| Objective:In this study,we screened the prevalence of lung function decline in the elderly,understood the lung function of the elderly,and analyzed related factors that affect the level of lung function.Ultrasound was used to observe the morphological changes of the diaphragm in patients with reduced lung function.The results obtained by the examination methods are analyzed to verify the effectiveness and sensitivity of diaphragm ultrasound;the intervention study of diaphragm electrical stimulation is completed under its guidance,and the effect of conventional breathing training is compared to explore the rehabilitation methods for elderly patients with reduced lung function,Provide new ideas for clinical pulmonary rehabilitation.Methods:A random selection of 230 inpatients who attended the Department of Geriatrics of Xi’an Hospital of Traditional Chinese Medicine from November 2019 to December2020 were screened.They were tested by a pulmonary function instrument and a questionnaire was completed face-to-face.The content of the questionnaire included age,gender,and gender.Knowledge of lung diseases,smoking history,calcium supplement habit and comorbid conditions,etc.,sort out and statistically analyze the risk factors related to lung function decline;use diaphragm ultrasound to observe the diaphragm movement and thickness of patients with lung function decline,and calculate the diaphragm thickness Score,evaluate its correlation with pulmonary function test results and 6-minute walk test results;Include 27 elderly patients with reduced lung function that meet the criteria and randomly divide them into 3 groups,namely breathing training group,breathing training combined with acupoint electrical stimulation Group,breathing training combined with diaphragm electrical stimulation group,the three groups all received 20 minutes of routine breathing training,and the electrical stimulation group received 20 minutes of electrical stimulation on specific acupoints or diaphragmatic muscles,1 time/day,5 times/week,and the intervention time was as follows: 4 weeks.Before and after the intervention,the respiratory function scale(CAT,m MRC),lung function(FVC%pred,FEV1%pred,FEV1/FVC%),diaphragm ultrasound(diaphragm thickness,thickness variation rate,motion range),6Minute walking test(walking distance,Borg(evaluation before test),RPE(evaluation immediately after the test),RPB),grip strength,anxiety score and other evaluations,and statistical analysis of the results.Results:1.Epidemiological survey results of decreased lung function in elderly patientsIn this study,a total of 212 elderly patients completed lung function screening.The results showed that 154 patients with reduced lung function,accounting for 72.6%,and58 patients with normal lung function,accounting for 27.4%.Among the patients with reduced lung function,they were classified according to the degree of decline: mild High-degree patients accounted for 21.2%,moderate patients accounted for 25.5%,severe patients accounted for 16.5%,and extremely severe patients accounted for 9.4%.The analysis of related factors affecting the level of lung function showed that age(OR=0.918,95%CI 0.872～0.966),smoking history(OR=0.171,95%CI 0.072～0.406),osteoporosis(OR =0.272,95%CI0.105～0.699),knowledge of lung disease(OR=10.067,95%CI4.704～21.529)are related factors influencing the decline of lung function in the elderly(P<0.05).2.Correlation analysis results of different assessment methods of lung functionThis study compared the results of diaphragm ultrasound test and pulmonary function test.The results showed that diaphragmatic muscle mobility,diaphragm thickness score and pulmonary function indexes(FVC%pred,FEV1/FVC%)were significantly correlated,of which diaphragmatic muscle mobility was related to FEV1%pred Highly correlated(r=0.851,P < 0.01),moderately correlated with FVC%pred,FEV1/FVC%(r=0.67,P<0.05;r=0.658,P<0.01);diaphragm thickness score and FVC% pred and FEV1%pred were moderately correlated(r=0.601,P<0.01;r=0.676,P<0.01),and lowly correlated with FEV1/FVC%(r=0.483,P<0.05).Comparing the walking distance of the 6-minute test with the results of diaphragm ultrasound and pulmonary function indexes,it was found that the 6-minute walking distance was significantly correlated with the diaphragm thickness score and the degree of movement of the diaphragm,and the correlation was low(r=0.455,P<0.05;r= 0.384,P<0.05);there was significant correlation with lung function indexes FVC%pred,FEV1%pred,FEV1/FVC%,and FVC%pred,FEV1%pred showed a moderate correlation(r=0.523,P<0.01;r= 0.528,P<0.01),and low correlation with FEV1/FVC%(r=0.477,P<0.05).3.Intervention results of different rehabilitation programsThere were no significant differences in the indicators of the three groups before intervention(P>0.05),and they were comparable.After 4 weeks of intervention,comparison before and after intervention within the group: the breathing training group had significant differences in CAT score,6-minute walking distance,grip strength(right),FEV1%pred,and anxiety score(P<0.05);CAT score,m MRC score,6-minute walk test(distance,Borg(evaluation before the test),RPE(evaluate immediately after the test),RPB),grip strength(left),grip strength(right),FVC%pred,FEV1%pred,anxiety There are significant differences in scores(P<0.05);the diaphragmatic muscle electrical stimulation group has CAT score,m MRC score,6-minute walk test(distance,Borg(evaluation before test),RPE(evaluation immediately after test),RPB),grip strength(Left),grip strength(right),FEV1/FVC%,and anxiety scores have significant differences(P<0.05).Comparison between groups after intervention: There were significant differences in the m MRC scale score between the breathing training group and the acupoint electrical stimulation group and the 6-minute walking distance group(P<0.05);the breathing training group and the diaphragm electrical stimulation group were scored on the m MRC scale,6-minute walk test(walking distance,RPB,RPE(assessed immediately after the test)),lung function level(FEV1%pred),there are significant differences between the groups(P<0.05);the electrical stimulation group is only in RPB There is a significant difference in comparison(P<0.05).Comparison of differences between before and after intervention: Breath training group and acupoint electrical stimulation group in terms of m MRC scale score,6-minute walk(distance,Borg(evaluation before test),RPE(evaluation immediately after the test)),and grip strength(left)There is a significant difference between the two groups(P<0.05);the breathing training group and the diaphragmatic electrical stimulation group are in m MRC score,6-minute walking(walking distance,RPB,RPE(evaluated immediately after the test)),grip strength(left and right),anxiety There were significant differences in the scores between the groups(P<0.05);but the electrical stimulation group only had significant differences in the grip strength(right)(P<0.05).Conclusion:1.This study shows that age,smoking history,knowledge of lung disease and osteoporosis are related factors of lung function decline,and knowledge of lung disease is a protective factor.Health education of lung function should be strengthened in daily life to prevent the occurrence of lung disease;2.Like conventional static lung function and 6MWT tests,diaphragm ultrasound can be used as an objective and effective examination method to assess the level of lung function.3.Respiratory training combined with electrical stimulation(acupoint electrical stimulation or diaphragmatic electrical stimulation)is effective in improving the level of lung function,and the effect of diaphragmatic ultrasound-guided electrical stimulation is the most significant.The main manifestations are the decrease of RPB score,the increase of grip strength and the increase of FEV1 / FVC%. |
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