Posterolateral Surface Electrical Stimulation of Abdominal Expiratory Muscles to Enhance Cough in Spinal Cord Injury
Posterolateral Surface Electrical Stimulation of Abdominal Expiratory Muscles to Enhance Cough in Spinal Cord Injury
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DOI：
10.1177/1545968310378509
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发表时间：
2011-02-01
影响因子：
4.2
通讯作者：
Gandevia, Simon C.
中科院分区：
文献类型：
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作者：
Butler, Jane E.;Lim, Julianne;Gandevia, Simon C.
背景脊髓损伤（SCI）患者由于腹部肌肉无力和麻痹而具有呼吸系统并发症，这损害了咳嗽的能力。Objective.本研究旨在通过2对后外侧放置的电极使用腹部肌肉的表面电刺激来增强高水平SCI受试者（n = 11，SCI在T6或以上）的咳嗽。方法.从总肺容量，受试者进行最大呼气压力（MEP）的努力对一个封闭的气道和自愿咳嗽的努力。这两种努力都是在有和没有叠加的电刺激（50 Hz，1秒）的情况下进行的，其强度设置为次最大强度，以在功能残气量下诱发40 cm H2O的胃压（P-ga）。结果在MEP努力中，刺激增加了最大P-ga（从21.4 +/- 7.0到59.0 +/- 5.7 cm H2O）和食管压力（P-es; 47.2 +/- 11.7到65.6 +/- 13.6 cm H2O）。在咳嗽努力期间，刺激增加P-ga（19.5 +/- 6.0至57.9 +/- 7.0 cm H2O）和P-es（31.2 +/- 8.7至56.6 +/- 10.5 cm H2O）。在刺激的咳嗽努力期间增加的呼气压力增加了峰值呼气流量（PEF，增加36% +/- 5%）、平均呼气流量（增加80% +/- 8%）和呼气肺容量（增加41% +/- 16%）。在每名受试者中，叠加电刺激改善了咳嗽努力期间的呼气峰流量（0.99 +/- 0.12 L/s;范围，0.41-1.80 L/s）。佩戴腹带并不能改善刺激性咳嗽流量或压力。结论.使用新型后外侧电极放置进行电刺激的P-ga和PEF的增加是其他研究中报告的改善的2 - 3倍。这表明，腹部肌肉的后外侧电刺激是一种简单的非侵入性方式，以加强SCI患者的咳嗽。
Background. Spinal cord injury (SCI) patients have respiratory complications because of abdominal muscle weakness and paralysis, which impair the ability to cough. Objective. This study aims to enhance cough in high-level SCI subjects (n = 11, SCI at or above T6) using surface electrical stimulation of the abdominal muscles via 2 pairs of posterolaterally placed electrodes. Methods. From total lung capacity, subjects performed maximum expiratory pressure (MEP) efforts against a closed airway and voluntary cough efforts. Both efforts were performed with and without superimposed trains of electrical stimulation (50 Hz, 1 second) at a submaximal intensity set to evoke a gastric pressure (P-ga) of 40 cm H2O at functional residual capacity. Results. In the MEP effort, stimulation increased the maximal P-ga (from 21.4 +/- 7.0 to 59.0 +/- 5.7 cm H2O) and esophageal pressure (P-es; 47.2 +/- 11.7 to 65.6 +/- 13.6 cm H2O). During the cough efforts, stimulation increased P-ga (19.5 +/- 6.0 to 57.9 +/- 7.0 cm H2O) and P-es (31.2 +/- 8.7 to 56.6 +/- 10.5 cm H2O). The increased expiratory pressures during cough efforts with stimulation increased peak expiratory flow (PEF, by 36% +/- 5%), mean expiratory flow (by 80% +/- 8%), and expired lung volume (by 41% +/- 16%). In every subject, superimposed electrical stimulation improved peak expiratory flow during cough efforts (by 0.99 +/- 0.12 L/s; range, 0.41-1.80 L/s). Wearing an abdominal binder did not improve stimulated cough flows or pressures. Conclusions. The increases in P-ga and PEF with electrical stimulation using the novel posterolateral electrode placement are 2 to 3 times greater than improvements reported in other studies. This suggests that posterolateral electrical stimulation of abdominal muscles is a simple noninvasive way to enhance cough in individuals with SCI.