| 摘要: |
| ［摘要］ 目的 探讨腹部电刺激联合膈肌起搏治疗仪干预对脑外伤后气管切开患者气道廓清能力及拔管成功率的影响。方法 招募2021年8月至2025年6月东南大学附属中大医院溧水分院收治的脑外伤患者80例，均行气管切开术。采用随机数字表法将其分为观察组和对照组，各40例。对照组接受膈肌起搏治疗仪干预，观察组接受腹部电刺激联合膈肌起搏治疗仪干预，干预疗程均为2周。比较两组干预前后咳嗽排痰能力指标、膈肌超声指标、肺通气功能指标以及生活质量综合评定问卷-74（GQOLI-74）评分、简易智力状态检查量表（MMSE）评分、格拉斯哥预后评分量表（GOS）评分。比较两组拔管时间、拔管成功率和住院时间。记录治疗相关不良反应发生情况。结果 两组干预后的非自主咳嗽峰流速（ICPF）、半定量咳嗽强度评分量表（SCSS）评分较干预前升高，排痰量较干预前增加，且观察组指标水平较对照组更高，差异有统计学意义（P<0.05）。两组干预后膈肌移动度、膈肌厚度、膈肌增厚分数、第1秒用力呼气量（FEV1）、呼气峰流速值（PEF）、用力肺活量（FVC）和最大通气量（MVV）水平均较干预前升高，且观察组指标水平较对照组更高，差异有统计学意义（P<0.05）。观察组拔管时间早于对照组，拔管成功率高于对照组，住院时间短于对照组，差异有统计学意义（P<0.05）。两组干预后GQOLI-74评分、MMSE评分和GOS评分均较干预前升高，且观察组评分较对照组更高，差异有统计学意义（P<0.05）。两组治疗期间均未出现治疗相关不良反应。结论 腹部电刺激联合膈肌起搏治疗仪干预可有效改善脑外伤后气管切开患者气道廓清能力，提高拔管成功率，安全性好。 |
| 关键词: 脑外伤 气管切开 腹部电刺激 膈肌起搏治疗仪 气道廓清能力 拔管成功率 |
| DOI：10.3969/j.issn.1674-3806.2026.07.09 |
| 分类号:R 493 |
| 基金项目:江苏省卫生健康委医学科研立项项目（编号：S2022060） |
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| Effects of abdominal electrical stimulation plus diaphragm pacing therapy device intervention on airway clearance ability and extubation success rate in patients with tracheotomy after cerebral trauma |
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Liu Ting1, Sun Yunlei1, Hou Lingxian1, Tang Congzhi2
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1.Department of Rehabilitation Medicine, Zhongda Hospital Lishui Branch, Southeast University, Nanjing 211200, China; 2.Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, China
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| Abstract: |
| ［Abstract］ Objective To explore the effects of abdominal electrical stimulation combined with diaphragm pacing therapy device intervention on airway clearance ability and extubation success rate in patients with tracheotomy after cerebral trauma. Methods Eighty patients with cerebral trauma who were admitted to Zhongda Hospital Lishui Branch, Southeast University from August 2021 to June 2025 were recruited and underwent tracheotomy. The patients were divided into observation group and control group by using random number table method, with 40 patients in each group. The control group received intervention with a diaphragm pacing therapy device, while the observation group received abdominal electrical stimulation plus intervention with a diaphragm pacing therapy device. Both groups were intervened for 2 weeks. The indicators of cough and sputum expulsion ability, diaphragm ultrasound and pulmonary ventilation function, as well as the scores of Generic Quality of Life Inventory-74(GQOLI-74), Mini-Mental State Examination Scale(MMSE) and Glasgow Outcome Scale(GOS) were compared between the two groups before and after the intervention. The extubation time, extubation success rate and length of hospital stay were compared between the two groups. The occurrence of treatment-related adverse reactions was recorded. Results After the intervention, the involuntary cough peak flow(ICPF) and Semi-Quantitative Cough Strength Score(SCSS) were increased while the amount of sputum discharge was increased in both groups compared with those before the intervention, and the levels of these indicators in the observation group were higher than those in the control group after the intervention, with statistically significant differences(P<0.05). After the intervention, the levels of diaphragmatic excursion, diaphragmatic thickness, diaphragmatic thickening fraction, forced expiratory volume in 1 second(FEV1), peak expiratory flow(PEF), forced vital capacity(FVC), and maximum ventilation volume(MVV) in both groups were higher than those before the intervention, and the levels of these indicators in the observation group were higher than those in the control group after the intervention, with statistically significant differences(P<0.05). The time for extubation in the observation group was earlier than that in the control group, and the success rate of extubation in the observation group was higher than that in the control group, and the length of hospital stay in the observation group was shorter than that in the control group, with statistically significant differences(P<0.05). After the intervention, the scores of GQOLI-74, MMSE and GOS in both groups were higher than those before the intervention, and these scores in the observation group were higher than those in the control group after the intervention, with statistically significant differences(P<0.05). During the treatment period, no treatment-related adverse reactions occurred in either group. Conclusion Abdominal electrical stimulation plus diaphragm pacing therapy device intervention is safe and effectively improves the airway clearance ability, and increases the success rate of extubation in patients with tracheotomy after cerebral trauma. |
| Key words: cerebral trauma tracheotomy abdominal electrical stimulation diaphragm pacing therapy device airway clearance ability extubation success rate |
