不同类型人工辅助咳嗽技术对脑干卒中患者咳嗽功能的影响

doi:10.3969/j.issn.1673-5765.2026.02.002

中国卒中杂志 ›› 2026, Vol. 21 ›› Issue (2): 137-144.DOI: 10.3969/j.issn.1673-5765.2026.02.002

不同类型人工辅助咳嗽技术对脑干卒中患者咳嗽功能的影响

王骁^1*，贾高婷^2*，付艳鑫¹，蔡阗暄¹，蔡苗苗¹，靳沙沙³，张华¹，武亮¹（*第一作者）

1北京 100144 北京大学首钢医院康复医学科
2保定 071702 雄安宣武医院康复医学科
3北京 102211 北京小汤山医院运动康复科

收稿日期:2025-10-29 修回日期:2026-01-30 接受日期:2026-02-10 出版日期:2026-02-20 发布日期:2026-02-20
通讯作者: 武亮 wuliang1972@sina.com
基金资助:
首都卫生发展科研专项（首发2020-2-2201）

Effects of Different Manually Assisted Coughing Techniques on Cough Function in Patients with Brainstem Stroke

WANG Xiao^1*, JIA Gaoting^2*, FU Yanxin¹, CAI Tianxuan¹, CAI Miaomiao¹, JIN Shasha³, ZHANG Hua¹, WU Liang¹ (*contributed equally)

1Department of Rehabilitation Medicine, Peking University Shougang Hospital, Beijing 100144, China
2Department of Rehabilitation Medicine, Xiongan Xuanwu Hospital, Baoding 071702, China
3Department of Sports Rehabilitation, Beijing Xiaotangshan Hospital, Beijing 102211, China

Received:2025-10-29 Revised:2026-01-30 Accepted:2026-02-10 Online:2026-02-20 Published:2026-02-20
Contact: WU Liang, E-mail: wuliang1972@sina.com

摘要/Abstract

摘要： 目的探讨不同类型人工辅助咳嗽（manually assisted coughing，MAC）技术对脑干卒中患者咳嗽功能、痰液清除能力及肺功能的影响，为卒中后咳嗽功能障碍的康复干预提供临床依据。
方法采用前瞻性随机对照设计，连续纳入2023年5月—2024年5月于北京小汤山医院运动康复科住院的脑干卒中患者，将其随机分为膈肌刺激组、气管刺激组和舌根刺激组。3组患者均接受常规康复治疗及呼吸训练，在此基础上，各组分别接受膈肌刺激、气管刺激或舌根刺激干预，每日2次，每次30 min，每周5 d，持续2周。干预前、后采用便携式肺功能检测仪测量峰值咳嗽流量（peak cough flow，PCF），检测24 h痰液量，通过运动心肺功能测试系统检测用力肺活量（forced vital capacity，FVC）、第1秒用力呼气容积（forced expiratory volume in one second，FEV1）、呼气流量峰值（peak expiratory flow，PEF）等静态肺功能指标，并使用超声评估吸气末膈肌厚度（diaphragm thickness at the end of inspiration，TEI）、呼气末膈肌厚度（diaphragm thickness at the end of expiration，TEE）、膈肌厚度分数（diaphragm thickness fraction，DTF）、膈肌移动度（diaphragmatic mobility，DM）等膈肌参数。记录干预后肺炎发生率。
结果共纳入33例脑干卒中患者，每组11例。干预后，3组患者的PCF、FVC、FEV1、PEF、TEI、TEE及DTF较干预前均显著提高（均P＜0.05），24 h痰液量显著降低（P＜0.05）。干预后组间两两比较显示，舌根刺激组的24 h痰液量改善效果优于膈肌刺激组[（35.64±10.71）mL vs.（46.09±9.52）mL，P=0.025]；舌根刺激组与气管刺激组的FVC、FEV1、PEF均优于膈肌刺激组（均P<0.05）。干预后3组在PCF、TEI、TEE、DTF等方面的差异均无统计学意义。干预后膈肌刺激组的肺炎发生率为36.4%，气管刺激组为18.2%，舌根刺激组为9.1%，组间差异无统计学意义（P=0.439）。
结论膈肌刺激、气管刺激和舌根刺激3种MAC技术均可有效改善脑干卒中患者的咳嗽功能、肺功能及痰液清除能力，其中舌根刺激在诱发咳嗽反射和改善排痰方面的效果更佳。

