Liaw Mei-Yun, Wang Lin-Yi, Pong Ya-Ping, Tsai Yu-Chin, Huang Yu-Chi, Yang Tsung-Hsun, Lin Meng-Chih
Department of Physical Medicine and Rehabilitation Department of Respiratory Therapy Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Medicine (Baltimore). 2016 Oct;95(40):e5071. doi: 10.1097/MD.0000000000005071.
The aim of this study was to investigate the relationships between pulmonary function, respiratory muscle strength, perceived dyspnea, degree of fatigue, and activity of daily living with motor function and neurological status in stroke patients with stable congestive heart failure (CHF).This was a cohort study in a tertiary care medical center. Stroke patients with CHF and exertional dyspnea (New York Heart Association class I-III) were recruited. The baseline characteristics included duration of disease, Brunnstrom stage, spirometry, resting heart rate, resting oxyhemoglobin saturation (SpO2), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), Borg scale, fatigue scale, and Barthel index.A total of 47 stroke patients (24 males, 23 females, mean age 65.9 ± 11.5 years) were included. The average Brunnstrom stages of affected limbs were 3.6 ± 1.3 over the proximal parts and 3.5 ± 1.4 over the distal parts of upper limbs, and 3.9 ± 0.9 over lower limbs. The average forced vital capacity (FVC) was 2.0 ± 0.8 L, with a predicted FVC% of 67.9 ± 18.8%, forced expiratory volume in the first second (FEV1) of 1.6 ± 0.7 L, predicted FEV1% of 70.6 ± 20.1%, FEV1/FVC of 84.2 ± 10.5%, and maximum mid-expiratory flow of 65.4 ± 29.5%. The average MIP and MEP were -52.9 ± 33.3 cmH2O and 60.8 ± 29.0 cmH2O, respectively. The Borg scale was 1.5 ± 0.8. MIP was negatively associated with the average Brunnstrom stage of the proximal (r = -0.318, P < 0.05) and distal (r = -0.391, P < 0.01) parts of the upper extremities and lower extremities (r = -0.288, P < 0.05), FVC (r = -0.471, P < 0.01), predicted FVC% (r = -0.299, P < 0.05), and FEV1 (r = -0.397, P < 0.01). MEP was positively associated with average Brunnstrom stage of the distal area of the upper extremities (r = 0.351, P < 0.05), FVC (r = 0.526, P < 0.01), FEV1 (r = 0.429, P < 0.01), and FEV1/FVC (r = -0.482, P < 0.01). FEV1/FVC was negatively associated with the average Brunnstrom stage over the proximal (r = -0.414, P < 0.01) and distal (r = -0.422, P < 0.01) parts of the upper extremities and lower extremities (r = -0.311, P < 0.05) and Barthel index (r = -0.313, P < 0.05).Stroke patients with stable CHF and exertional dyspnea had restrictive lung disorder and respiratory muscle weakness, which were associated with the neurological status of the affected limbs. FVC was more strongly associated with MIP and MEP than predicted FVC%. FEV1/FVC may be used as a reference for the pulmonary dysfunction.
本研究旨在探讨稳定型充血性心力衰竭（CHF）的中风患者的肺功能、呼吸肌力量、感知呼吸困难、疲劳程度、日常生活活动与运动功能和神经状态之间的关系。这是一项在三级医疗中心进行的队列研究。招募了患有CHF和劳力性呼吸困难（纽约心脏协会I-III级）的中风患者。基线特征包括病程、Brunnstrom分期、肺量计检查、静息心率、静息氧合血红蛋白饱和度（SpO2）、最大吸气压力（MIP）、最大呼气压力（MEP）、Borg量表、疲劳量表和Barthel指数。
共纳入47例中风患者（男性24例，女性23例，平均年龄65.9±11.5岁）。受累肢体的平均Brunnstrom分期在上肢近端为3.6±1.3，远端为3.5±1.4，下肢为3.9±0.9。平均用力肺活量（FVC）为2.0±0.8L，预测FVC%为67.9±18.8%，第一秒用力呼气量（FEV1）为1.6±0.7L，预测FEV1%为70.6±20.1%，FEV1/FVC为84.2±10.5%，最大呼气中期流量为65.4±29.5%。平均MIP和MEP分别为-52.9±33.3cmH2O和60.8±29.0cmH2O。Borg量表评分为1.5±0.8。MIP与上肢近端（r=-0.318，P<0.05）和远端（r=-0.391，P<0.01）以及下肢（r=-0.288，P<0.05）的平均Brunnstrom分期、FVC（r=-0.471，P<0.01）、预测FVC%（r=-0.299，P<0.05）和FEV1（r=-0.397，P<0.01）呈负相关。MEP与上肢远端区域的平均Brunnstrom分期（r=0.351，P<0.05）、FVC（r=0.526，P<0.01）、FEV1（r=0.429，P<0.01）和FEV1/FVC（r=-0.482，P<0.01）呈正相关。FEV1/FVC与上肢近端（r=-0.414，P<0.01）和远端（r=-0.422，P<0.01）以及下肢（r=-0.311，P<0.05）的平均Brunnstrom分期和Barthel指数（r=-0.313，P<0.05）呈负相关。
患有稳定型CHF和劳力性呼吸困难的中风患者存在限制性肺疾病和呼吸肌无力，这与受累肢体的神经状态相关。FVC与MIP和MEP的相关性比预测FVC%更强。FEV1/FVC可作为肺功能障碍的参考指标。
