Clinical Study Of Threshold Pressure Load Respiratory Muscle Training On Pulmonary Rehabilitation Of Patients With Traumatic Brain Injury

Background and ObjectiveAccording to epidemiological estimates,the incidence rate of TBI is about 50million worldwide each year.About half of the world’s people suffer from brain injury in their lifetime.In the UK,it is the most common cause of disability and death among people under 40.In China,there are about 700000 to 750000 deaths caused by craniocerebral injury every year,which is the fifth cause of death after malignant tumor,cerebrovascular disease,respiratory system disease and heart disease.In addition,the incidence rate and mortality rate of low and middle income countries are even higher.TBI causes about 400 billion US dollars of losses to the global economy every year,accounting for 0.5%of the world’s GDP.In addition,survivors of traumatic brain injury often face a series of problems,including decreased physical activity,decreased respiratory function,fatigue,emotional and behavioral changes,and sleep disorders.These factors will lead to a significant increase in incidence rate and mortality of survivors.Respiratory dysfunction is an important factor affecting their quality of life.Patients with long-term brain injury due to respiratory dysfunction often have immune function decline,which can increase the risk of infection,such as lung infection.If not diagnosed and treated in time,it can cause respiratory failure and even endanger life.Therefore,early rehabilitation treatment is needed to control and solve these problems.At present,respiratory muscle training is widely used,including cardiopulmonary system,inspiratory muscle dysfunction caused by various diseases,athletes and other healthy people.At present,the clinical medical staff can not cure the disease completely through respiratory muscle exercise,but can improve the quality of life through various inspiratory muscle training methods and measures,which is of great significance to patients with irreversible or chronic lung disease and respiratory system disease.The threshold stress muscle training（TIMT）is a widely used training method in improving respiratory dysfunction.This device relies on the pressure threshold when it is applied.Patients need to carry out repetitive respiratory muscle training under the condition of external load.The training of respiratory muscle is based on the premise that when respiratory muscles respond to training stimulation,the structure of respiratory muscles will be adjusted in the case of excessive fiber load,like other skeletal muscles.Breathing muscles can overload their workload due to their longer working hours,higher intensity and/or more frequent.In addition,because TIMT not only resists respiratory muscles,but also involves long-term over ventilation,it may have additional effects on respiratory muscle endurance,which may make more effective use of respiratory muscles in daily life activities.At present,there are few clinical rehabilitation studies on respiratory dysfunction after brain injury by TIMT at home and abroad.We have studied this point of view.Material and methodsA total of 60 patients who were bedridden due to cerebral trauma and were treated in the Department of Neurosurgery,Intensive Care Unit and Rehabilitation Department of our hospital from March 2018 to June 2019 were selected according to the random number table,and they were divided into an observation group（n=30）and a control group（n=30）.Both groups received routine internal surgery treatment and rehabilitation training.On the basis of the above results,the observation group also received threshold pressure load respiratory muscle training,which lasted for six weeks.The maximum volume per minute（MVV）,one-second forced expiratory volume（FEV1）,forced vital capacity（FVC）,one-second rate（FEV1/FVC）,inspiratory muscle inotropic index（MIP）,inspiratory peak flow rate（PIF）,partial pressure of arterial oxygen（Pa O₂）and partial pressure of arterial blood carbon dioxide（Pa CO₂）of patients in the two groups before and after treatment were evaluated,together with the pulmonary infection at the beginning of treatment and at the end of six weeks of treatment.Results1.FVC,FEV1,FEV1/FVC and MVV indexes of patients in the two groups after treatment were significantly increased compared with those before treatment,and the differences were statistically significant（P<0.05）.Besides,the indexes of patients in the observation group were increased more significantly,and the differences were statistically significant as compared with those in the control group（P<0.05）;2.The Pa O₂ level of patients between the two groups after treatment was significantly higher than that before treatment,and Pa CO₂ was significantly reduced,with statistical significance（P<0.05）.Moreover,the improvement of indicators in the observation group was more significant,and the difference was statistically significant（P<0.05）;3.Compared with those before treatment,the MIP and PIF indexes in the two groups after treatment were significantly increased and the differences were statistically significant（P<0.05）.In addition,the above indexes in patients of the observation group were increased more significantly and the differences were statistically significant as compared with those in the control group（P<0.05）;4.The pulmonary infection rate in the observation group was lower than that in the control group during the treatment period,and the difference between the two groups was statistically significant（P<0.05）.ConclusionsThreshold pressure load respiratory muscle training can significantly improve the pulmonary function and respiratory muscle function of patients with traumatic brain injury,increase arterial oxygen partial pressure,reduce arterial carbon dioxide partial pressure,and significantly reduce the rate of pulmonary infection.