The Effect Of Diaphragmatic Pacing On Early Pulmonary Rehabilitation In Patients With Acute Exacerbation Of Severe Chronic Obstructive Pulmonary Disease

Objective:To investigate the value of external diaphragm pacing（EDP）in early pulmonary rehabilitation in patients with acute exacerbation of chronic obstructive pulmonary disease（COPD）.Methods:In this prospective randomized controlled study,patients with severe AECOPD admitted to the Intensive Respiratory Treatment Unit（RICU）of the First Affiliated Hospital of Xinjiang Medical University from September 2020 to March 2022 were selected as subjects.Before the use of EDP,all subjects were able to complete simple lung function test after NPPV and medical treatment.First second forced expiratory volume（FEV₁）/forced vital capacity（FVC）<0.7,FEV₁%Pred<50%.Subjects were randomly divided into two groups:one group received EDP+NPPV+routine medical treatment（EDP group）and the other group received NPPV+routine medical treatment（control group）.NPPV+medical treatment was started in the two groups after inclusion in the study.EDP was started in the experimental group when the subjects’vital signs were stable and body temperature was normal,and the experiment was terminated at the end of 7 days.The EDP treatment start time（0d）and treatment time point（7d）were used as observation time points of the two groups.Chronic obstructive pulmonary disease assessment test（CAT）,modified British Medical Research Council dyspnea Index（m MRC）,finger pulse oxygen saturation（Sp O₂）,arterial blood gas analysis,lung function and diaphragm measurement indexes were recorded.Results:A total of 67 patients were enrolled.There were 32 cases in the experimental group and 35 cases in the control group.（1）CAT score（28.59±2.71 vs 30.50±2.50）,m MRC score（3.47±0.51 vs 3.75±0.44）and arterial partial pressure of carbon dioxide（Pa CO2）（54.0±5.9 vs 62.4±7.6）at the end of 7 days in EDP group were significantly lower than those at 0d,with statistical significance,P<0.05.FEV₁（0.722±0.144 vs 0.720±0.144）,FVC（1.199±0.265 vs 1.196±0.264）,forced expiratory flow at 50%of FVC（FEF50）（0.366±0.088 vs 0.364±0.087）,maximal mid expiratory flow（MMEF）（0.400±0.085 vs 0.398±0.085）,peak expiratory flow（PEF）（2.396±0.982 vs 2.285±0.817）,maximal inspiratory pressure（MIP）（40.19±8.87 vs 25.59±8.17）,maximal expiratory pressure（MEP）（45.78±7.81 vs 43.50±6.71）and arterial blood p H（p H）（7.364±0.026 vs 7.281±0.023）at the end of 7 days in EDP group were significantly higher than those on 0d.The differences were statistically significant,P<0.05.（2）In the control group,CAT score（29.09±2.45 vs 30.57±2.39）,m MRC score（3.51±0.51 vs 3.69±0.47）and Pa CO₂（56.6±4.2 vs 61.0±6.3）at the end of7d were significantly decreased compared with 0d,and the differences were statistically significant,P<0.05.And FEV₁（0.706±0.236 vs 0.705±0.236）,FVC（1.146±0.410 vs1.144±0.411）,FEF50（0.381±0.074 vs 0.379±0.075）,MMEF（0.396±0.070 vs 0.392±0.069）,PEF（2.523±0.578 vs 2.394±0.529）,MIP（32.40±9.62 vs 27.14±8.60）,MEP（46.26±8.04 vs 44.03±6.09）and p H（7.330±0.023 vs 7.276±0.029）of the control group at the end of 7d were significantly higher than those at 0d,the differences were statistically significant,P<0.05.（3）The ABSOLUTE values ofΔCAT score（-1.91±0.82vs-1.49±0.51）,ΔMIP（14.59±3.63 vs 5.26±2.37）,Δp H（0.083±0.029 vs 0.055±0.031）andΔPa CO₂（-8.47±9.94 vs-4.40±3.57）in EDP group were higher than those in control group,the differences were statistically significant,P<0.05.Conclusion:Early use of EDP in patients with severe acute exacerbation of COPD can help patients with respiratory recovery,but the effect on lung function and diaphragm activity is not obvious,which requires further study to extend the treatment time in the future.