膈肌放松技术结合抗阻呼吸训练对脑卒中患者运动能力的影响研究

doi:10.3969/j.issn.1004-583X.2023.11.007

摘要/Abstract

摘要：

目的探究膈肌放松技术结合抗阻呼吸训练对脑卒中患者运动能力的影响。方法以郑州市中心医院康复治疗部60例住院脑卒中患者为研究对象,将其随机分为A组、B组和C组。A组进行常规康复训练、膈肌放松和抗阻呼吸训练,B组进行常规康复训练和膈肌放松,C组进行常规康复训练和抗阻呼吸训练。分别在试验干预前、康复训练4周、8周和12周时对所有受试者的最大吸气压(maximal inspiratory pressure,MIP)、吸气流速峰值(peak inspiratory velocity,PIF)、肢体运动功能(fugl-Meyer motor function assessment,FMA)、10 m步行测试(10-meter walking test,10MWT)、Berg平衡功能(berg balance function,BBS)和稳定极限(limits of stability,LOS)进行评估,并对统计数据进行分析。结果试验干预前A组、B组和C组受试者MIP、PIF、FMA、10MWT、BBS和LOS间差异均无统计学意义( $P$ >0.05);试验干预后,在4周、8周和12周时A组、B组和C组相比试验干预前MIP、PIF、FMA、BBS和LOS均显著增加( $P$ <0.05),10MWT均显著减少( $P$ <0.05);试验干预后,在4周、8周和12周时A组、B组和C组组间比较MIP、PIF、FMA、10MWT、BBS和LOS差异有统计学意义( $P$ <0.05),其中A组MIP、PIF、FMA、BBS和LOS均高于B组和C组,A组10MWT较B组和C组更低( $P$ <0.05);C组MIP、PIF、FMA、BBS和LOS均高于B组,C组10MWT较B组更低( $P$ <0.05)。结论膈肌放松技术结合抗阻呼吸训练相比单独使用这两种训练方法康复效果更佳。膈肌放松技术可拓展应用作为脑卒中患者居家康复锻炼的选择。

关键词: 卒中, 膈肌放松, 呼吸训练, 运动能力

Abstract:

Objective To explore the effects of diaphragm relaxation technique combined with resistance breathing training on motor ability of stroke survivors. Methods A total of 60 patients with cerebral apoplexy in the Rehabilitation Department of Zhengzhou Central Hospital were randomly divided into group A, group B and group C. Patients in Group A received routine rehabilitation training, diaphragm relaxation and resistance breathing training; those in group B received routine rehabilitation training and diaphragm relaxation; and those in group C received routine rehabilitation training and resistance breathing training. Maximal inspiratory pressure, peak inspiratory velocity, Fugl-Meyer motor function assessment (FMA), 10-meter walking test (10MWT), Berg balance function (BBS), and limits of stability (LOS) of all subjects were evaluated before intervention and 4, 8, and 12 weeks after rehabilitation training. Statistical data were analyzed. Results Before experiment intervention, there were no significant differences in MIP, PIF, FMA, 10MWT, BBS and LOS among group A, B and C ( $P$ >0.05). After experiment intervention, MIP, PIF, FMA, BBS and LOS in groups A, B and C significantly increased ( $P$ <0.05), but 10MWT significantly decreased at 4, 8 and 12 weeks compared with those before the experimental intervention ( $P$ <0.05). After experiment intervention, there were significant differences in the MIP, PIF, FMA, 10MWT, BBS and LOS at 4, 8 and 12 weeks among group A, B and C ( $P$ <0.05). MIP, PIF, FMA, BBS and LOS of group A were significantly higher than those of group B and C, while 10MWT was significantly lower ( $P$ <0.05). MIP, PIF, FMA, BBS and LOS of group C were significantly higher than those of group B, but 10MWT of group C was significantly lower than that of group B ( $P$ <0.05). Conclusion Diaphragm relaxation technique combined with resistance breathing training has better healing effects than the single training. Diaphragm relaxation technique can be extended as a choice of home rehabilitation exercise for stroke patients.

Key words: stroke, diaphragm relaxation, breathing training, motor ability

中图分类号:

R743.3

余一夫, 袁春华. 膈肌放松技术结合抗阻呼吸训练对脑卒中患者运动能力的影响研究[J]. 临床荟萃, 2023, 38(11): 1002-1007.

