Effects Of External Diaphragm Pacing Therapy On Pneumonia After Stroke

Background: More than 30% of stroke patients are complicated by respiratory and urinary system infections,the most common of which is lung infection.Therefore,it is of great clinical significance to clarify the risk factors of pneumonia after stroke and to give targeted interventions.A large number of studies have shown that due to cerebral cortex and / or brainstem injury,the voluntary regulation and / or involuntary regulation of respiratory muscles is weakened after stroke,resulting in decreased strength of the diaphragm and insufficient exercise range,causing respiratory and cough dysfunction.Increased risk of pneumonia.The diaphragm is the main respiratory muscle.The normal contraction of the diaphragm can ensure sufficient inhalation and maintain sufficient negative pressure in the thoracic cage,which is essential for respiratory function and cough function.An external diaphragm pacemaker(EDP)uses electrical stimulation of the phrenic nerve to cause excitement of the phrenic nerve,increase the contractile function of the diaphragm,help improve the respiratory and cough functions of stroke patients,and reduce the incidence of pneumonia.Objective: 1.To explore the risk factors of post-stroke pneumonia;2.To explore the effect of external diaphragm pacing therapy on the respiratory function and cough function of stroke patients,so as to further observe its impact on post-stroke pneumonia.Method:1.From September 2017 to January 2020,a total of 46 stroke patients who met the inclusion criteria were admitted to the Department of Rehabilitation Medicine of the First Affiliated Hospital of Chongqing Medical University,and their age,gender,and body mass index(Body)were recorded at the time of admission Mass Index(BMI),stroke type,activities of daily living(ADL),National Institute of Health stroke scale(NIHSS score),modified RANKIN scale(Modified Rankin Scale,mRS)And other basic data,and measure the patient's respiratory function and cough function,observation indicators include forced vital capacity(FVC),forced expiratory volume in first second(FEV1),peak cough expiratory flow(Peak expiratory cough flow,PECF),maximum phonation time(MPT).After 1 month of follow-up,they were divided into pneumonia group(9 cases)and non-pneumonia group(37 cases)according to whether pneumonia occurred.The distribution of relevant risk factors was counted.The risk factors related to post-stroke pneumonia were analyzed by univariate analysis and logistic regression.2.From September 2017 to March 2020,a total of 45 stroke patientsadmitted to the Department of Rehabilitation Medicine of the First Affiliated Hospital of Chongqing Medical University who met the inclusion criteria were randomly divided into an experimental group(22cases)and a control group(23 cases),both groups received conventional rehabilitation therapy such as exercise therapy,physical factor therapy,and occupational therapy.The experimental group added extracorporeal diaphragm pacing therapy on the basis of conventional rehabilitation therapy.The respiratory function and cough function of the patients were measured before treatment and after 4 weeks of treatment.Observation indicators include FVC,FEV1,PECF,MPT,ADL,NIHSS score,partial pressure of oxygen(PO2),and carbon dioxide partial pressure(Partial Pressure of Carbon Dioxide(PCO2),blood oxygen saturation(Blood Oxygen Saturation,SaO2).Result:1.Analysis of risk factors for post-stroke pneumonia:(1)Of 46 stroke patients,9 cases had pneumonia,and the incidence of pneumonia was19.55%.(2)The results of univariate analysis and logistic regression analysis showed that there was a statistically significant difference in MPT between the pneumonia group and the non-pneumonia group(P <0.05).MPT is related to post-stroke pneumonia.The greater the MPT,the lower the risk of pneumonia after stroke.The smaller the MPT,the higher the risk of pneumonia after stroke.(3)MPT is related to PECF.2.The effect of external diaphragm pacing therapy on the respiratory and cough function of stroke patients:(1)Respiratory function: After 4weeks of treatment,the FVC and FEV1 values of the two groups of patients were higher than before treatment.After treatment,FVC and FEV1 in the experimental group were significantly higher than those in the control group,and the difference was statistically significant(P <0.05).(2)Cough function: After 4 weeks of treatment,the PECF of the control group did not increase significantly compared with before treatment.After treatment,the PECF of the experimental group was higher than before treatment,but the difference was not statistically significant(P> 0.05).(3)Maximum vocalization time: After 4 weeks of treatment,the MPT values of both groups of patients were higher than before treatment.After treatment,the MPT of the experimental group was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).(4)Blood gas analysis: After 4 weeks of treatment,the PO2 and SaO2 values of the two groups of patients were higher than before treatment.After treatment,PO2 and SaO2 in the experimental group were significantly higher than those in the control group,and the difference was statistically significant(P <0.05).There was no significant improvement in PCO2 between the two groups after treatment compared with before treatment,and the difference was not statistically significant(P> 0.05).(5)NIHSS score: After 4 weeks of treatment,the NIHSS scores of the twogroups of patients were lower than before treatment.After treatment,the NIHSS score of the experimental group was not significantly lower than that of the control group,and the difference was not statistically significant(P> 0.05).(6)ADL: After 4 weeks of treatment,the ADL scores of the two groups of patients were higher than before treatment.After treatment,the ADL score of the experimental group was not significantly higher than that of the control group,and the difference was not statistically significant(P>0.05).(7)Pneumonia after stroke: After 4 weeks of treatment,6 of 23 cases in the control group developed SAP,and 2 of 22 cases in the experimental group developed pneumonia.There was no statistically significant difference between groups(P> 0.05).Conclusion: 1.MPT is related to post-stroke pneumonia and is an independent risk factor for post-stroke pneumonia.The lower the MPT,the higher the risk of pneumonia.2.MPT and PECF have a high correlation,which can replace PECF to predict the risk of pneumonia after stroke,and can be used as an index for bedside screening for the risk of pneumonia after stroke.3.EDP can significantly improve the respiratory function and MPT of stroke patients,but the effect on the cough function of stroke patients and the impact of pneumonia remains to be seen.