Complete Restoration of Respiratory Muscle Function in Three Subjects With Spinal Cord Injury Pilot Interventional Clinical Trial
Complete Restoration of Respiratory Muscle Function in Three Subjects With Spinal Cord Injury Pilot Interventional Clinical Trial
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DOI：
10.1097/phm.0000000000001018
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发表时间：
2019-01-01
影响因子：
3
通讯作者：
Kowalski, Krzysztof E.
中科院分区：
文献类型：
--
作者：
DiMarco, Anthony F.;Geertman, Robert T.;Kowalski, Krzysztof E.
目的评价脊髓损伤患者呼吸肌功能完全恢复的安全性和有效性。方法对3例膈肌起搏受试者植入脊髓电刺激系统恢复咳嗽进行了干预性研究。最大呼气气流和气道压力生成是主要的生理结果指标;评估分泌物升高的困难程度是主要的临床结果指标。结果在自发努力过程中平均呼气峰流量和气道压力分别为1.7 +/- 0.2 L/s和31 +/- 7 cmH（2）O。当在与受试者的最大吸气努力相关的起搏体积后施加脊髓刺激并与受试者的最大呼气努力同步时，峰值呼气气流和气道压力分别为9.0 +/- 1.9 L/s和90 +/- 6 cmH 2 O（P < 0.05）。此外，与其他方法相比，每个受试者在分泌物提升方面都经历了更大的容易性和明显的改善。结论脊髓损伤后呼吸肌功能完全恢复是安全有效的。脊髓刺激导致正常咳嗽的呼气峰流量和气道压力产生，而隔膜起搏则成功地维持患者脱离机械通气。
Objectives The aim of this study was to assess the safety and efficacy of complete restoration of respiratory muscle function in subjects with spinal cord injury. Methods This was an interventional study investigating three subjects maintained on a diaphragm pacing system who were implanted with the spinal cord stimulation system to restore cough. Peak expiratory airflow and airway pressure generation were the primary physiologic outcome measures; an assessment of the degree of difficulty in raising secretions was the primary clinical outcome measure. Results Mean peak expiratory airflow and airway pressure generation during spontaneous efforts were 1.7 +/- 0.2 L/s and 31 +/- 7 cmH(2)O, respectively. When spinal cord stimulation was applied after pacing volume associated with the subject's maximum inspiratory effort and synchronized with the subject's maximum expiratory effort, peak expiratory airflow and airway pressure generation were 9.0 +/- 1.9 L/s and 90 +/- 6 cmH(2)O, respectively (P < 0.05). Moreover, each subject experienced much greater ease in raising secretions and marked improvement in the ease in raising secretions compared with other methods. Conclusions Complete restoration of respiratory muscle function can be safely and effectively achieved in the same individuals with spinal cord injury. Spinal cord stimulation results in peak expiratory airflow and airway pressure generation characteristic of a normal cough, whereas diaphragm pacing was successful in maintaining patients off mechanical ventilation.