针刺联合体外膈肌起搏对重症脑卒中气管切开患者膈肌功能的影响OA

Objective To evaluate the effects of acupuncture combined with external diaphragm pacing on diaphragmatic func-tion in patients with severe stroke after tracheostomy.Methods A total of 60 patients with severe stroke after tracheostomy admit-ted to the Department of Critical Rehabilitation of Shanghai Third Rehabilitation Hospital from July 2021 to July 2023 were enrolled and randomly divided into control group and experimental group,with 30 cases in each group.Both groups received conventional clinical treatments(oxygen inhalation,nebulization,and anti-infection)and respiratory rehabilitation training(pursed-lip breathing,diaphragmatic breathing,and sandbag resistance training for abdominal muscles).The control group received external diaphragm pacing in addition to the conventional treatment and respiratory training.External diaphragm pacing was set at a rate of 12-18 times per minute,stimulation intensity of 10-15 mA,a pulse frequency of 40 Hz,30 minutes per session,once daily,five times per week,for a total of six weeks.The experimental group received acupuncture in addition to the control group's regimen.The selected acu-puncture points included bilateral Geshu,bilateral Feishu,Danzhong,bilateral Lieque,and bilateral Neiguan.Needles were retained for 30 minutes per session,once daily,five times per week,for a total of six weeks.Before and after treatment,color Doppler imag-ing was used to assess diaphragmatic thickness,diaphragmatic thickness fraction,and diaphragmatic excursion during quiet breath-ing.The Modified Borg Dyspnea Scale(mBorg)was used to assess respiratory function.The Modified Barthel Index(MBI)was used to evaluate activities of daily living.Arterial blood gas analysis was performed to determine partial pressure of oxygen(PaO₂)and partial pressure of carbon dioxide(PaCO₂).Serum levels of C-reactive protein,procalcitonin,and interleukin-6(IL-6)were mea-sured by dry immunofluorescence.Within one week after treatment,the success rates of tracheostomy capping trial and decannula-tion were evaluated.Adverse reactions during treatment were observed.Results(1)Diaphragmatic thickness,diaphragmatic thick-ness fraction,and diaphragmatic excursion:compared with those before treatment,diaphragmatic thickness,diaphragmatic thickness fraction,and diaphragmatic excursion in both groups increased significantly after treatment(P<0.05).Compared with the control group,diaphragmatic thickness fraction and diaphragmatic excursion in the experimental group were significantly higher after treat-ment(P<0.05),whereas no statistically significant difference was observed in diaphragmatic thickness(P>0.05).(2)Respiratory function and MBI scores:compared with those before treatment,mBorg scores in both groups decreased significantly after treatment(P<0.05),while MBI scores in both groups increased significantly after treatment(P<0.05).Compared with the control group,the mBorg score in the experimental group was significantly lower after treatment(P<0.05),and the MBI score in the experimental group was significantly higher after treatment(P<0.05).(3)PaO ₂ and PaCO2:compared with those before treatment,PaO2 in both groups increased significantly after treatment(P<0.05),while PaCO2 decreased significantly after treatment(P<0.05).Compared with the control group,PaO₂ in the experimental group was significantly higher after treatment(P<0.05),and PaCO₂ was significantly lower after treatment(P<0.05).(4)Inflammatory markers:compared with those before treatment,the levels of C-reactive protein,procalcitonin,and IL-6 levels in both groups decreased significantly after treatment(P<0.05).Compared with the control group,the levels of C-reactive protein,procalcitonin and IL-6 levels in the experimental group were significantly lower after treatment(P<0.05).(5)Success rates of tracheostomy capping trial and decannulation:there was no statistically significant difference in the suc-cess rates of tracheostomy capping trial and decannulation between two groups(P>0.05).(6)Safety:no adverse reactions occurred during external diaphragm pacing treatment in either group.Druing treatment,two cases of minor bleeding at the acupuncture sites were observed in the experimental group,with no other adverse reactions such as pain at acupuncture points,needle fainting,or skin allergy at the puncture sites.Conclusion Acupuncture combined with external diaphragm pacing can enhance diaphragmatic func-tion,improve respiratory function,reduce the levels of inflammatory factors,and increase the activities of daily living in severe stroke patients with tracheostomy.