文章导读： 本研究以精准评估为导向，结合多种人工辅助咳嗽技术协同实施个体化呼吸康复策略，强化咳嗽反射通路干预并促进呼吸肌功能重塑，有助于推动脑干卒中患者咳嗽功能障碍的规范化、系统化康复管理，为临床实践提供有效且安全的非药物干预新路径。

关键词: 脑干卒中; 人工辅助咳嗽; 咳嗽反射; 肺功能; 康复治疗

Abstract: Objective To investigate the effects of different manually assisted coughing (MAC) techniques on cough function, sputum clearance ability, and pulmonary function in patients with brainstem stroke, and to provide clinical evidence for the rehabilitation intervention of post-stroke cough dysfunction.
Methods A prospective randomized controlled design was used. Patients with brainstem stroke who were hospitalized at the Department of Sports Rehabilitation, Beijing Xiaotangshan Hospital from May 2023 to May 2024 were consecutively enrolled and randomly divided into the diaphragmatic stimulation group, the tracheal stimulation group, and the tongue root stimulation group. All three groups received routine rehabilitation therapy and respiratory training. On this basis, each group received diaphragm stimulation, tracheal stimulation, or tongue root stimulation, respectively. The intervention was performed twice daily, 30 minutes per session, 5 days per week for 2 consecutive weeks. Before and after intervention, peak cough flow (PCF) was measured using a pulmonary function tester, and 24-hour sputum volume was recorded. Static pulmonary function indices, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow (PEF), were tested using a cardiopulmonary exercise testing system. Ultrasonic examination was used to evaluate diaphragmatic parameters, including diaphragm thickness at end of inspiration (TEI), diaphragm thickness at end of expiration (TEE), diaphragm thickness fraction (DTF), and diaphragmatic mobility (DM). The incidence of pneumonia after intervention was recorded.
Results A total of 33 patients with brainstem stroke were enrolled, with 11 patients in each group. After intervention, PCF, FVC, FEV1, PEF, TEI, TEE, and DTF were significantly increased, and 24-hour sputum volume was significantly decreased in all three groups compared with those before intervention (P<0.05). Pairwise comparisons between groups after intervention showed that the tongue root stimulation group achieved greater improvement in 24-hour sputum volume than the diaphragmatic stimulation group [(35.64±10.71) mL vs. (46.09±9.52) mL, P=0.025]. FVC, FEV1, and PEF in the tongue root stimulation group and the tracheal stimulation group were better than those in the diaphragmatic stimulation group (all P<0.05). There were no statistically significant differences in PCF, TEI, TEE, and DTF among the three groups after intervention. The incidence of pneumonia after intervention was 36.4% in the diaphragmatic stimulation group, 18.2% in the tracheal stimulation group, and 9.1% in the tongue root stimulation group, with no statistically significant difference among groups (P=0.439).
Conclusions Diaphragmatic stimulation, tracheal stimulation, and tongue root stimulation— three MAC techniques—all effectively improve cough function, pulmonary function, and sputum clearance in patients with brainstem stroke. Tongue root stimulation yields superior effects in eliciting cough reflex and promoting sputum excretion.

Key words: Brainstem stroke; Manually assisted coughing; Reflex cough; Pulmonary function; Rehabilitation therapy

中图分类号:

王骁, 贾高婷, 付艳鑫, 蔡阗暄, 蔡苗苗, 靳沙沙, 张华, 武亮. 不同类型人工辅助咳嗽技术对脑干卒中患者咳嗽功能的影响[J]. 中国卒中杂志, 2026, 21(2): 137-144.

WANG Xiao, JIA Gaoting, FU Yanxin, CAI Tianxuan, CAI Miaomiao, JIN Shasha, ZHANG Hua, WU Liang. Effects of Different Manually Assisted Coughing Techniques on Cough Function in Patients with Brainstem Stroke[J]. Chinese Journal of Stroke, 2026, 21(2): 137-144.

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不同类型人工辅助咳嗽技术对脑干卒中患者咳嗽功能的影响

Effects of Different Manually Assisted Coughing Techniques on Cough Function in Patients with Brainstem Stroke

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