| Objective: This study compared the effects of respiratory training,external diaphragm pacing and repetitive peripheral magnetic stimulation on diaphragmatic function in patients with cerebral infarction.To compare the efficacy of external diaphragm pacing and repetitive peripheral magnetic stimulation,and to observe the advantages and disadvantages of repetitive peripheral magnetic stimulation in the application of diaphragm function in patients with cerebral infarction,so as to provide a basis for clinical application.Methods: In this study,36 subjects were selected and randomly divided into control group,EDP group and r PMS group.Finally,32 cases completed the experiment and 4 cases fell off,including 1 case in the control group and 1 case in the r PMS group,and 2 cases in the EDP group.The control group received respiratory training,including abdominal breathing,lip contraction breathing,resistance breathing,respiratory rhythm control,thoracic expansion exercise and cough training.The EDP group was treated with external diaphragm pacing.The main electrode was attached to the lower third of the sternocleidomastoid muscle on both sides,and the auxiliary electrode was attached to the second intercostal space of the midline of the clavicle on both sides.The pacing was 9～12 times / min,the frequency was 40 Hz,and the intensity was 12～30 units.The r PMS group was treated with repeated peripheral magnetic stimulation.The stimulation site was C7 spinous process,the frequency was 20 Hz,and the intensity was 80 % ～120 % activity threshold intensity.The treatment was 20 min / time,once a day,five days a week for four weeks.Three groups of subjects were treated 20 min / times,once a day,five days a week,a total of four weeks.Three groups of subjects were evaluated before and after the intervention,including diaphragmatic ultrasound(diaphragmatic thickness during inspiratory,diaphragmatic thickness during expiratory,diaphragmatic thickness fraction,diaphragmatic mobility),phrenic nerve motor conduction(compound muscle action potential amplitude,phrenic nerve conduction time),static lung function(forced vital capacity,forced expiratory volume in the first second,one second rate,peak expiratory flow rate),thoracic activity,Sheikh trunk control score scale.Statistical analysis was performed after data collection.SPSS 26.0 software was used for statistical analysis.Paired t test or Wilcoxon rank sum test was used to compare the same group before and after intervention..Single factor analysis of variance or Kruskal-Wallis nonparametric rank sum test was used for comparison between different groups.Fisher exact test was used for count data.P < 0.05 indicated statistical difference.Results:(1)After four weeks of intervention,the end-inspiratory diaphragm thickness,diaphragm thickness fraction and diaphragm mobility of the three groups were significantly higher than those before intervention.There was no significant difference in the end-expiratory diaphragm thickness between the three groups before and after intervention.There was no significant difference in diaphragm thickness at the end of inspiration between the three groups after four weeks of intervention.After four weeks of intervention,the diaphragm thickness fraction and diaphragm mobility of the EDP group and the r PMS group were significantly higher than those of the control group,and there was no significant difference in diaphragm thickness fraction and diaphragm mobility between the EDP group and the r PMS group after four weeks of intervention.It shows that the three groups can increase the end-inspiratory diaphragm thickness,diaphragm thickness fraction and diaphragm mobility at the end of inspiration,but the EDP group and the r PMS group are better than the control group in increasing the diaphragm thickness fraction and diaphragm mobility.(2)The phrenic nerve conduction time of the three groups of subjects after four weeks of intervention was significantly lower than that before intervention;after four weeks of intervention,the amplitude of compound muscle action potential in the three groups was significantly higher than that before intervention.After four weeks of intervention,the phrenic nerve conduction time of EDP group and r PMS group was significantly lower than that of control group,and the phrenic nerve conduction time of r PMS group was significantly lower than that of EDP group.There was no significant difference in the amplitude of compound muscle action potential between the three groups after four weeks of intervention.It shows that the three groups can reduce the phrenic nerve conduction time and increase the amplitude of compound muscle action potential,but the EDP group and r PMS group are better than the control group in reducing the phrenic nerve conduction time,and the r PMS group is better than the EDP group in reducing the phrenic nerve conduction time.(3)After four weeks of intervention,FVC,FEV1,one-second rate and PEF of the three groups were significantly higher than those before intervention.After four weeks of intervention,FVC,FEV1 and PEF in EDP group and r PMS group were significantly higher than those in control group,and there was no significant difference in FVC,FEV1 and PEF between EDP group and r PMS group.After four weeks of intervention,the one-second rate of r PMS group was significantly higher than that of control group and EDP group,and there was no significant difference between control group and EDP group after four weeks of intervention.It shows that the three groups can improve the pulmonary ventilation function,but the EDP group and the r PMS group are better than the control group in improving FVC,FEV1 and PEF,and the r PMS group is better than the control group and the EDP group in improving the one-second rate.(4)The thoracic mobility of the three groups of subjects after intervention was significantly higher than that before intervention,and the effect of EDP group and r PMS group was better than that of control group after intervention.(5)The TCT scale score of the three groups of subjects after intervention was significantly higher than that before intervention,and the effect of the EDP group and the r PMS group after intervention was better than that of the control group.Conclusion:(1)Four weeks of respiratory training,external diaphragm pacing,and repetitive peripheral magnetic stimulation can improve the patient ’s end-inspiratory diaphragm thickness,diaphragm thickening ability,diaphragmatic activity ability,phrenic nerve motor conduction velocity,pulmonary ventilation function,thoracic expansion degree,and trunk control ability,so as to improve the overall diaphragm function in patients with cerebral infarction.(2)The effect of external diaphragm pacing and repetitive peripheral magnetic stimulation on improving diaphragm function is better than that of respiratory training in the control group.(3)Repeated peripheral magnetic stimulation is superior to external diaphragm pacing in improving phrenic nerve conduction velocity.(4)Repetitive peripheral magnetic stimulation can be used to improve diaphragmatic function in patients with cerebral infarction,and clinical application can be considered. |
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