Analysis of Diaphragmatic Function and the Related Factors in Stroke Patients

doi:10.3969/j.issn.1673-5765.2022.06.004

Abstract

Abstract:

Objective To analyze the changes of diaphragm function with the correlation of diaphragm function with stroke duration, swallowing function, respiratory function, extremity motor function, balance function and daily living ability in stroke patients with hemiplegia.

Methods This prospective study enrolled the consecutive patients and unilateral hemiplegia after first stroke. The following data were recorded, including general demographic information, water swallow test (WST) score, subjective respiratory dysfunction scale, Fugl-Meyer motor function assessment (FMA) scale, Berg balance scale (BBS), modified Barthel index (mBI). Diaphragmatic function was measured by ultrasound, including diaphragmatic mobility and during quiet and deep breathing and diaphragm thickening fraction (DTF). The diaphragm function of the hemiplegia and healthy sides among the total patients and different unilateral hemiplegia patients, and between right and left hemiplegia patients were compared. The correlation of diaphragm function of the hemiplegia side with stroke duration, WST score, subjective respiratory dysfunction scale, FMA, BBS, and mBI were analyzed.

Results A total of 45 stroke patients were included in the study, with 27 (60.00%) left hemiplegia and 18 (40.00%) right hemiplegia patients. Under deep breathing, for the total patients, the diaphragm mobility (31.69±15.18 mm vs. 40.24±14.66 mm, P<0.001) and DTF (34.99%±23.70% vs. 48.13%±21.98%, P<0.001) of the hemiplegia side were lower than those of the healthy side; for unilateral hemiplegia patients, the diaphragm mobility (30.13±12.64 mm vs. 44.10±12.95 mm, P<0.001) and the DTF (41.20%±23.42% vs. 54.63%±21.08%, P=0.004) of the hemiplegia side were lower than those of the healthy side in left hemiplegia patients, the DTF of the hemiplegia side (25.67%±21.47% vs. 38.37%±20.07%, P=0.005) was lower than that of the healthy side in right hemiplegia patients. Under deep breathing, the DTF of the hemiplegic side in right hemiplegia patients was lower than that in left hemiplegia patients (P=0.029), the diaphragmatic activity (P=0.028) and DTF (P=0.012) in right hemiplegia patients were lower than those in left hemiplegia patients. Under quiet breathing, the diaphragm mobility of the hemiplegia side was positively correlated with the FMA (r=0.362, P=0.015); under deep breathing, the diaphragm mobility of the hemiplegia side was positively correlated with the WST score (r=0.298, P=0.047), subjective respiratory dysfunction scale score (r=0.437, P=0.003), FMA (r=0.330, P=0.027), BBS (r=0.370, P=0.012), mBI (r=0.321, P=0.031), and the DTF of the hemiplegia side was negatively correlated with stroke duration (r=-0.298, P=0.047).

Conclusions The diaphragm function of the hemiplegia side after stroke was lower than that of the healthy side. The bilateral diaphragm function in right hemiplegia patients were worse than that in left hemiplegia patients. Diaphragmatic function in stroke patients was negatively correlated with stroke duration, and positively correlated with swallowing function, respiratory function, extremity motor function, balance function and daily living ability.

Key words: Stroke; Hemiplegia; Diaphragm function; Swallowing; Respiratory function;Extremity motor; Balance function; Daily living ability

摘要： 目的分析卒中后偏瘫患者的膈肌功能，并探讨其与卒中病程以及吞咽、呼吸、运动、平衡功能和日常生活能力的相关性。方法本研究为前瞻性研究，连续纳入首次卒中后单侧偏瘫的患者，记录患者的一般资料，洼田饮水试验、主观呼吸功能障碍程度量表、Fugl-Meyer运动功能评定量表（Fugl-Meyer motor function assessment scale，FMA）、Berg平衡量表（Berg balance scale，BBS）、改良Barthel指数（modified Barthel index，mBI）。采用超声测定膈肌功能，包括平静呼吸时的膈肌活动度以及用力呼吸状态下的膈肌活动度和膈肌增厚率。比较整体和不同瘫痪侧患者偏瘫侧和健侧的膈肌功能，分别比较左侧偏瘫和右侧偏瘫患侧的膈肌功能和健侧的膈肌功能。分析瘫痪侧的膈肌功能与病程、洼田饮水试验、主呼吸功能障碍程度量表、FMA、BBS、mBI等指标的相关性结果研究共纳入45例卒中患者，其中左侧偏瘫27例（60.00%），右侧偏瘫18例（40.00%）。在整体患者中，用力呼吸状态下，偏瘫侧膈肌活动度（31.69±15.18 mm vs. 40.24±14.66 mm，P＜0.001）及膈肌增厚率（34.99%±23.70% vs. 48.13%±21.98%，P＜0.001）低于健侧。用力呼吸状态下，左侧偏瘫患者的偏瘫侧膈肌活动度（30.13±12.64 mm vs. 44.10±12.95 mm，P＜0.001）和膈肌增厚率（41.20%±23.42% vs. 54.63%±21.08%，P =0.004）较健侧低；右侧偏瘫患者的偏瘫侧膈肌增厚率（25.67%±21.47% vs. 38.37%±20.07%，P =0.005）较健侧低。用力呼吸状态下，右侧偏瘫患者的偏瘫侧膈肌增厚率低于左侧偏瘫患者（P =0.029）。右侧偏瘫患者的健侧膈肌活动度（P =0.028）及膈肌增厚率低于左侧偏瘫患者（P =0.012）。卒中患者平静呼吸状态下，偏瘫侧膈肌活动度与FMA（r =0.362，P =0.015）呈正相关；用力呼吸状态下，偏瘫侧膈肌活动度与洼田饮水试验（r =0.298，P =0.047）、主观呼吸功能障碍程度量表（r =0.437，P =0.003）、FMA（r =0.330，P =0.027）、BBS（r =0.370，P =0.012）、mBI（r =0.321，P =0.031）呈正相关，偏瘫侧膈肌增厚率与病程（r =-0.298，P =0.047）呈负相关。结论卒中后偏瘫侧膈肌功能较健侧下降，右侧偏瘫患者双侧膈肌功能较左侧偏瘫患者更差。卒中患者膈肌功能与病程呈负相关，与吞咽功能、呼吸功能、肢体运动功能、平衡能力及日常生活能力呈正相关。

