体外膈肌起搏与重复外周磁刺激对脑梗死患者膈肌功能的影响研究

doi:10.3969/j.issn.1673-5765.2026.02.003

中国卒中杂志 ›› 2026, Vol. 21 ›› Issue (2): 145-153.DOI: 10.3969/j.issn.1673-5765.2026.02.003

体外膈肌起搏与重复外周磁刺激对脑梗死患者膈肌功能的影响研究

蔡虹菲¹，付艳鑫²，王骁²，蔡阗暄²，蔡苗苗²，靳沙沙³，武亮²

1成都 611130 成都市第五人民医院神经内科
2北京 100144 北京大学首钢医院康复医学科
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:2026-02-05 接受日期:2026-02-15 出版日期:2026-02-20 发布日期:2026-02-20
通讯作者: 靳沙沙 jinshasha2007@126.com 武亮 wuliang1972@sina.com
基金资助:
科技创新2030-“脑科学与类脑研究”重大项目

Effects of External Diaphragm Pacing and Repetitive Peripheral Magnetic Stimulation on Diaphragmatic Function in Patients with Cerebral Infarction

CAI Hongfei¹, FU Yanxin², WANG Xiao², CAI Tianxuan², CAI Miaomiao², JIN Shasha³, WU Liang²

1Department of Neurology, Chengdu Fifth People’s Hospital, Chengdu 611130, China
2Department of Rehabilitation Medicine, Peking University Shougang Hospital, Beijing 100144, China
3Department of Sports Rehabilitation, Beijing Xiaotangshan Hospital, Beijing 102211, China

Received:2025-10-29 Revised:2026-02-05 Accepted:2026-02-15 Online:2026-02-20 Published:2026-02-20
Contact: JIN Shasha, E-mail: jinshasha2007@126.com WU Liang, E-mail: wuliang1972@sina.com

摘要/Abstract

摘要： 目的对比呼吸训练、体外膈肌起搏（external diaphragm pacing，EDP）和重复外周磁刺激（repetitive peripheral magnetic stimulation，rPMS）对脑梗死患者膈肌功能的影响，评估EDP与rPMS的临床疗效，为脑梗死后膈肌功能障碍的临床康复干预提供参考依据。
方法连续纳入2022年1—12月于北京小汤山医院运动康复科住院的脑梗死患者，并随机分为对照组、EDP组与rPMS组。对照组予呼吸训练，EDP组于膈神经表浅处行EDP治疗，rPMS组于C7棘突处施加高频磁刺激；3组的干预方案均为每次20 min，每日1次，每周5次，持续4周。观察并比较3组患者干预前、后膈肌厚度、膈肌移动度（diaphragm mobility，DM）、膈神经运动传导、静态肺功能、胸廓活动度及Sheikh躯干控制测试（trunk control test，TCT）的变化，分析3种干预方式对患者膈肌各项指标的影响。
结果共纳入36例脑梗死患者，每组12例。干预期间共脱落4例，其中对照组、rPMS组各脱落1例，EDP组脱落2例，最终共32例患者完成全部研究流程。组内比较显示，与干预前相比，3组干预后的吸气末膈肌厚度（diaphragm thickness at the end of inspiration，TEI）、膈肌厚度分数（diaphragm thickening fraction，DTF）、DM、复合肌肉动作电位（compound muscle action potential，CMAP）波幅、用力肺活量（forced vital capacity，FVC）、第1秒用力呼气容积（forced expiratory volume in first second，FEV1）、一秒率、呼气流量峰值（peak expiratory flow，PEF）、胸廓活动度及TCT均升高，膈神经传导时间（phrenic nerve conduction time，PNCT）缩短，差异均具有统计学意义（均P<0.05）；呼气末膈肌厚度（diaphragm thickness at the end of expiration，TEE）的变化无统计学意义。组间比较显示，干预后EDP组、rPMS组在DTF、DM、FVC、FEV1、PEF、胸廓活动度、TCT及PNCT等方面的改善效果方面均优于对照组（均P<0.05）；rPMS组在缩短PNCT（P=0.017）及升高一秒率（P=0.008）方面的效果优于EDP组；干预后TEI、CMAP波幅的差异均无统计学意义。
结论呼吸训练、EDP及rPMS均能改善脑梗死患者的膈肌功能，EDP与rPMS对脑梗死后膈肌功能障碍的康复疗效优于呼吸训练，其中rPMS在促进脑梗死患者膈神经运动传导功能恢复方面更具优势。

