| Research ObjectiveIn this study,acupuncture,rehabilitation and acupuncture combined with rehabilitation were used to intervene the respiratory function rehabilitation of patients with tracheotomy after stroke In order to improve the extubation rate of patients with tracheotomy,it is necessary to seek an optimal treatment for patients with respiratory rehabilitation after stroke.Research Methods(1)literature StudyIn the literature research part,we mainly reviewed the etiological mechanism and current rehabilitation methods of patients with tracheotomy after stroke in recent 10 years.(2)Clinical Research135 patients aged 35-75 years with tracheotomy after stroke were enrolled in this study.All patients were referred to the Chinese guidelines for the prevention and treatment of cerebrovascular diseases(2018 Edition)and the Chinese guidelines for the diagnosis and treatment of acute ischemic brain disease(2018 Edition).135 patients were treated with basic treatment of stroke,including anticoagulation and anti aggregation,lipid regulation and plaque stabilization,nerve nutrition,improvement of circulation,elimination of oxygen free radicals,rehabilitation exercise of limbs,control of basic diseases,regular turning over and patting on the back,sputum suction and nutritional support,etc.refer to the Chinese guidelines for prevention and treatment of cerebrovascular diseases(2018 Edition).The acupuncture group was treated with acupuncture at Cervical Jia ji C1-7,Fengchi(GB20),Tianding(LI17),Qishe(ST11)andTanzhong(CV 17).The rehabilitation group was treated with thoracic relaxation training and respiratory training.The combined group was acupuncture group and rehabilitation group.28 days was a course of treatment.Before treatment,14 days and 28 days of treatment,the patients were given tracheotomy intubation cough reflex Rating Scale(GFC),blood gas analysis,diaphragm measurement,coma Recovery scale(CRS-R),standard swallowing function scale(SSA)and National Institutes of Health Stroke Scale(NIHSS)were evaluated.The clinical efficacy of cough reflex was evaluated by GFC cough reflex ability.The patients were followed up within half a year after the treatment to evaluate the success rate of tracheal extubation.Research Results(1)General InformationThe general data of age,gender,course of disease,type of disease and cough reflex scale GFC of the patients in the group are detailed in Table 1.After statistical analysis,there is no significant difference between the groups(P>0.05),suggesting that they are comparable.(2)Evaluation of therapeutic effect of cough reflexThree groups of patients before and after treatment by cough reflex scale GFC scale evaluation,the curative effect comparison among the three groups by chi square test showed that the combined group was significantly better than the acupuncture group and rehabilitation group,the combined group can effectively improve the cough reflex function of patients.(3)Evaluation of GFC Sscale ResultsAfter statistical treatment,the analysis results of repeated measurement design variance test with F grou P=0.049,P=0.952>0.05 showed that there was no significant difference between the three groups before treatment.In the process of statistical test,through paired t test method,the data of rehabilitation group before treatment and 14,28 days of treatment,P<0.05,P<0.01 results show that it has significant statistical significance.Through paired t-test,the data of acupuncture group before treatment and 14 and 28 days of treatment,P<0.01,showed significant statistical significance.Through paired t-test method,the data of the combined group before treatment and 14,28 days of treatment,P<0.01 showed that it had significant statistical significance.Using the method of repeated analysis of variance,after 14 and 28 days of treatment,the results of P<0.01 in the combination group,the rehabilitation group and the rehabilitation group showed significant statistical significance;in the comparison between the acupuncture group and the rehabilitation group,the results of P<0.01 showed that it had significant statistical significance.Compared with rehabilitation treatment and acupuncture group,the combination group had significant advantages P<0.01;the acupuncture group had significant advantages compared with the rehabilitation group P<0.01.(4)Evaluation of Blood Gas Analysis ResultsPaO2 analysis:F grou P=0.059,P=0.943>0.05 repeated measurement design variance test results showed that there was no significant difference between the three groups before treatment.In the process of statistical test,through paired t-test method,the data of rehabilitation group before treatment and 14,28 days of treatment,P<0.01 results show that it has significant statistical significance.Through paired t-test,the data of acupuncture group before treatment and 14 and 28 days of treatment,P<0.01,showed significant statistical significance.Through paired t-test method,the data of the combined group before treatment and 14,28 days of treatment,P<0.01 showed that it had significant statistical significance.Using the method of repeated analysis of variance,after 14 days of treatment,there was significant difference between the acupuncture group and the rehabilitation group P<0.05;after 28 days of treatment,there was statistical significance P<0.01;in the comparison of 14 days and 28 days after treatment,the results of P<0.01 showed that there was significant statistical significance;compared with the acupuncture group,the combined group had P<0.05,The combination group has obvious advantages.In the comparison of the difference between the three groups,the combination group and the rehabilitation group,the combination group