关键词: 卒中; 偏瘫; 膈肌功能; 吞咽; 呼吸; 运动; 平衡; 日常生活能力

LIU Xiaoman, YANG Ying, QU Qingming, DENG Panmo, ZHAO Yuehua, LIU Chenghong, JIA Jie. Analysis of Diaphragmatic Function and the Related Factors in Stroke Patients[J]. Chinese Journal of Stroke, 2022, 17(06): 579-584.

刘小曼, 杨颖, 曲庆明, 邓盼墨, 赵月华, 刘承弘, 贾杰. 卒中后膈肌功能及相关因素分析[J]. 中国卒中杂志, 2022, 17(06): 579-584.

References

[1]KIM C Y，LEE J S，KIM H D，et al. Effects of the combination of respiratory muscle training and abdominal drawing-in maneuver on respiratory muscle activity in patients with post-stroke hemiplegia：a pilot randomized controlled trial[J]. Top Stroke Rehabil，2015，22（4）：262-270.

[2]MCCOOL F D，TZELEPIS G E. Dysfunction of the diaphragm[J]. N Engl J Med，2012，8，366（10）：932-942.

[3]KıLıÇOĞLU M S，YURDAKUL O V，ÇELIK Y，et al. Investigating the correlation between pulmonary function tests and ultrasonographic diaphragm measurements and the effects of respiratory exercises on these parameters in hemiplegic patients[J]. Top Stroke Rehabil，2022，29（3）：218-229.

[4]黄秋霞，林宁，张慧珍，等. 超声评价慢性阻塞性肺疾病患者膈肌运动异常[J]. 中国医学影像技术，2019，35（10）：1513-1516.

[5]李明秋，郭瑞君，张谱，等. M型超声观察膈肌运动与肺功能的相关性研究[J]. 首都医科大学学报，2014，35（2）：189-193.

[6]SFERRAZZA PAPA G F，PELLEGRINO G M，DI MARCO F，et al. A review of the ultrasound assessment of diaphragmatic function in clinical practice[J]. Respiration，2016，91（5）：403-411.

[7]中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志，2019，52（9）：710-715.

[8]VOYVODA N，YÜCEL C，KARATAS G，et al. An evaluation of diaphragmatic movements in hemiplegic patients[J]. Br J Radiol，2012，85（1012）：411-414.

[9]丁东杰. 呼吸中枢与呼吸调节[J]. 中华结核和呼吸杂志，2000，23（9）：14-17.

[10] COHEN E，MIER A，HEYWOOD P，et al. Diaphragmatic movement in hemiplegic patients measured by ultrasonography[J]. Thorax，1994，49（9）：890-895.

[11] GOTTESMAN E，MCCOOL F D. Ultrasound evaluation of the paralyzed diaphragm[J]. Am J Respir Crit Care Med，1997，155（5）：1570-1574.

[12] CATALÁ-RIPOLL J V，MONSALVE-NAHARRO J Á，HERNÁNDEZ-FERNÁNDEZ F. Incidence and predictive factors of diaphragmatic dysfunction in acute stroke[J/OL]. BMC Neurol，2020，20（1）：79[2022-05-10]. https://doi.org/10.1186/s12883-020-01664-w.

[13] JUNG K J，PARK J Y，HWANG D W，et al. Ultrasonographic diaphragmatic motion analysis and its correlation with pulmonary function in hemiplegic stroke patients[J]. Ann Rehabil Med，2014，38（1）：29-37.

[14] SIMILOWSKI T，CATALA M，RANCUREL G，et al. Impairment of central motor conduction to the diaphragm in stroke[J]. Am J Respir Crit Care Med，1996，154（2）：436-441.

[15] YUN R Y，PARK H E，HONG J W，et al. Correlation of swallowing function with bilateral diaphragmatic movement in hemiplegic stroke patients[J]. Ann Rehabil Med，2019，43（2）：156-162.

[16] 杨延辉，肖建华，田亚峰，等. 肺功能训练结合作业治疗对脑卒中患者上肢运动功能的影响[J]. 中华物理医学与康复杂志，2020，42（10）：924-926.

[17] 刘建华，董继革，黄宝靓. 心肺康复对脑卒中患者运动功能恢复的效果[J]. 中国康复理论与实践，2019，25（11）：1342-1347.