Clinical Study Of Diaphragm Dysfunction In Subacute Phase Of Stroke

Objective To observe the incidence rate of diaphragm dysfunction in stroke patients;The difference of prognosis between stroke patients with diaphragm dysfunction and stroke patients without diaphragm dysfunction;To explore whether diaphragmatic ultrasound can be an effective examination for evaluating lung function in the sub-severe stage of cerebral stroke.Method This study is divided into two parts.Part Ⅰ:Collect 30 healthy people who met the inclusion criteria in the physical examination of the First Affiliated Hospital of Zhejiang University School of Medicine in February 2023,conduct routine lung function examination and diaphragm ultrasound examination for healthy people,verify the correlation between them based on data validation,and conduct statistical regression modeling of normal lung function and diaphragm function.Part Ⅱ:Using a prospective cohort study,100 stroke patients hospitalized in the Department of Rehabilitation Medicine of the First Affiliated Hospital of Zhejiang University Medical College from October 2021 to February 2023 who met the inclusion criteria were included.The right diaphragm position and diaphragm thickening fraction(DTF)of the enrolled patients were measured with ultrasonic equipment,According to the results of diaphragmatic ultrasound measurement,patients were divided into stroke(diaphragmatic dysfunction)group and stroke(normal diaphragmatic function)group.After grouping,routine treatment was performed on both groups of patients.At the 4th and 12th weeks after treatment,the modified Rankin Scale(MRS),motor index(MI),and modified Barthel index(MBI)were measured,Blood gas analysis(PO2 and SaO2)and chest CT were used to analyze and compare the differences in prognosis between stroke patients with diaphragmatic dysfunction and stroke patients with normal diaphragmatic function after routine treatment.Result:The first part of the experiment:the forced vital capacity(FVC),forced expiratory volume in one second(FEV1)and maximum ventilation volume per minute(MVV)of lung function in healthy people were significantly correlated with the diaphragm ultrasonic parameters,diaphragm displacement(DE)and DTF(P<0.05);The lung function indicators of the healthy group were not correlated with other parameters of diaphragmatic ultrasound,such as right diaphragm position,left diaphragm position,end-inspiratory diaphragm thickness(DT),and end-expiratory DT.Multiple linear regression analysis of diaphragm ultrasound parameters and lung function in healthy individuals,showing DE(β=1.589;P=0.000)and DTF(β=0.051;P=0.000)is significantly and independently correlated with FVC.DE(β=1.265;P=0.000)and DTF(β=0.040;P=0.000)is significantly and independently correlated with FEV1.DE(β=29.130;P=0.016)and DTF(β=1.138;P=0.008)is significantly and independently correlated with MVV.The second part of the experiment:After statistical testing,the baseline data of the two groups were compared with P>0.05,and there was no statistically significant difference in the baseline data between the two groups.Modified Rankin Scale(MRS):There was no significant difference in MRS between the stroke group with diaphragm dysfunction and the group with normal diaphragm function at week 4,and the difference was not statistically significant(P>0.05);There was a statistically significant difference in MRS between the two groups at week 12(P<0.05).There was a statistically significant difference in MRS between the diaphragm dysfunction group at week 4 and week 12(P<0.05).There was a statistically significant difference in MRS between the group with normal diaphragm function at week 4 and week 12(P<0.05).Exercise index(MI):There was no significant difference in MI between the stroke group with diaphragm dysfunction and the group with normal diaphragm function at week 4(P>0.05),and the difference was not statistically significant(P>0.05).There was a difference in MI between the two groups at week 12,and the difference was statistically significant(P<0.05).There was a statistically significant difference in MI between the diaphragm dysfunction group at 4 and 12 weeks(P<0.05).There was a statistically significant difference in MI between the group with normal diaphragm function at 4 and 12 weeks after enrollment(P<0.05).Modified Barthel Index(MBI):There was no significant difference in MBI between the stroke group with diaphragmatic dysfunction and the group with normal diaphragmatic function at week 4(P>0.05),but there was a difference in MBI between the two groups at week 12(P<0.05).There was a statistically significant difference in MBI between the diaphragm dysfunction group at weeks 4 and 12(P<0.05).The group with normal diaphragm function showed differences in MBI at weeks 4 and 12,and the difference between the two groups was statistically significant(P<0.05).Blood gas analysis(PO2+SaO2):There was a statistically significant difference in PO2 and SaO2 between the stroke group with diaphragm dysfunction and the group with normal diaphragm function at week 4(P<0.05).There was no significant difference in PO2 and SaO2 between the two groups at week 12,and the difference was not statistically significant(P>0.05).There was a statistically significant difference in PO2 and SaO2 between the diaphragm dysfunction group at week 4 and week 12(P<0.05).There was a statistically significant difference in PO2 and SaO2 levels between the group with normal diaphragm function at 4 weeks and 12 weeks(P<0.05).Chest CT:In the experimental group,28 cases of pulmonary inflammation occurred in the group with diaphragm dysfunction,and 16 cases in the group with normal diaphragm function.There was no significant difference in the absorption of chest CT inflammation between the two groups at the 4th and 12th weeks after enrollment,and the difference in data between the two groups was not statistically significant(P>0.05).Conclusion:1.The incidence rate of diaphragmatic dysfunction in stroke was significantly increased;2.The recovery of neurological function and disability of patients with phrenic dysfunction after stroke were worse than those with normal phrenic function after stroke;3.Diaphragm ultrasound has a positive correlation with pulmonary function examination.Diaphragm ultrasound is an indirect indicator that can better reflect the state of pulmonary function in the sub-severe stage of stroke.