had obvious advantages,P<0.01,compared with the acupuncture group,P<0.05.Compared with the rehabilitation group,the acupuncture group had significant advantages P<0.05.PCO2 analysis:F grouP=0.147,P=0.863>0.05 repeated measurement design variance test results showed that there was no significant difference between the three groups before treatment.In the process of statistical test,through paired t-test method,the data of rehabilitation group before treatment and 14,28 days of treatment,P<0.01 results show that it has significant statistical significance.Through paired t-test,the data of acupuncture group before treatment and 14 and 28 days of treatment,P<0.01,showed significant statistical significance.Through paired t-test method,the data of the combined group before treatment and 14,28 days of treatment,P<0.01 showed that it had significant statistical significance.After 14 days of treatment,repeated ANOVA was used to compare the acupuncture group with the rehabilitation group,and the results showed that P<0.05 had significant statistical significance.After 28 days of treatment,in the comparison between acupuncture group and rehabilitation group,P<0.01 showed that it had significant statistical significance.After 14 days and 28 days of treatment,there was significant difference between the combined group and the rehabilitation group P<0.01;there was no significant difference between the combined group and the acupuncture group after 14 days of treatment P>0.05,but there was a significant difference after 28 days of treatment P<0.01.Compared with rehabilitation group and acupuncture group,the combined group had obvious advantages,with statistical significance P<0.01.There was no significant difference between the rehabilitation group and the acupuncture group P>0.05.OI analysis:F grou P=0.057,P=0.944>0.05 repeated measurement design variance test results showed that there was no significant difference between the three groups before treatment.In the process of statistical test,through paired t-test method,the data of rehabilitation group before treatment and 14,28 days of treatment,P<0.01 results show that it has significant statistical significance.Through paired t-test,the data of acupuncture group before treatment and 14 and 28 days of treatment,P<0.01,showed significant statistical significance.Through paired t-test method,the data of the combined group before treatment and 14,28 days of treatment,P<0.01 showed that it had significant statistical significance.Using the method of repeated analysis of variance,after 14 days and 28 days of treatment,there was statistical significance between acupuncture group and rehabilitation group,P<0.05;in comparison between combination group and rehabilitation group,P<0.01 showed that it had significant statistical significance;in comparison between combination group and acupuncture group,P<0.05 showed that it had statistical significance.Compared with the rehabilitation group,the combined group had obvious advantages,P<0.01 had statistical significance;compared with acupuncture,there was significant difference P<0.05;compared with the rehabilitation group,the acupuncture group had no statistical significance P>0.05.(5)Evaluation of Diaphragm ResultsDiaphragmatic thickness:Fgrou P=0.061,P=0.941>0.05 repeated measurement design variance test results showed that there was no significant difference between the three groups before treatment.In the process of statistical test,through paired t-test method,the data of rehabilitation group before treatment and 14,28 days of treatment,P<0.01 results show that it has significant statistical significance.Through paired t-test,the data of acupuncture group before treatment and 14 and 28 days of treatment,P<0.01,showed significant statistical significance.Through paired t-test method,the data of the combined group before treatment and 14.28 days of treatment,P<0.01 showed that it had significant statistical significance.After 14 days and 28 days of treatment,repeated ANOVA was used to compare the acupuncture group with the rehabilitation group,and the results showed that P<0.05 had significant statistical significance.In the comparison between the combined group and the rehabilitation group,the results of P<0.01 showed that it had significant statistical significance.In the comparison between the combined group and the acupuncture group,the results of P<0.05 showed that it had statistical significance.Compared with the rehabilitation group and acupuncture group,the combined group had obvious advantages,with statistical significance P<0.01,P<0.05.There was no significant difference between acupuncture group and rehabilitation group P>0.05.Diaphragmatic mobility:Fgroup=0.009,P=0.991>0.05 repeated measurement design variance test results showed that there was no significant difference between the three groups before treatment.In the process of statistical test,through paired t-test method,the data of rehabilitation group before treatment and 14,28 days of treatment,P<0.01 results show that it has significant statistical significance.Through paired t-test,the data of acupuncture group before treatment and 14 and 28 days of treatment,P<0.01,showed significant statistical significance.Through paired t-test method,the data of the combined group before treatment and 14,28 days of treatment,P<0.01 showed that it had significant statistical significance.After 14 days and 28 days of treatment,repeated ANOVA was used to compare the acupuncture group with the rehabilitation group,and the results showed that P<0.05 had significant statistical significance.In the comparison between the combined group and the rehabilitation group,the results of P<0.01 showed that it had significant statistical significance.In the comparison between the combined group and the acupuncture group,the results of P<0.05 showed that it had statistical significance.Compared with the rehabilitation group and acupuncture group,the combined group had obvious advantages,with statistical significance P<0.01,P<0.05.There was significant difference between acupuncture group and rehabilitation group P<0.05.