Effect Of Extracorporeal Diaphragm Pacemaker On Diaphragm Function And Cannula Extubation In Stroke Patients With Tracheotomy

Objective(s): Objective To investigate the effect of in vitro diaphragm pacing on diaphragm function and tube extubation in patients with cerebral apoplexy after tracheotomy.Method(s): Thirty patients with cerebral apoplexy undergoing tracheotomy in the rehabilitation department of Guilin People’s Hospital were selected.The enrolled patients were divided into control group and treatment group by random number table method,with 15 patients in each group.All patients received routine rehabilitation training such as exercise therapy and swallowing training.The control group received respiratory training,and the treatment group received respiratory training and external diaphragm pacemaker(EDP).Both respiratory training and EDP treatment were set at 30 minutes/time,once/day and 5 days/week for 4 weeks,respectively.Diaphragm movement,tracheal tube extubation time and success rate,activities of daily living,were recorded before and after 4 weeks of treatment in both groups.ADL score(Barthel index),patients’ cough,sputum,fever,wet rales and other symptoms,the incidence of lung infection and other indicators,and the collected data were statistically processed by SPSS26.0 statistical software.To analyze the changes of diaphragm function,extubation time,extubation success rate,activities of daily living,improvement of clinical symptoms and incidence of pulmonary infection in patients with cerebral apoplexy after extracorporeal diaphragm pacing and the differences between them and the control group.Result(s):(1)The comparison of general data between the control group and the treatment group was not statistically significant,and the data of the two groups were comparable;(2)After 4 weeks of rehabilitation,diaphragmatic mobility,Barthel index and other indicators in 2 groups were improved compared with those before treatment(P < 0.05);Compared with the control group,diaphragmatic mobility and Barthel index in the treatment group were significantly higher than those in the control group(P < 0.001).(3)After 4weeks of treatment,compared with the control group,the extubation time in the treatment group was shortened(P < 0.05),and the extubation rate was increased(P < 0.05),the difference was statistically significant.(4)The incidence of pulmonary infection in the treatment group was lower than that in the control group(P < 0.05),and the improvement of cough symptoms in the treatment group was better than that in the control group(P < 0.05).However,there was no significant difference in the improvement of cough,fever and pulmonary moist rales in the treatment group compared with the control group(P > 0.05).Conclusion(s): Breathing training can improve the diaphragm function and daily living ability of stroke patients with tracheotomy.The diaphragmatic function and the ability of daily living in the patients with tracheotomy were significantly improved by external diaphragmatic pacing,which was better than that in the patients without external diaphragmatic pacing.In addition,external diaphragmatic pacing can shorten the extubation time of patients with tracheotomy,improve the success rate of extubation,effectively reduce the incidence of pulmonary infection,improve cough symptoms,and improve the prognosis of patients with stroke,but it does not show obvious advantages in the improvement of sputum,fever,pulmonary moist rales and other symptoms.