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中华脑科疾病与康复杂志(电子版) ›› 2024, Vol. 14 ›› Issue (03) : 133 -139. doi: 10.3877/cma.j.issn.2095-123X.2024.03.002

临床研究

超声评估脑卒中气管切开患者膈肌功能与肺功能的相关性研究
梁明1, 魏珍2,†(), 祖合热·肉孜1, 李金贤1   
  1. 1. 830001　乌鲁木齐，新疆维吾尔自治区人民医院康复医学科
    2. 830001　乌鲁木齐，新疆维吾尔自治区人民医院高血压诊疗研究中心
  • 收稿日期:2023-12-19 出版日期:2024-06-15
  • 通信作者: 魏珍

Ultrasound evaluation of diaphragmatic function in stroke tracheotomy patients and its correlation with pulmonary function

Ming Liang1, Zhen Wei2,†(), Rouzi Zu Here·1, Jinxian Li1   

  1. 1. Department of Rehabilitation Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
    2. The Center of Hypertension, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
  • Received:2023-12-19 Published:2024-06-15
  • Corresponding author: Zhen Wei
  • Supported by:
    People's Hospital of Xinjiang Uygur Autonomous Region Fund(20200102); Xinjiang Uygur Autonomous Region Natural Science Fund(2021D01C131); Autonomous Region Hygiene and Health Youth Medical Science and Technology Talents Special Fund(WJWY-202026)
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引用本文：

梁明, 魏珍, 祖合热·肉孜, 李金贤. 超声评估脑卒中气管切开患者膈肌功能与肺功能的相关性研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 133-139.

Ming Liang, Zhen Wei, Rouzi Zu Here·, Jinxian Li. Ultrasound evaluation of diaphragmatic function in stroke tracheotomy patients and its correlation with pulmonary function[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(03): 133-139.

目的

应用超声技术观察脑卒中气管切开患者膈肌的结构及运动学的特征并探究其与肺功能的相关性，评估膈肌的超声影像学参数预测肺功能的应用价值。

方法

选取新疆维吾尔自治区人民医院康复医学科自2020年1月到2023年11月收治的40例脑卒中气管切开患者为气切组，选择同期体检的40名健康受试者为对照组。所有受试者均进行肺功能评估和膈肌超声检查，评定指标包括用力肺活量（FVC）、一秒用力呼气容积（FEV1.0）、一秒率（FEV1.0/FVC比值）、呼气末膈肌厚度（EDT）、吸气末膈肌厚度（IDT）、膈肌厚度分数（DTF）和膈肌移动度。分析气切组患者的肺功能与膈肌的超声影像学参数的相关性。

结果

气切组患者的FVC、FEV1.0/FVC、EDT、IDT、DTF及膈肌移动度低于对照组，差异均有统计学意义（P<0.05）。相关性分析显示：气切组患者的EDT值（r=0.949，P<0.05）、IDT值（r=0.973，P<0.05）、DTF值（r=0.974，P<0.05）及膈肌移动度（r=0.978，P<0.05）与FVC值呈正相关；EDT值（r=0.961，P<0.05）、IDT值（r=0.971，P<0.05）、DTF值（r=0.968，P<0.05）及膈肌移动度（r=0.979，P<0.05）与FEV1.0/FVC值呈正相关。

结论

脑卒中气管切开患者膈肌的结构和功能与肺功能呈正性相关，膈肌的超声影像学参数可用来预测肺功能的状态。

关键词: 脑卒中, 气管切开, 膈肌, 超声
Objective

To explore the diaphragmatic structure and kinematic characteristic by using ultrasound and its correlation with pulmonary function in stroke tracheotomy patients and evaluate the application value of predicting pulmonary function by using ultrasonography parameters of diaphragm.

Methods

Forty patients with stroke tracheotomy admitted to the Rehabilitation Medicine Department of People's Hospital of Xinjiang Uygur Autonomous Region from January 2020 to November 2023 were selected as the tracheostomy group, and 40 healthy subjects who underwent physical examinations during the same period were selected as the control group. All subjects underwent pulmonary function assessment and diaphragmatic ultrasound examination. The forced vital capacity (FVC), forced expiratory volume in one second (FEV1.0), FEV1.0/FVC, end-expiratory diaphragm thickness (EDT), end-inspiration diaphragm thickness (IDT), diaphragm thickening fraction (DTF) and diaphragm mobility were used as outcome measures. The correlation of pulmonary function with ultrasonography parameters of diaphragm were analyzed.