(6)CRS-R Result EvaluationThe analysis results of repeated measurement design variance test with F grou P=0.378,P=0.686>0.05 showed that there was no significant difference among the three groups before treatment.In the process of statistical test,through paired t-test method,the data of rehabilitation group before treatment and 14,28 days of treatment,P<0.01 results show that it has significant statistical significance.Through paired t-test,the data of acupuncture group before treatment and 14 and 28 days of treatment,P<0.01,showed significant statistical significance.Through paired t-test method,the data of the combined group before treatment and 14,28 days of treatment,P<0.01 showed that it had significant statistical significance.After 14 days and 28 days of treatment,repeated ANOVA was used to compare the acupuncture group with the rehabilitation group,and the results showed that P<0.01 had significant statistical significance.In the comparison between the combined group and the rehabilitation group,the results of P<0.01 showed that it had significant statistical significance.There was no difference between the combined group and the acupuncture group,P>0.05 showed that there was no statistical significance.Compared with the rehabilitation group and the acupuncture group,the combined group had obvious advantages,with statistical significance P<0.01.There was significant difference between acupuncture group and rehabilitation group P<0.01.(7)Evaluation of SSA ResultsThe results of F grou P=0.3 78,P=0.686>0.05 were obtained by repeated measurement design variance test analysis,which showed that there was no statistically significant difference among the three groups before treatment.In the process of statistical test,through paired t-test method,the data of rehabilitation group before treatment and 14,28 days of treatment,P<0.01 results show that it has significant statistical significance.Through paired t test,the data of acupuncture group before treatment,14 days and 28 days of treatment,P<0.01,showed that the statistical significance was very significant.Through paired test,the data of the combined group before treatment,14 days and 28 days of treatment,P<0.01,showed that it was statistically significant.After 14 days and 28 days of treatment,repeated ANOVA was used to compare the acupuncture group with the rehabilitation group,and the results showed that P<0.01 had significant statistical significance.In the comparison between the combined group and the rehabilitation group,the results of P<0.01 showed that it was statistically significant.In the comparison between the combined group and the acupuncture group,the difference was not obvious,P>0.05 showed that there was no statistical significance.Compared with the rehabilitation group,the combined group had obvious advantages,with statistical significance P<0.01;the combination group had no statistical significance compared with the acupuncture group,P>0.05;the acupuncture group and the rehabilitation group had significant difference,P<0.01.(8)NIHSS Result EvaluationThere was no significant difference among the three groups before treatment.There was significant difference between the combined group and the acupuncture group and the rehabilitation group P<0.01.There was no difference between the two groups P>0.05.Compared with the analysis of variance of repeated measurement design,the difference of the three groups was significantly better in the combined group than in the rehabilitation group and acupuncture group,with statistical significance P<0.01;compared with the rehabilitation group,there was no difference,with statistical significance P>0.05.(9)Extubation efficiencyThe results showed that the total effective rate of extubation in the combined group was 87.5%,80%in the acupuncture group and 55%in the rehabilitation group.Therefore,the combination group and the acupuncture group have obvious advantages in improving the extubation rate.ConclusionThrough the research results of this project,the combined group can improve the cough reflex function of patients,effectively improve the airway clearance function,and lay a solid foundation for the later extubation of patients.The combined group has obvious clinical effect in improving diaphragm function,promoting diaphragmatic movement,strengthening active breathing,preventing diaphragmatic atrophy or improving diaphragm thickness;meanwhile,it has obvious curative effect in improving lung function,mainly reflected in improving blood oxygen partial pressure,oxygenation index and reducing carbon dioxide partial pressure.In the process of research,we found that acupuncture combined with rehabilitation therapy not only has a good effect on the respiratory function of patients,but also has obvious effect on the improvement of swallowing function and consciousness level of patients.At the same time,the combined group has a certain clinical value for the recovery of neurological function loss after stroke.In the rehabilitation treatment of patients with tracheotomy after stroke,acupuncture combined with rehabilitation training,in patients with functional improvement after 87.5%extubation rate,with good clinical significance,can be widely used in clinic. |
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