Effects Of External Diaphragm Pacing Combined With Abdominal Functional Electrical Stimulation On Respiratory Function In Continuously Bedridden Patients

Background:Continuous bed rest could cause varying degrees of damage to the respiratory system of patients.When the patient is in the supine position,the diaphragm moves upward and the chest volume decreases,resulting in limited lung expansion,decreased respiratory muscle strength,decreased cough and sputum excretion and greatly increased the risk of lung infection,even some patients may have recurrent problems,these could seriously affect the prognosis of the disease and quality of life.External diaphragm pacing（EDP）is a non-invasive electrical stimulation technique,which stimulates the phrenic nerve by electrical stimulation,promotes regular contraction of the diaphragm,maintains muscle strength and endurance and improves diaphragm function.Abdominal muscle electrical stimulation（AFES）uses the principle of low-frequency electrical stimulation to cause abdominal muscle contraction,so as to improve respiratory efficiency and cough function.In this study,EDP combined with AFES was used to improve respiratory function and quality of life of continuously bedridden patients.Objective:To explore the effects of EDP combined with AFES therapy on respiratory function in continuously bedridden patients.Methods:From October 2020 to November 2022,105 continuously bedridden patients in the Department of Rehabilitation Medicine of Affiliated Hospital of Nantong University were randomly divided into three groups:control group（n=35）,EDP group（n=35）and combined treatment group（n=35）.Due to the influence of the epidemic situation and the reasons of patients themselves,10 cases dropped off.Finally,there were 95cases completed,including 33 cases in control group,31 cases in EDP group and 31 cases in combined treatment group.In this study,all patients received routine rehabilitation training and respiratory training,while EDP group added EDP therapy on the basis of control group,and combined treatment group received EDP and AFES therapy in addition,for two weeks.They were measured forced vital capacity（FVC）,forced expiratory volume in first second（FEV₁）,ratio of forced expiratory volume in first second in forced vital capacity（FEV₁/FVC）,peak expiratory flow（PEF）,maximal inspiratory pressure（MIP）and maximal expiratory pressure（MEP）with pulmonary function instrument;measured diaphragmatic excursion（DE）,diaphragmatic thickness（DT）,rectus abdominis thickness（RAT）and transversus abdominis thickness（Tr AT）with ultrasound;evaluated clinical pulmonary infection score（CPIS）;measured infection indices:hs-CRP and FIB;measured PH,Pa O₂,Pa CO₂ and Sa O₂ by blood gas analysis and evaluated activities of daily living（ADL）before and after treatment.Results:There was no statistically significant difference in the general data and pulmonary function,diaphragm and abdominal ultrasound,CPIS,hs-CRP,FIB,blood gas analysis and ADL before treatment among the three groups,and there were comparable among these groups（P>0.05）;after two weeks of treatment,FVC,FEV₁,PEF,MIP and MEP in pulmonary function,DE in ultrasound,CPIS,infection indices:hs-CRP and FIB and ADL were significantly improved in the three groups（P<0.05）,but there was no significant difference in FEV₁/FVC in pulmonary function,DT,RAT and Tr AT in ultrasound and blood gas analysis indices（P>0.05）;in the inter-group comparison,FVC,FEV₁,PEF,MIP and MEP in pulmonary function,DE in ultrasound and ADL increased more in the EDP group and the combined treatment group than in the control group（P<0.05）,the FVC and FEV₁ in pulmonary function in the combined treatment group were significantly higher than in the EDP group（P<0.05）.Conclusion:For continuously bedridden patients,pulmonary rehabilitation therapy can improve respiratory function,reduce infection indices,improve respiratory health status and quality of life.On the basis of routine respiratory training,EDP can better improve pulmonary function and respiratory muscle strength,increase diaphragm movement and improve the ability to participate in daily life activities.After EDP combined with AFES,the improvement of pulmonary ventilation function is more obvious,which is more conducive to the recovery of respiratory function.