Effect Of External Diaphragm Pacing On Pulmonary Rehabilitation In Stable Copd Patients

Objective: To assess the effect of diaphragm pacing in vitro on pulmonary ventilation,arterial blood gas,exercise tolerance,and q uality of life in patients with stable COPD.Method: Patients with stable chronic obstructive pulmonary dise ase who were selected according to the revised 2017 COPD criteria for chronic obstructive pulmonary disease were selected.All patien ts were in accordance with the GOLD 2017 Guideline for Chronic Obstructive Pulmonary Disease before treatment.On this basis,exter nal diaphragm pacing was performed.Patients were divided into mild group,moderate group,severe group,and extremely severe group according to GOLD's lung function grading criteria.Patients were d ivided into A,B,C,and D groups according to the GOLD 2017 C omprehensive Evaluation Index for Chronic Obstructive Lung Diseas e.External diaphragm pacing was performed with a pulse frequency of 40 Hz.The number of stimulations was 9 beats per minute.The pulse amplitude was gradual and gradual from weak to strong accor ding to the tolerability of each patient.Twice daily,each time was30 minutes,and the course of treatment was 20 days.Pulmonary ve ntilation and arterial blood gas analysis were performed before and after treatment.Six-minute walking tests,CAT scores,and mMRC s cores were performed.Results:(1)A total of 34 patients were included,32 of which compl eted 20 days of external diaphragm pacing treatment.According to lung function grading criteria,9 patients in moderate group,13 pati ents in severe group and 10 patients in very severe group were gro uped according to GOLD 2017 comprehensive assessment criteria,i ncluding 6 patients in group B,6 patients in group C,and 20 patie nts in group D.(2)Changes in pulmonary ventilation: There was no significa nt difference in FEV1 between the moderate group(1.34±0.37 VS1.11±0.38,P>0.05)and the B group(1.17±0.34 VS 0.99±0.36,P>0.05).Severe group(1.14±0.24 VS 0.97±0.21,P<0.05),Extremely seve re group(0.92±0.16 VS 0.63±0.12,P<0.05),group C(1.32±0.28 V S 1.21±0.30,P<0.05),group D(0.97±0.20 VS 0.78±0.22,P<0.05),t he FEV1 increased compared with that before treatment,and the di fference was statistically significant.(3)Changes in Arterial Blood Gas: Changes in Pa O2: In the moderate group(65.70±10.05 VS 64.10±9.57,P>0.05),severe group(66.63±8.90 VS 66.35±9.22,P>0.05),group B(64.57±9.22 VS 63.97±9.12,P>0.05),group C(67.87±9.18 vs 67.92±9.93,P>0.05).There was no statistical difference in Pa O2 in patients.Pa O2 in the extre mely severe group(59.78±6.74 VS 58.83±7.11,P<0.05),group D(63.05±8.91 VS 61.82±8.74,P<0.05)increased compared with that before treatment,and the difference was statistically significant.Cha nges in Pa CO2: Moderate group(40.48±3.00 VS 44.86±5.07,P<0.05),severe group(39.25±3.50 VS 43.48±5.08,P<0.05),extremely se vere group(46.02±8.94 VS 54.64±12.40,P<0.05),group B(39.48±2.26 VS 43.78±3.93,P<0.05),group C(39.15±3.73 VS 43.53±5.26,P<0.05),group D(43.15±7.29 VS 49.57±10.77,P<0.05),Pa CO2 decr eased compared with before treatment,and the difference was statist ically significant.(4)Change in 6-minute walking distance: Moderate group(413.28±51.78 VS 386.28±58.70,P<0.05),severe group(436.73±72.92 VS 387.85±62.27,P<0.05),extremely severe group(415.00±62.72 VS 357.60±59.77,P<0.05),group B(449.33±58.93 VS 411.00±43.00,P<0.05),group C(494.00±50.99 VS 441.00±47.88,P<0.05),and group D(394.35±47.81 VS 349.13±48.43,P<0.05),the 6-minute wa lking distance increased compared with before treatment,and the di fference was statistically significant.(5)Changes of CAT scores: Moderate group(13.78±5.59 VS15.56±6.13,P<0.05),severe group(13.08±5.86 VS 15.46±6.64,P<0.05),extremely severe group(16.20±4.37 VS 19.60±4.95,P<0.05),group B(11.17±1.72 VS 13.33±1.63,P<0.05),group C(7.33±0.82 VS 8.00±0.55,P<0.05),and group D(17.25±4.28 VS 20.30±4.70,P<0.05),the CAT score decreased compared with that before treatme nt,and the difference was statistically significant.(6)Changes in mMRC scores: Patients in the moderate grou p(1.67±0.50 VS 1.89±0.78,P>0.05),group B(1.50±0.55 VS 1.67±0.52,P>0.05),and group C(1.00±0.00 VS 1.00±0.00,P>0.05),pat ients mMRC scores were not ascendingly different from those befor e treatment.Patients in the severe group(1.46±0.52 VS 1.85±0.90,P<0.05),very severe group(2.00±0.47 VS 2.50±0.71,P<0.05),and group D(1.95±0.39 VS 2.55±0.60,P<0.05),the mMRC score was lower than before treatment,and the difference was statistically significant.In conclusion:External diaphragm pacing therapy can improve pulmonary vent ilation function and arterial blood gas in patients with chronic obstr uctive pulmonary disease during the stabilization period,and improv e exercise tolerance and quality of life of patients.The patients wit h the greatest degree of benefit are those with severe,severe,and D groups.