Results

Compared with the control group, the tracheotomy group had significantly greater decreased on FVC, FEV1.0/FVC, EDT, IDT, DTF and diaphragm mobility (all P<0.05). The FVC were significantly positively correlated with EDT (r=0.949, P<0.05), IDT (r=0.973, P<0.05), DTF (r=0.974, P<0.05) and diaphragm mobility (r=0.978, P<0.05). The FEV1.0/FVC were significantly positively correlated with EDT (r=0.961, P<0.05), IDT (r=0.971, P<0.05), DTF (r=0.968, P<0.05) and diaphragm mobility (r=0.979, P<0.05).

Conclusion

The pulmonary function improves along with the diaphragm aticstructure and function improves in stroke tracheotomy patients. The ultrasonography parameters of diaphragm can predict the pulmonary function.

Key words: Stroke, Tracheotomy, Diaphragm, Ultrasound
表1 2组患者的一般资料比较
Tab.1 Comparison of baseline information between two groups
项目 气切组（n=40） 对照组（n=40） χ2/t值 P值
性别（男/女） 24/16 22/18 0.205 0.651
年龄（岁，Mean±SD） 59.83±5.84 60.90±4.90 0.891 0.376
身高（cm，Mean±SD） 165.63±8.55 167.03±7.27 0.789 0.432
体质量指数（kg/m2，Mean±SD） 22.32±2.88 21.62±2.48 1.175 0.244
高血压病 34 31 0.738 0.390
糖尿病 29 25 0.912 0.340
吸烟 13 10 0.549 0.459
心脏病 21 18 0.450 0.502
血氧饱和度（%，Mean±SD） 94.50±2.76 95.33±2.26 1.462 0.148
呼吸频率（次/min，Mean±SD） 17.75±1.60 18.30±1.95 1.380 0.172
心率（次/min，Mean±SD） 76.55±9.23 79.05±9.70 1.181 0.241
血红蛋白（g/L，Mean±SD） 116.90±6.88 117.18±7.31 0.173 0.863
白蛋白（g/L，Mean±SD） 33.78±4.71 35.10±3.99 1.357 0.179
图1 超声二维模式下不同呼吸相时的膈肌厚度图像A：吸气末膈肌厚度评估超声图像；B：呼气末膈肌厚度评估超声图像
Fig.1 Image of diaphragm thickness in different respiratory phase at 2D ultrasound mode
图2 平静呼吸时的膈肌移动度的图像A：超声M模式下膈肌定位解剖图；B：超声M模式下膈肌随呼吸运动的曲线图
Fig.2 Image of diaphragm mobility in eupnea
表2 2组患者的肺功能参数比较（Mean±SD）
Tab.2 Comparison of lung function parameter between two groups (Mean±SD)
组别 例数 FVC（L） FEV1.0/FVC（%）
气切组 40 1.07±0.18 73.05±8.25
对照组 40 2.60±0.37 93.35±2.44
t值   23.632 14.922
P值   <0.001 <0.001
表3 2组患者的EDT和IDT比较（mm，Mean±SD）
Tab.3 Comparison of diaphragm thickness at the end of expiration or inspiration between two groups (mm, Mean±SD)
组别 例数 EDT IDT
气切组 40 1.04±0.11 1.46±0.16
对照组 40 2.66±0.43 3.59±0.52
t值   23.012 24.616
P值   <0.001 <0.001
表4 2组患者的DTF和膈肌移动度比较（Mean±SD）
Tab.4 Comparison of diaphragm thickening fraction and diaphragm mobility between two groups (Mean±SD)
组别 例数 DTF（%） 膈肌移动度（mm）
气切组 40 14.30±1.71 8.30±1.73
对照组 40 27.68±3.62 20.10±5.32
t值   21.128 13.332
P值   <0.001 <0.001
图3 膈肌在不同状态下的厚度与用力肺活量间的相关性A：EDT值；B：IDT值；EDT：呼气末膈肌厚度；IDT：吸气末膈肌厚度；FVC：用力肺活量
Fig.3 Correlation between thickness with forced vital capacity at different state
图4 膈肌动力学参数与用力肺活量间的相关性A：DTF值；B：膈肌移动度；DTF：膈肌厚度分数；FVC：用力肺活量
Fig.4 Correlation between kinetic parameter with forced vital capacity
图5 膈肌在不同状态下的厚度与一秒率间的相关性A：EDT值；B：IDT值；EDT：呼气末膈肌厚度；IDT：吸气末膈肌厚度；FVC：用力肺活量；FEV1.0：一秒用力呼气容积
Fig.5 Correlation between thickness with FEV1.0/FVC at different state
图6 膈肌动力学参数与一秒率间的相关性A：DTF值；B：膈肌移动度；DTF：膈肌厚度分数；FVC：用力肺活量；FEV1.0：一秒用力呼气容积
Fig.6 Correlation between kinetic parameter with FEV1.0/FVC
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