Department of Sports Rehabilitation, Shanghai University of Sport, Shanghai, People's Republic of China.
School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2022 Mar 3;17:457-473. doi: 10.2147/COPD.S338583. eCollection 2022.
This review summarizes the characteristics, assessment methods, and targeted rehabilitation therapies of diaphragm dysfunction in patients with chronic obstructive pulmonary disease (COPD).
Extensive literature was searched in PubMed, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure Database, Wanfang, and SinoMed.
Under the influence of oxidative stress, inflammation, and other factors, the diaphragm function of patients with COPD changes in mobility, muscle strength, thickness, and thickening. In patients with COPD, diaphragm mobility can be assessed using ultrasound, X-ray fluoroscopy, and magnetic resonance imaging. Diaphragmatic strength can be measured by transdiaphragmatic pressure and maximal inspiratory pressure. Diaphragmatic thickness and thickening can be assessed using ultrasound. Rehabilitation therapies targeting the diaphragm include diaphragmatic breathing, diaphragm-related manual therapy, and phrenic nerve electrical stimulation. Diaphragmatic breathing is safe, simple, and not limited by places. Diaphragmatic manual therapies, which require patient cooperation and one-on-one operation by a professional therapist, are effective. Phrenic nerve electrical stimulation is suitable for patients with severe conditions. These therapies improve the diaphragmatic function, lung function, dyspnea, and exercise capacity of patients with COPD.
The diaphragmatic function is commonly assessed in terms of mobility, strength, thickness, and thickening. Diaphragmatic targeted rehabilitation therapies have proven to be efficient, which are recommended to be included in the pulmonary rehabilitation strategy for patients with COPD.
本综述总结了慢性阻塞性肺疾病（COPD）患者膈肌功能障碍的特点、评估方法和针对性康复治疗。
在 PubMed、Cochrane 图书馆、Web of Science、中国知网、万方和中国生物医学文献服务系统中广泛检索文献。
在氧化应激、炎症等因素的影响下，COPD 患者的膈肌功能在活动度、肌肉力量、厚度和增厚方面发生改变。在 COPD 患者中，可以使用超声、X 射线透视和磁共振成像评估膈肌活动度。膈肌强度可以通过跨膈压和最大吸气压力来测量。膈肌厚度和增厚可以通过超声评估。针对膈肌的康复治疗包括膈式呼吸、膈肌相关手法治疗和膈神经电刺激。膈式呼吸安全、简单，不受地点限制。需要患者配合并由专业治疗师进行一对一操作的膈肌手法治疗效果确切。膈神经电刺激适用于病情严重的患者。这些治疗方法可改善 COPD 患者的膈肌功能、肺功能、呼吸困难和运动能力。
通常从活动度、力量、厚度和增厚等方面评估膈肌功能。针对膈肌的康复治疗已被证明是有效的，建议将其纳入 COPD 患者的肺康复策略中。