Yu Yifu, Yuan Chunhua. Research on the effects of diaphragm relaxation technique combined with resistance breathing training on motor ability of stroke survivors[J]. Clinical Focus, 2023, 38(11): 1002-1007.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.11.007

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I11/1002

图/表 4

表1 3组一般资料比较

Tab.1 Comparison of general data between groups

组别	例数	年龄 (岁)	病程 (月)	BMI值 (kg/m²)	性别[例(%)]		偏瘫侧[例(%)]		疾病类型[例(%)]
组别	例数	年龄 (岁)	病程 (月)	BMI值 (kg/m²)	男	女	左侧	右侧	脑出血	脑梗死
A组	20	50.95±6.63	4.33±1.30	23.65±2.35	13(65.0)	7(35.0)	12(60.0)	8(40.0)	6(30.0)	14(70.0)
B组	19	47.32±4.27	4.42±1.39	24.63±2.40	11(57.9)	8(42.1)	10(52.6)	9(47.4)	5(26.3)	14(73.7)
C组	19	49.43±5.83	3.87±1.21	22.83±2.62	12(63.2)	7(36.8)	11(57.9)	8(42.1)	6(31.6)	13(68.4)
χ²/ $F$ 值		2.083	0.982	2.563	0.219		0.223		0.132
$P$ 值		0.134	0.381	0.086	0.896		0.894		0.936

表1 3组一般资料比较

Tab.1 Comparison of general data between groups

组别	例数	年龄 (岁)	病程 (月)	BMI值 (kg/m²)	性别[例(%)]		偏瘫侧[例(%)]		疾病类型[例(%)]
组别	例数	年龄 (岁)	病程 (月)	BMI值 (kg/m²)	男	女	左侧	右侧	脑出血	脑梗死
A组	20	50.95±6.63	4.33±1.30	23.65±2.35	13(65.0)	7(35.0)	12(60.0)	8(40.0)	6(30.0)	14(70.0)
B组	19	47.32±4.27	4.42±1.39	24.63±2.40	11(57.9)	8(42.1)	10(52.6)	9(47.4)	5(26.3)	14(73.7)
C组	19	49.43±5.83	3.87±1.21	22.83±2.62	12(63.2)	7(36.8)	11(57.9)	8(42.1)	6(31.6)	13(68.4)
χ²/ $F$ 值		2.083	0.982	2.563	0.219		0.223		0.132
$P$ 值		0.134	0.381	0.086	0.896		0.894		0.936

表2 试验干预前、后3组吸气功能比较( x -±s)

Tab.2 Comparison of inspiratory function between groups before and after intervention ( x -±s)

组别	例数	MIP(cmH₂O)				PIF(L/min)
组别	例数	0周	4周	8周	12周	0周	4周	8周	12周
A组	20	37.81±7.17	65.38±9.08^#	75.52±7.93^△	83.99±6.41^*#	1.97±0.51	3.51±0.74^#	4.25±0.82^△	4.90±0.73^*#
B组	19	38.74±7.01	53.79±7.72^#	62.22±7.27^△	67.67±6.11^*#	1.89±0.54	2.46±0.60^#	3.21±0.64^△	3.54±0.62^*#
C组	19	38.47±8.78	57.36±9.68^#	67.73±8.29^△	74.16±8.46^*#	1.99±0.62	2.94±0.66^#	3.97±0.72^△	4.30±0.76^*#
组间		$F$ =10.738 $P$ =0.000				$F$ =11.326 $P$ =0.000
时点间		$F$ =740.420 $P$ =0.000				$F$ =269.760 $P$ =0.000
组间·时点间		$F$ =11.534 $P$ =0.000				$F$ =9.497 $P$ =0.000

表2 试验干预前、后3组吸气功能比较( x -±s)

Tab.2 Comparison of inspiratory function between groups before and after intervention ( x -±s)

组别	例数	MIP(cmH₂O)				PIF(L/min)
组别	例数	0周	4周	8周	12周	0周	4周	8周	12周
A组	20	37.81±7.17	65.38±9.08^#	75.52±7.93^△	83.99±6.41^*#	1.97±0.51	3.51±0.74^#	4.25±0.82^△	4.90±0.73^*#
B组	19	38.74±7.01	53.79±7.72^#	62.22±7.27^△	67.67±6.11^*#	1.89±0.54	2.46±0.60^#	3.21±0.64^△	3.54±0.62^*#
C组	19	38.47±8.78	57.36±9.68^#	67.73±8.29^△	74.16±8.46^*#	1.99±0.62	2.94±0.66^#	3.97±0.72^△	4.30±0.76^*#
组间		$F$ =10.738 $P$ =0.000				$F$ =11.326 $P$ =0.000
时点间		$F$ =740.420 $P$ =0.000				$F$ =269.760 $P$ =0.000
组间·时点间		$F$ =11.534 $P$ =0.000				$F$ =9.497 $P$ =0.000

表3 试验干预前、后3组运动功能比较( x -±s)

Tab.3 Comparison of motor function between groups before and after intervention ( x -±s)

