吸气肌训练联合体外膈肌起搏对老年慢性心衰患者的疗效

doi:10.3969/j.issn.1006-5725.2025.13.010

Abstract

Abstract:

Objective To investigate the therapeutic efficacy of inspiratory muscle training （IMT） combined with external diaphragm pacing （EDP） in elderly patients with chronic heart failure （CHF）. Methods 147 patients with CHF admitted to the Department of Cardiology of the Second Affiliated Hospital of Xi'an Jiaotong University from March 2024 to October 2024 were selected， of which 38 patients were in the conventional drug therapy group （standard care group）， 52 patients were in the conventional drug therapy + EDP therapy （dual therapy group）， and 57 patients were in the conventional drug therapy + EDP therapy + IMT therapy （triple therapy group）. Comparative analyses were performed for maximum inspiratory pressure （MIP）， maximum expiratory pressure （MEP）， handgrip strength， 6-minute walk distance （6MWD）， modified Medical Research Council （mMRC） scores， resting heart rate， and blood pressure before treatment and 4 weeks post-intervention. Results After treatment， The dual therapy group demonstrated higher MIP， 6MWD， and lower mMRC scores than the standard care group （P < 0.05）. The triple therapy group exhibited superior improvements in MIP， MEP， handgrip strength， 6MWD， and lower mMRC scores compared to both standard care and dual therapy groups （P < 0.05）， with additional benefits including lower resting systolic blood pressure versus dual therapy group （P < 0.05） and reduced resting heart rate compared to standard care group （P < 0.05）. Conclusion The combined IMT and EDP significantly enhances respiratory and upper limb muscle strength in CHF patients， effectively improves cardiopulmonary function， alleviates dyspnea， and reduces resting heart rate and blood pressure，thus improving the quality of life.It is worthy of clinical promotion and application.

Key words: elderly chronic heart failure, inspiratory muscle training, external diaphragm pacing, inspiratory muscle weakness, respiratory muscle function

CLC Number:

R541.6

Su LIU,Tengfei JI,Dan LIU,Juanli ZHANG,Hong WEN,Li LI,Shuguang QIN. Efficacy of inspiratory muscle training combined with external diaphragm pacing in elderly patients with chronic heart failure[J]. The Journal of Practical Medicine, 2025, 41(13): 2011-2017.

Figures/Tables 6

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References 38

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项目	常规组（n = 38）	双联治疗组（n = 52）	三联治疗组（n = 57）	F/H/χ²值	P值
性别（女/男）/例	16/22	21/31	18/39	1.382	0.501
年龄（x ± s）/岁	72.55 ± 7.98	72.19 ± 9.58	72.35 ± 7.56	0.020	0.980
体质量指数（x ± s）/（kg/m²）	23.84 ± 2.87	23.74 ± 3.64	23.52 ± 3.44	0.120	0.887
NYHA分级（Ⅲ/Ⅳ级）/例	26/12	40/12	41/16	0.836	0.658
左室射血分数［M（P₂₅，P₇₅ ）］/%	58.50（52.75，66.50）	62.00（45.75，67.25）	57.00（41.00，64.00）	3.695	0.158
左室舒张末期内径［M（P₂₅，P₇₅ ）］/mm	50.00（46.00，58.00）	53.50（47.00，59.00）	53.00（48.00，59.00）	3.250	0.197
氨基末端脑利钠肽前体［M（P₂₅，P₇₅ ）］/（pg/mL）	895.00（450.75，2 429.25）	1 324.50（608.75，3 200.50）	1 532.00（568.00，3 708.00）	1.584	0.453
合并疾病［例（%）］				4.897	0.769
缺血性心肌病	4（10.53）	5（9.62）	9（15.79）
扩张型心肌病	3（7.89）	10（19.23）	8（14.04）
冠心病	27（71.05）	40（76.92）	43（75.44）
高血压	25（65.79）	34（65.38）	27（47.37）
糖尿病	11（28.95）	15（28.85）	19（33.33）

组别	例数	MIP		MEP
组别	例数	治疗前	治疗后	治疗前	治疗后
常规组	38	45.24 ± 17.39	46.57 ± 17.46^abc	63.73 ± 19.20	67.26 ± 20.09^ab
双联治疗组	52	47.33 ± 21.86	54.79 ± 21.51^ab	66.69 ± 27.44	73.35 ± 27.05^ab
三联治疗组	57	45.32 ± 17.79	62.12 ± 18.22^a	66.33 ± 27.19	83.04 ± 26.92^a
F值		0.189	7.484	0.169	4.700
P值		0.828	< 0.001	0.845	0.011

组别	例数	左侧握力		右侧握力
组别	例数	治疗前	治疗后	治疗前	治疗后
常规组	38	19.11 ± 8.12	19.80 ± 8.04^ab	20.92 ± 7.94	21.61 ± 7.86^ab
双联治疗组	52	18.28 ± 7.44	19.36 ± 7.64^ab	20.40 ± 7.60	21.99 ± 8.18^ab
三联治疗组	57	20.12 ± 7.43	23.68 ± 7.32^a	22.21 ± 8.15	26.38 ± 8.27^a
F值		0.803	5.163	0.754	5.483
P值		0.450	0.007	0.472	0.005

组别	例数	6MWD（x ± s）/m		mMRC量表［M（P₂₅，P₇₅ ）］/分
组别	例数	治疗前	治疗后	治疗前	治疗后
常规组	38	272.47 ± 45.14	298.05 ± 41.74^abc	3.00（2.25，3.00）	2.00（2.00，2.75）^abc
双联治疗组	52	286.85 ± 52.21	323.85 ± 53.32^ab	3.00（2.00，3.25）	2.00（1.00，2.00）^ab
三联治疗组	57	284.33 ± 50.46	346.53 ± 50.43^a	3.00（2.00，3.00）	1.00（1.00，2.00）^a
F/H值		1.004	11.037	1.263	31.143
P值		0.369	< 0.001	0.532	< 0.001

组别	例数	收缩压		舒张压
组别	例数	治疗前	治疗后	治疗前	治疗后
常规组	38	128.79 ± 19.69	122.55 ± 17.37^a	80.24 ± 13.54	75.26 ± 9.52^a
双联治疗组	52	135.96 ± 14.61	124.75 ± 16.57^ab	76.96 ± 11.28	72.63 ± 11.09^a
三联治疗组	57	134.70 ± 18.34	116.98 ± 14.18^a	78.05 ± 11.32	71.46 ± 8.71^a
F值		2.023	3.437	0.840	1.736
P值		0.136	0.035	0.434	0.180

Efficacy of inspiratory muscle training combined with external diaphragm pacing in elderly patients with chronic heart failure

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组别	例数	心率
组别	例数	治疗前	治疗后
常规组	38	80.42 ± 13.69	75.79 ± 11.15^ab
双联治疗组	52	77.77 ± 15.23	72.13 ± 9.63^a
三联治疗组	57	80.05 ± 13.74	69.61 ± 8.25^a
F值		0.495	4.764
P值		0.611	0.010