呼吸肌训练与收腹呼吸联合应用对脑卒中偏瘫患者呼吸肌活动的影响：一项前瞻性随机对照试验
Effects of the combination of respiratory muscle training and abdominal drawing-in maneuver on respiratory muscle activity in patients with post-stroke hemiplegia: a pilot randomized controlled trial.
作者信息
Kim Chang-Yong, Lee Jung-Sun, Kim Hyeong-Dong, Kim In-Seob
出版信息
Top Stroke Rehabil. 2015 Aug;22(4):262-70. doi: 10.1179/1074935714Z.0000000020. Epub 2015 Feb 18.
PURPOSE
No study has examined the effects of the combination of respiratory muscle training (RMT) and abdominal drawing-in maneuver (ADIM) on respiratory muscle activity and function in stroke patients during early pulmonary rehabilitation. The purpose of this study was to investigate the effects of RMT combined with ADIM on decreased respiratory muscle activity and function in patients with post-stroke hemiplegia.
METHODS
Thirty-seven subjects with post-stroke hemiplegia were randomly allocated to three groups; integrated training group (ITG), respiratory muscle training group (RMTG), and control group (CG). All of the subjects received routine therapy for stroke rehabilitation for 1 hour, five times a week for 6 weeks. Especially, the ITG received RMT using an incentive respiratory spirometer and ADIM using a Stabilizer, and the RMTG only received RMT using incentive respiratory spirometer for 15 minutes a day, five times a week for 6 weeks. Pulmonary function was evaluated using spirometry for measuring the forced vital capacity (FVC) and force expiratory volume in 1 second (FEV1). Additional surface electromyography (sEMG) analysis was included by measuring the respiratory muscle activity.
RESULTS
Our results showed that changes between the pre- and post-test values of FVC (F = 12.50, P = 0.02) and FEV1 (F = 12.81, P = 0.01) (P < 0.05) in the ITG were significantly (P < 0.05) greater. Changes in EMG activation of the diaphragm (F = 13.75, P = 0.003) and external intercostal (F = 14.33, P = 0.002) (P < 0.01) muscles of patients in the ITG during maximal static inspiratory efforts were significantly (P < 0.05) greater than those in patients of the RMTG and the CG at post-test.
CONCLUSIONS
Our findings suggested that RMT combined with ADIM could improve pulmonary function in patients with post-stroke hemiplegia.
目的
尚无研究探讨呼吸肌训练（RMT）与收腹呼吸法（ADIM）相结合对脑卒中患者早期肺康复期间呼吸肌活动及功能的影响。本研究旨在调查RMT联合ADIM对脑卒中后偏瘫患者呼吸肌活动及功能下降的影响。
方法
37例脑卒中后偏瘫患者被随机分为三组；综合训练组（ITG）、呼吸肌训练组（RMTG）和对照组（CG）。所有受试者均接受每周5次、每次1小时、为期6周的常规脑卒中康复治疗。特别是，ITG使用激励式呼吸训练器进行RMT，并使用稳定器进行ADIM，而RMTG仅使用激励式呼吸训练器每天进行15分钟的RMT，每周5次，为期6周。使用肺量计评估肺功能，以测量用力肺活量（FVC）和1秒用力呼气量（FEV1）。通过测量呼吸肌活动进行额外的表面肌电图（sEMG）分析。
结果
我们的结果显示，ITG中FVC（F = 12.50，P = 0.02）和FEV1（F = 12.81，P = 0.01）（P < 0.05）的测试前和测试后值之间的变化显著更大（P < 0.05）。在最大静态吸气努力期间，ITG患者膈肌（F = 13.75，P = 0.003）和肋间外肌（F = 14.33，P = 0.002）（P < 0.01）的肌电图激活变化在测试后显著大于RMTG和CG患者。
结论
我们的研究结果表明，RMT联合ADIM可改善脑卒中后偏瘫患者的肺功能。
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