组别	例数	FMA(分)				10MWT(s)
组别	例数	0周	4周	8周	12周	0周	4周	8周	12周
A组	20	43.55±6.07	57.25±5.09^#	64.25±5.17^△	69.30±5.49^*#	50.33±4.36	38.41±4.26^#	27.91±3.49^△	23.47±3.31^*#
B组	19	43.32±5.21	49.53±6.23^#	54.79±5.88^△	58.84±5.35^*#	48.74±4.52	42.28±4.55^#	35.86±3.51^△	31.36±3.52^*#
C组	19	46.05±5.12	54.21±5.48^#	59.68±4.74^△	63.47±4.94^*#	47.71±4.35	38.24±3.38^#	29.13±3.69^△	26.01±4.13^*#
组间		$F$ =10.794 $P$ =0.000				$F$ =14.640 $P$ =0.000
时点间		$F$ =581.769 $P$ =0.000				$F$ =436.637 $P$ =0.000
组间·时点间		$F$ =5.139 $P$ =0.007				$F$ =19.034 $P$ =0.000

表3 试验干预前、后3组运动功能比较( x -±s)

Tab.3 Comparison of motor function between groups before and after intervention ( x -±s)

组别	例数	FMA(分)				10MWT(s)
组别	例数	0周	4周	8周	12周	0周	4周	8周	12周
A组	20	43.55±6.07	57.25±5.09^#	64.25±5.17^△	69.30±5.49^*#	50.33±4.36	38.41±4.26^#	27.91±3.49^△	23.47±3.31^*#
B组	19	43.32±5.21	49.53±6.23^#	54.79±5.88^△	58.84±5.35^*#	48.74±4.52	42.28±4.55^#	35.86±3.51^△	31.36±3.52^*#
C组	19	46.05±5.12	54.21±5.48^#	59.68±4.74^△	63.47±4.94^*#	47.71±4.35	38.24±3.38^#	29.13±3.69^△	26.01±4.13^*#
组间		$F$ =10.794 $P$ =0.000				$F$ =14.640 $P$ =0.000
时点间		$F$ =581.769 $P$ =0.000				$F$ =436.637 $P$ =0.000
组间·时点间		$F$ =5.139 $P$ =0.007				$F$ =19.034 $P$ =0.000

表4 试验干预前、后3组平衡功能比较( x -±s)

Tab.4 Comparison of balance function between groups before and after intervention ( x -±s)

组别	例数	BBS(分)				LOS
组别	例数	0周	4周	8周	12周	0周	4周	8周	12周
A组	20	27.75±2.57	35.55±1.93^#	41.05±2.44^△	44.75±2.15^*#	49.25±4.31	61.05±3.05^#	68.38±2.50^△	72.14±2.93^*#
B组	19	28.74±2.40	32.95±2.30^#	35.89±2.26^△	37.89±2.40^*#	47.39±3.54	55.69±2.90^#	61.74±2.77^△	64.82±2.34^*#
C组	19	29.05±2.53	34.26±2.28^#	38.47±2.04^△	41.21±2.68^*#	48.41±4.13	58.15±3.03^#	64.86±2.27^△	68.20±3.47^*#
组间		$F$ =14.379 $P$ =0.000				$F$ =53.370 $P$ =0.000
时点间		$F$ =500.719 $P$ =0.000				$F$ =502.927 $P$ =0.000
组间·时点间		$F$ =22.231 $P$ =0.000				$F$ =3.994 $P$ =0.017

表4 试验干预前、后3组平衡功能比较( x -±s)

Tab.4 Comparison of balance function between groups before and after intervention ( x -±s)

组别	例数	BBS(分)				LOS
组别	例数	0周	4周	8周	12周	0周	4周	8周	12周
A组	20	27.75±2.57	35.55±1.93^#	41.05±2.44^△	44.75±2.15^*#	49.25±4.31	61.05±3.05^#	68.38±2.50^△	72.14±2.93^*#
B组	19	28.74±2.40	32.95±2.30^#	35.89±2.26^△	37.89±2.40^*#	47.39±3.54	55.69±2.90^#	61.74±2.77^△	64.82±2.34^*#
C组	19	29.05±2.53	34.26±2.28^#	38.47±2.04^△	41.21±2.68^*#	48.41±4.13	58.15±3.03^#	64.86±2.27^△	68.20±3.47^*#
组间		$F$ =14.379 $P$ =0.000				$F$ =53.370 $P$ =0.000
时点间		$F$ =500.719 $P$ =0.000				$F$ =502.927 $P$ =0.000
组间·时点间		$F$ =22.231 $P$ =0.000				$F$ =3.994 $P$ =0.017

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