Effects Of External Diaphragm Pacingcombined With Airway Clearance On Pulmonary Rehabilitation In Patients With Tracheotomy After Stroke

Objective:Study on patients with stroke tracheotomy by using extracorporeal diap hragmatic pacing combined with airway clearance,To investigate the effects of tracheal t ube extubation rate,pulmonary infection rate,respiratory muscle strength and respiratory function.Methods:A total of 46 patients with stroke who underwent tracheotomy after admission to the rehabilitation department of our hospital on January 1,2017 and December 31,2018 were prospectively collected,According to the random number table method,23 cases were randomly divided into the observation group and the control group.Both groups received routine rehabilitation training and respiratory function rehabilitation,including limb movement rehabilitation and application of airway clearance technology.On this basis,the observation group was treated with extracorporeal diaphragmatic pacing.Treatment parameters:pacing frequency of 9?15 beats/min,pulse frequency of 30?50Hz,stimulus intensity of 12?30 units,according to the patient's tolerance,gradually from weak to strong,2 times/day,20 min/time,5 times/week,4 weeks.Results:1)there was no significant difference between the observation group and the control group in basic data analysis,and the two groups were comparable(P>0.05).2)after treatment,the incidence of pulmonary infection in the observation group was lower than that in the control group(9%vs18%),and the difference was not statistically significant(P>0.05).The extubation rate of tracheal cannula in the observation group was higher than that in the control group(59%vs27%),and the difference was statistically significant(P<0.05).3)respiratory function indexes of the two groups:FVC:post-treatment comparison between the observation group and the control group(79.49 4.65vs66.49 3.52,P<0.05);Comparison between the observation group before and after treatment(63.99 3.47vs79.494.65,P<0.05);Control group before and after treatment(62.97 3.03vs66.49 3.52,p<0.05);FEV1:post-treatment comparison between the observation group and the control(2.92 0.10vs2.50 0.12,p<0.05);Comparison before and after treatment in the observation(2.16 0.11vs2.92 0.10,p<0.05);Control group before and after treatment(2.11 0,07vs2.50 0.12,p<0.05);Fevl%:post-treatment comparison between the observation group and the control group(85.50 1.86vs84.22 2.79,p>0.05);Comparison before and after treatment in observation group(77.96 1.47vs85.50 1.86,p<0.05);Control group before and after(78.72 1.42vs84.22 2.79,p<0.05);PEF:post-treatment comparison between the observation group and the control group(6.93 0.31vs6.12 0.31,p<0.05).Comparison before and treatment in the observation group(5.37 0.37vs6.93 0.31,p<0.05);Control group before after treatment(5.31 0.43vs6.12 0.31,p<0.05);4)comparison of respiratory muscle strength between the two groups after trea·PImax(62.15+/-7.32 vs49.68+/-4.95);PEmax(77.38 3.80vs72.71 6.70),the di nces were statistically significant(P<0.05).Conclusion:Extracorporeal diaphragmatic pacing combined with airway clearance improve diaphragm muscle strength and cough capacity,facilitate early removal of cannula,improve pulmonary ventilation,and have no effect on pulmonary infection after stroke.