文章导读： 本研究对比体外膈肌起搏与重复外周磁刺激对脑梗死患者膈肌功能的改善效果，为脑梗死后的临床呼吸康复治疗提供了新的干预方案选择。

关键词: 脑梗死; 体外膈肌起搏; 重复外周磁刺激; 膈肌

Abstract: Objective To compare the effects of respiratory training, external diaphragm pacing (EDP), and repetitive peripheral magnetic stimulation (rPMS) on diaphragmatic function in patients with cerebral infarction, evaluate the clinical efficacy of EDP and rPMS, and provide a reference for clinical application intervention of diaphragmatic dysfunction after cerebral infarction.
Methods Patients with cerebral infarction admitted to the Department of Sports Rehabilitation, Beijing Xiaotangshan Hospital from January to December 2022 were consecutively enrolled and randomly divided into a control group, an EDP group, and an rPMS group. The control group received respiratory training, the EDP group received EDP at the superficial position of the phrenic nerve, and the rPMS group received high-frequency magnetic stimulation at the spinous process of C7. The intervention protocol for all three groups was 20 minutes per session, once a day, five days a week for four consecutive weeks. The changes in diaphragm thickness, diaphragm mobility (DM), phrenic nerve motor conduction, static pulmonary function, thoracic mobility, and Sheikh trunk control test (TCT) of the three groups were observed and compared before and after intervention. The effects of the three intervention methods on various diaphragmatic indexes were analyzed.
Results A total of 36 patients with cerebral infarction were enrolled, with 12 cases in each group. Four patients dropped out during the intervention, including one case in both the control group and the rPMS group, and two cases in the EDP group. Finally, 32 patients completed the entire research process. Intragroup comparison showed that after intervention, the diaphragm thickness at the end of inspiration (TEI), diaphragm thickening fraction (DTF), DM, compound muscle action potential (CMAP) amplitude, forced vital capacity (FVC), forced expiratory volume in first second (FEV1), FEV1/FVC, peak expiratory flow (PEF), thoracic mobility, and TCT were significantly higher in the three groups, while the phrenic nerve conduction time (PNCT) was significantly shorter in the three groups compared with those before intervention (all P<0.05). There was no significant change in diaphragm thickness at the end of expiration (TEE). Intergroup comparison showed that after intervention, the DTF, DM, FVC, FEV1, PEF, thoracic mobility, TCT, and the improvement in PNCT in the EDP group and the rPMS group were significantly better than those in the control group (all P<0.05). The rPMS group had better effects in shortening PNCT (P=0.017) and increasing FEV1/FVC (P=0.008) than the EDP group. There were no significant differences in TEI and CMAP amplitude among the three groups after intervention by multiple comparison.
Conclusions Respiratory training, EDP, and rPMS can all improve diaphragmatic function in patients with cerebral infarction. EDP and rPMS have better rehabilitation efficacy on diaphragmatic dysfunction after cerebral infarction than respiratory training, and rPMS has more advantages in promoting the recovery of phrenic nerve motor conduction function in patients with cerebral infarction.

Key words: Cerebral infarction; External diaphragm pacing; Repetitive peripheral magnetic stimulation; Diaphragm

中图分类号:

蔡虹菲, 付艳鑫, 王骁, 蔡阗暄, 蔡苗苗, 靳沙沙, 武亮. 体外膈肌起搏与重复外周磁刺激对脑梗死患者膈肌功能的影响研究[J]. 中国卒中杂志, 2026, 21(2): 145-153.

CAI Hongfei, FU Yanxin, WANG Xiao, CAI Tianxuan, CAI Miaomiao, JIN Shasha, WU Liang. Effects of External Diaphragm Pacing and Repetitive Peripheral Magnetic Stimulation on Diaphragmatic Function in Patients with Cerebral Infarction[J]. Chinese Journal of Stroke, 2026, 21(2): 145-153.

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体外膈肌起搏与重复外周磁刺激对脑梗死患者膈肌功能的影响研究

Effects of External Diaphragm Pacing and Repetitive Peripheral Magnetic Stimulation on Diaphragmatic Function in Patients with Cerebral Infarction

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