- 期刊
高位頸髓損傷患者呼吸肌訓練的效果：個案報告
Effect of Respiratory Muscle Training on Respiratory Functions Following High Cervical Cord Injury: Report of a Case
摘要
肺炎及呼吸衰竭是頸髓損傷患者常見的併發症合併，呼吸肌的訓練被認為是可能改善呼吸肌或肺功能的有效方式。本篇報告高位頸髓損傷，半邊橫膈膜輕癱(hemiparesis)之呼吸肌訓練的效果。患者是一位27歲男性頸髓第三節以下受損的四肢麻痺患者(C3 complete quadriplegia)，於民國80年9月19日車禍受傷，於81年1月21日病情穩定，開始接受呼吸肌的訓練。理學檢查為頸髓C5以下感覺完全喪失，全身肌肉除頭頸及上肩部可動（肌力接近正常）外，其餘皆不會動（肌力測試為零分）。X光片顯示右半邊橫膈膜的呼吸位移僅1.2公分，左半邊為5公分。神經節(neurological level)判斷確定為頸髓第3節(C3)。呼吸肌的訓練包括：(l)方式：利用阻力負荷呼吸肌訓練器(resistor, Model DHD); (2)強度：以最大吸氣壓和最大呼氣壓的70%分別為吸吐的阻力；(3)頻率：每次5~8分，每天六次，一星期七天；(4)訓練週期：一個月。訓練前後的評估，包括：(l)肺功能檢查；(2)呼吸肌肌力評估；(3)呼吸肌耐力評估；(4)胸廓活動度測量。訓練結果顯示：(l)肺活量由1.87增加為1.96升，第一秒最大吐氣量由1.45增加為1.51升；(2)最大吸氣壓由68增為78cm H2O，最大吐氣壓由22增為25cm H2O；(3)吸氣耐力時間向1.5增為2.0分，呼氣耐力時間由2.4增為2.8分；(4)胸廓活動於路易斯角(Louis angle)由1公分增為1.6公分位移，在肚臍位移由3公分增為4.5公分。而阻力負荷吸氣時，橫膈膜肌電圖頻率增加，表示殘存肌肉神經運動單位元的參與增加。以上結果表示阻力負荷呼吸對高頸位損傷者，有其正面效果。
並列摘要
Present paper reports the respiratory muscle training effect on high cervical lesioned subject with right diaphragmatic hemiparesis. A 27 years old male C3 complete quadriplegia who injured on 80-9-19 due to a motor-vehicle accident The respiratory muscle training program was started on 81-1-21. Physical examination showed anesthesia below C5, zero muscel power of all the skeletal muscles except head, neck and suprascapular region, and the neurological level was C3. X-ray showed 1.2cm descent of R't diaphragm and 5.0cm descent of L't diaphragm during maximal inspiration. The respiratory muscle training program included: (1) mode: resistor(Model DHD); (2)intensity: 70% maximal inspiratory pressure(PImax) and maximal expiratory pressure(PEmax)for inspiration and expiration, respectively; (3)5-8 minutes/time an& 6 times/day for inspiration and expiration separately; (4)duration:7 days/week and for 4 weeks; (5) protocol: inhale and exhale through resistor intermittently. The evaluation performed before and after training included: (1)pulmonary function test; (2)respiratory muscle strength assessment by pressure meter(Boehringer)to obtain PImax and PEmax; (3)respiratory muscle endurance assessment by measuring the endurance time;(4)chest mobility measurement by the tape at the level of Louis angle, xyphoid process and umbilicus, The training effects were: (1)Vital capacity increased from 1.87 to 1.96 L and FEV1 increased from 1.45 to 1.51L; (2)PImax increased from 68 to 78 cmH2O and PEmax increased from 22 to 25 cmH2O; (3)Inspiratory endurance time increased from 1.5 to 2.0 minutes and expiratory endurance time increased from 2.4 to 2.8 minutes; (4)the circumference deviation at Louis angle increased from 1.0 to 1.6cm and the circumference deviation at umbilicus increased from 3.0 to 4.5cm. The enhanced EMG activity of diaphragm during resistive breathing indicated the recruitment of diaphragmatic motor unit. The results of present study suggests that resistive breathing has positive effect on respiration in high cervical cord lesioned patients.