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Objective:To explore the effect of staged respiratory training in pulmonary rehabilitation nursing of patients with high spinal cord injury.Methods:A total of 76 patients with high spinal cord injury in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2019 were selected as the study subjects, and were divided into the control group and the observation group with random number table method, 38 cases each. The control group was given conventional respiratory training, while the observation group was given staged respiratory training. Both groups were intervened 6 days a week for 8 weeks. The differences of basic indexes, pulmonary ventilation function, respiratory muscle strength and incidence of pulmonary infection between the two groups before and after intervention were compared.Results:After 8 weeks of intervention, the blood oxygen saturation was 0.95±0.04 in the observation group and 0.90±0.04 in the control group, there was significant difference ( t value was 4.229, P<0.001). The percentages of predicted values of maximal vital capacity, forced expiratory vital capacity, forced expiratory volume in 1s, and maximal ventilation were (69.21±11.38)%, (61.83±11.53)%, (56.50±7.86)%, (51.62±8.73)% in the observation group after 8 weeks of intervention, and (56.70±14.65)%, (49.82±15.06)%, (45.61±10.32)%, (42.30±15.11)% in the control group, there was significant difference ( t values were 3.610-4.967, P<0.001). The inspiratory muscle strength index was (56.12±18.31) cmH 2O(1 cmH 2O= 0.098 kPa) in the observation group after intervention, and (46.61±11.62) cmH 2O in the control group, there was significant different ( t value was 2.806, P<0.01). The incidence of pulmonary infection was 5.26% (2/38) in the observation group and 15.78% (6/38) in the control group, there was no significant difference ( χ2 value was 2.235, P>0.05). Conclusions:Stage respiratory training can promote lung rehabilitation of patients with high spinal cord injury, which is worthy of promotion and application.
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BACKGROUND: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. MATERIALS AND METHODS: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. RESULTS: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. CONCLUSION: Prolonged bradycardia was associated with significantly higher incidence of asystole. Endotracheal suctioning and positioning of HSCI patients were significant provocative factors for prolonged bradycardia; hypotension on admission, pneumonia and tracheostomy were the risk factors for the development of prolonged bradycardia in these patients.
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OBJECTIVE: To determine the effects of abdominal functional electrical stimulation(FES) on the ability to clear the broncheal secretion in high spinal cord injury(SCI) patients. METHOD: Eleven cervical SCI male patients were assessed for the pulmonary function using a routine pulmonary function test. Maximal expiratory pressure(MEP) and peak expiratory flow rate(PEFR) measurements were recorded during (1) spontaneous cough attempts and (2) cough attempts with FES applied to the abdominal wall. Each measurement was recorded in supine and sitting positions. The portable FES unit was set at 24 Hz, with a pulse width of 150 microsecond( s), an asymmetrical biphasic waveform and a maximal intensity to 90 mA. RESULTS: All subjects had a decreased vital capacity, peak expiratory flow and increased ratio of forced expiratory volume at one second(FEV1) to the forced vital capacity(FVC) in a routine pulmonary function test. These cervical SCI patients were greatly reduced the MEP and the PEFR when they coughed spontaneously. FES-assisted coughing increased the MEP and PEFR in all patients in a supine and sitting positions with statistical significance(p<0.05). CONCLUSION: By increasing the MEP and PEFR, abdominal FES could enhance the coughs in high SCI patients. Abdominal FES can be a useful physical therapy for the prevention and treatment of pulmonary complications in high SCI patients at the bed side as well as at homes.
