卒中后膈肌功能及相关因素分析 Analysis of Diaphragmatic Function and the Related Factors in Stroke Patients

目的 分析卒中后偏瘫患者的膈肌功能，并探讨其与卒中病程以及吞咽、呼吸、运动、平衡功能和日常生活能力的相关性。 方法 本研究为前瞻性研究，连续纳入首次卒中后单侧偏瘫的患者，记录患者的一般资料，洼田饮水试验、主观呼吸功能障碍程度量表、Fugl-Meyer运动功能评定量表（Fugl-Meyer motor function assessment scale，FMA）、Berg平衡量表（Berg balance scale，BBS）、改良Barthel指数（modified Barthel index，mBI）。采用超声测定膈肌功能，包括平静呼吸时的膈肌活动度以及用力呼吸状态下的膈肌活动度和膈肌增厚率。比较整体和不同瘫痪侧患者偏瘫侧和健侧的膈肌功能，分别比较左侧偏瘫和右侧偏瘫患侧的膈肌功能和健侧的膈肌功能。分析瘫痪侧的膈肌功能与病程、洼田饮水试验、主呼吸功能障碍程度量表、FMA、BBS、mBI等指标的相关性 结果 研究共纳入45例卒中患者，其中左侧偏瘫27例（60.00%），右侧偏瘫18例（40.00%）。在整体患者中，用力呼吸状态下，偏瘫侧膈肌活动度（31.69±15.18 mm vs. 40.24±14.66 mm，P＜0.001）及膈肌增厚率（34.99%±23.70% vs. 48.13%±21.98%，P＜0.001）低于健侧。用力呼吸状态下，左侧偏瘫患者的偏瘫侧膈肌活动度（30.13±12.64 mm vs. 44.10±12.95 mm，P＜0.001）和膈肌增厚率（41.20%±23.42% vs. 54.63%±21.08%，P =0.004）较健侧低；右侧偏瘫患者的偏瘫侧膈肌增厚率（25.67%±21.47% vs. 38.37%±20.07%，P =0.005）较健侧低。用力呼吸状态下，右侧偏瘫患者的偏瘫侧膈肌增厚率低于左侧偏瘫患者（P =0.029）。右侧偏瘫患者的健侧膈肌活动度（P =0.028）及膈肌增厚率低于左侧偏瘫患者（P =0.012）。卒中患者平静呼吸状态下，偏瘫侧膈肌活动度与FMA（r =0.362，P =0.015）呈正相关；用力呼吸状态下，偏瘫侧膈肌活动度与洼田饮水试验（r =0.298，P =0.047）、主观呼吸功能障碍程度量表（r =0.437，P =0.003）、FMA（r =0.330，P =0.027）、BBS（r =0.370，P =0.012）、mBI（r =0.321，P =0.031）呈正相关，偏瘫侧膈肌增厚率与病程（r =-0.298，P =0.047）呈负相关。 结论 卒中后偏瘫侧膈肌功能较健侧下降，右侧偏瘫患者双侧膈肌功能较左侧偏瘫患者更差。卒中患者膈肌功能与病程呈负相关，与吞咽功能、呼吸功能、肢体运动功能、平衡能力及日常生活能力呈正相关。 Objective To analyze the changes of diaphragm function with the correlation of diaphragm function with stroke duration, swallowing function, respiratory function, extremity motor function, balance function and daily living ability in stroke patients with hemiplegia. Methods This prospective study enrolled the consecutive patients and unilateral hemiplegia after first stroke. The following data were recorded, including general demographic information, water swallow test (WST) score, subjective respiratory dysfunction scale, Fugl-Meyer motor function assessment (FMA) scale, Berg balance scale (BBS), modified Barthel index (mBI). Diaphragmatic function was measured by ultrasound, including diaphragmatic mobility and during quiet and deep breathing and diaphragm thickening fraction (DTF). The diaphragm function of the hemiplegia and healthy sides among the total patients and different unilateral hemiplegia patients, and between right and left hemiplegia patients were compared. The correlation of diaphragm function of the hemiplegia side with stroke duration, WST score, subjective respiratory dysfunction scale, FMA, BBS, and mBI were analyzed. Results A total of 45 stroke patients were included in the study, with 27 (60.00%) left hemiplegia and 18 (40.00%) right hemiplegia patients. Under deep breathing, for the total patients, the diaphragm mobility (31.69±15.18 mm vs. 40.24±14.66 mm, P