37(7): 627-630.
[8]	夏菁, 陈缪存, 林敏, 郝又国. 高频与低频重复经颅磁刺激对脑卒中后肌痉挛的改善效果比较[J]. 临床荟萃, 2022, 37(5): 427-430.
[9]	何洪真, 吕佩源. 调节性T细胞与缺血性脑卒中危险因素的相关性[J]. 临床荟萃, 2022, 37(4): 369-372.
[10]	田玉静, 李萍, 黄家容, 张宁, 平芬. 运动训练在慢性阻塞性肺疾病肺康复中的应用[J]. 临床荟萃, 2021, 36(9): 861-864.
[11]	孙秀丽, 肖尧, 胡国金, 张丽, 王陈信子, 华佳琪. 基于作业分析任务导向性训练对脑卒中患者上肢功能的疗效[J]. 临床荟萃, 2021, 36(3): 216-219.
[12]	夏晓黎, 马艳萍, 王亚锋. 充分氧合下综合肺康复治疗对老年COPD稳定期患者的临床疗效评价[J]. 临床荟萃, 2021, 36(2): 134-138.
[13]	于泓a，李佳艳a，付亚南b. 血清尿酸、肌酐及胱抑素C水平与青年卒中患者神经功能缺损程度的相关性[J]. 临床荟萃, 2020, 35(7): 616-619.
[14]	甘婉玲1，徐菊玲1，姚惠萍2，温焕1，陈燕1. 经鼻高流量湿化氧疗在成人重症免疫抑制患者应用疗效的meta分析[J]. 临床荟萃, 2020, 35(2): 116-122.
[15]	洪婉婷, 孙秀丽, 鲍兰军, 杨南华, 陈骕, 管晓波, 施敏. 脑卒中后恢复期患者抑郁影响因素和筛查效果分析[J]. 临床荟萃, 2020, 35(12): 1101-1105.