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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2023, Vol. 16 ›› Issue (05) : 370 -375. doi: 10.3877/cma.j.issn.1674-6880.2023.05.004

论著

低强度吸气肌训练对机械通气患者肺康复的影响
豆艺璇, 黄怀†(), 钱绮雯, 邢然然, 林丽, 白建芳   
  1. 510006　广州，广州中医药大学研究生院
    510010　广州，中国人民解放军南部战区总医院高压氧康复科（重症康复中心）
  • 收稿日期:2023-01-12 出版日期:2023-10-31
  • 通信作者: 黄怀
  • 基金资助:
    军队后勤科研项目(CLB20J034)

Effect of low-intensity inspiratory muscle training on pulmonary rehabilitation in mechanically ventilated patients

Yixuan Dou, Huai Huang†(), Qiwen Qian, Ranran Xing, Li Lin, Jianfang Bai   

  1. Graduate School of Guangzhou University of Chinese Medicine, Guangzhou 510006, China
    Department of Hyperbaric Oxygen Rehabilitation (Critical Care Rehabilitation Centre), General Hospital of Southern Theatre Command, Guangzhou 510010, China
  • Received:2023-01-12 Published:2023-10-31
  • Corresponding author: Huai Huang
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豆艺璇, 黄怀, 钱绮雯, 邢然然, 林丽, 白建芳. 低强度吸气肌训练对机械通气患者肺康复的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 370-375.

Yixuan Dou, Huai Huang, Qiwen Qian, Ranran Xing, Li Lin, Jianfang Bai. Effect of low-intensity inspiratory muscle training on pulmonary rehabilitation in mechanically ventilated patients[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(05): 370-375.

目的

探讨低强度的吸气肌训练对机械通气患者的作用。

方法

选取2020年3月至2022年6月南部战区总医院重症监护病房及高依赖病房收治的81例机械通气患者，分为对照组（41例）和试验组（40例）。试验过程中对照组失访6例，试验组失访4例，最终两组分别纳入35例和36例患者。对照组采用常规治疗，试验组在常规治疗基础上加用20%最大吸气压（MIP）作为起始阈值负荷的吸气肌训练。训练8周后，评估所有患者的MIP、用力肺活量变化、膈肌厚度、膈肌移动度、再插管率、院内病死率以及生活质量。

结果

训练8周后，试验组患者MIP[（29.6 ± 4.8）cmH2O vs.（20.3 ± 5.5）cmH2O，t = 6.402，P < 0.001]、用力肺活量[（1 768 ± 655）mL vs.（1 420 ± 420）mL，t = 4.303，P < 0.001]、膈肌移动度[（0.93 ± 0.44）cm vs.（0.79 ± 0.32）cm，t = 2.313，P = 0.023]和改良Barthel指数[15（5，19）vs. 10（2，14），U = 325.500，P = 0.040]均较对照组显著改善；而试验组与对照组患者膈肌厚度[（1.47 ± 0.38）mm vs.（1.39 ± 0.45）mm，t = 1.195，P = 0.236]、再插管率[8.3%（3/36）vs. 11.4%（4/35），P = 0.520]和院内病死率[8.3%（3/36）vs. 5.7%（2/35），P = 0.674]比较，差异均无统计学意义。

结论

低强度吸气肌训练可以显著提高机械通气患者的MIP及用力肺活量，并可能改善患者的膈肌移动度及生活质量。

关键词: 吸气肌训练, 机械通气患者, 肺康复
Objective

To explore the effect of low-intensity inspiratory muscle training on mechanically ventilated patients.

Methods

Eighty-one mechanically ventilated patients admitted to the intensive care unit and high dependency unit of the General Hospital of Southern Theatre Command from March 2020 to June 2022 were selected and randomly divided into a control group (41 patients) and an experimental group (40 patients). Six patients were lost to follow-up in the control group and four patients were lost in the experimental group during the trial, and finally 35 patients and 36 patients were included in the two groups, respectively. The control group was treated with conventional therapy, and the experimental group added inspiratory muscle training with 20% maximal inspiratory pressure (MIP) as the starting threshold load to the conventional therapy. After eight weeks of training, patients were assessed for the MIP, change in exertion spirometry, diaphragm thickness, diaphragm mobility, reintubation rate, in-hospital mortality, and quality of life.

Results

After eight weeks of training, the MIP [(29.6 ± 4.8) cmH2O vs. (20.3 ± 5.5) cmH2O, t = 6.402, P < 0.001], exertional lung volume [(1 768 ± 655) mL vs. (1 420 ± 420) mL, t = 4.303, P < 0.001], diaphragm mobility [(0.93 ± 0.44) cm vs. (0.79 ± 0.32) cm, t = 2.313, P = 0.023], and modified Barthel index [15 (5, 19) vs. 10 (2, 14), U = 325.500, P = 0.040] of patients in the experimental group were significantly improved compared with the control group. The diaphragm thickness [(1.47 ± 0.38) mm vs. (1.39 ± 0.45) mm, t = 1.195, P = 0.236], reintubation rate [8.3% (3/36) vs. 11.4% (4/35), P = 0.520], and in-hospital mortality [8.3% (3/36) vs. 5.7% (2/35), P = 0.674] were not statistically significantly different between the experimental and control groups.

Conclusion

Low-intensity inspiratory muscle training can significantly improve MIP and exertion spirometry, and may improve diaphragm mobility and quality of life in mechanically ventilated patients.

Key words: Inspiratory muscle training, Mechanical ventilation patients, Pulmonary rehabilitation
表1 两组机械通气患者一般资料比较
组别 例数 性别（例，男/女） 年龄（岁， ± s） 白蛋白[g/L，M（P25，P75）] 手术史[例（%）] 肺炎[例（%）]
对照组 35 23/12 67 ± 9 30（28，32） 30（85.7） 5（14.3）
试验组 36 21/15 65 ± 13 29（24，32） 32（88.9） 3（8.3）
χ2/t/U值   2.292 1.630 542.500 - -
P值   0.129 0.107 0.880 0.534 0.619
表2 两组机械通气患者MIP和用力肺活量比较（ ± s）
组别 例数 MIP（cmH2O） 用力肺活量（mL）
训练前 训练8周后 训练前 训练8周后
对照组 35 19.2 ± 2.9 20.3 ± 5.5 1 208 ± 331 1 420 ± 420a
试验组 36 18.9 ± 3.7 29.6 ± 4.8a 1 134 ± 298 1 768 ± 655a
t值   1.125 6.402 0.411 4.303
P值   0.265 <0.001 0.683 <0.001
表3 两组机械通气患者再插管率、院内病死率和Bathel指数比较
组别 例数 改良Bathel指数[M（P25，P75）] 再插管率[例（%）] 院内病死率[例（%）]
对照组 35 10（2，14） 4（11.4） 2（5.7）
试验组 36 15（5，19） 3（8.3） 3（8.3）
χ2/U值   325.500 - -
P值   0.040 0.520 0.674
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