Combined intercostal and diaphragm pacing to provide artificial ventilation in patients with tetraplegia
Combined intercostal and diaphragm pacing to provide artificial ventilation in patients with tetraplegia
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DOI：
10.1016/j.apmr.2004.11.027
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发表时间：
2005-06-01
影响因子：
4.3
通讯作者：
Kowalski, KE
中科院分区：
文献类型：
--
作者：
DiMarco, AF;Takaoka, Y;Kowalski, KE
目的：评价肋间膈联合起搏对维持机械通气独立性的作用。设计:前瞻性试验。参与者：4名仅单侧膈神经功能的脊髓损伤依赖呼吸机的受试者。干预措施：在初始手术过程中，通过半椎板切除术将多极硬膜外电极放置在上胸脊髓的腹侧表面，以激活吸气肋间肌。经胸椎入路单侧植入膈神经电极。主要观察指标：受试者在关闭机械通气支持时能够舒适维持的吸气量和持续时间。结果：肋间和横膈膜联合刺激的初始最大激发容积为。23和。在0.55 ~ 1.31L之间显著增加；受试者可以在一天16至24小时内不使用机械通气。结论：肋间联合单侧膈肌起搏可能是一种有效的治疗方式，能够维持单侧膈神经功能患者的长期通气支持。
Objective: To evaluate the usefulness of combined intercostal and diaphragm pacing to maintain independence from mechanical ventilation.Design: A prospective trial.Participants: Four ventilator-dependent subjects with spinal cord injury with only unilateral phrenic nerve function.Intervention: During an initial surgical procedure, a multipolar epidural disk electrode was positioned on the ventral surface of the upper-thoracic spinal cord via a hemilaminectomy to activate the inspiratory intercostal muscles. A phrenic nerve electrode was implanted unilaterally via the thoracic approach.Main Outcome Measures: Inspired volume production and duration that subjects could be comfortably maintained when off mechanical ventilatory support.Results: Initial maximum inspired volumes from combined intercostal and diaphragm stimulation ranged between .23 and .93L and significantly increased over the course of reconditioning period to between 0.55 and 1.31L; subjects could be maintained off mechanical ventilation between 16 and 24 hours a day.Conclusions: Combined intercostal and unilateral diaphragm pacing may be a useful therapeutic modality capable of maintaining long-term ventilatory support in patients with only unilateral phrenic nerve function.