Electromagnetic stimulation of the phrenic nerve preserves diaphragm muscle strength during mechanical ventilation in a rat model.
Electromagnetic stimulation of the phrenic nerve preserves diaphragm muscle strength during mechanical ventilation in a rat model.
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膈神经电磁刺激可在大鼠模型机械通气期间保持膈肌强度
DOI：
10.1097/eja.0000000000001590
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发表时间：
2021
影响因子：
3.6
通讯作者：
Schumann S
中科院分区：
文献类型：
--
作者：
Wenzel C;Spassov SG;Lengerer J;Schmidt J;Urban G;Schumann S
机械通气期间膈肌失活会导致膈肌力量丧失，并可能导致肌肉废用性萎缩，这被称为通气引起的膈肌功能障碍（VIDD）。 1 这种临床状况可能与撤机失败有关，2 并且当前的治疗策略无法完全预防 VIDD。对此，最近的研究表明，机械通气期间间歇性自主呼吸3或对膈神经进行侵入性电刺激可以降低VIDD的风险。 4-6 膈神经的无创电磁刺激 (EMS) 也可以诱导膈肌收缩。我们评估了间歇性经皮 EMS 在 VIDD 大鼠模型中维持膈肌强度的潜力（详细说明请参阅补充材料方法，https://links.lww.com/EJA/A607）。所有动物实验均经当地伦理委员会批准，并按照德国动物保护法和欧洲共同体动物实验指南进行。将对照动物 (Control) 与接受 9 小时机械通气 (Vent+ EMS) 和不使用 (Vent) 间歇性电磁刺激的动物进行比较。机械通气9h后，Vent组膈肌肌力较对照组降低43%（P<0.001）（图1）。当EMS与机械通气联合使用时，膈肌肌力较对照组仅降低19%（P=0.044），但仍显着高于Vent组大鼠（P=0.017）。值得注意的是，与对照组（937 μm，P= 0.027）和 Vent+ EMS 大鼠（967 μm，P= 0.006）相比，接受机械通气的动物膈肌厚度（图 2）显着减小（802 μm）。
Inactivation of the diaphragm during mechanical ventilation induces loss of diaphragm muscle strength and may result in muscle disuse atrophy, which is referred to as ventilation-induced diaphragm dysfunction (VIDD). 1 This clinical condition can be associated with weaning failure, 2 and current therapeutic strategies cannot completely prevent VIDD. In this regard, recent studies show that intermittent spontaneous breathing 3 or invasive electrical stimulation of the phrenic nerve during mechanical ventilation can reduce the risk of VIDD. 4–6 Contraction of the diaphragm can also be induced by noninvasive electromagnetic stimulation (EMS) of the phrenic nerve.We assessed the potential of intermittent transcutaneous EMS to maintain diaphragmatic muscle strength in a rat model of VIDD (for a detailed description please see Supplementary Material Methods, https://links. lww. com/EJA/A607). All animal experiments were approved by the local ethical committee and carried out in accordance with the German law for animal protection and the European Community guideline on animal experiments. Control animals (Control) were compared with animals subjected to 9 h of mechanical ventilation with (Vent+ EMS) and without (Vent) intermittent electromagnetic stimulation. After 9h of mechanical ventilation, diaphragm muscle strength in the Vent group was reduced by 43% compared with the control group (P< 0.001)(Fig. 1). When EMS was used along with mechanical ventilation, the diaphragm muscle strength was reduced by only 19% from the control group (P= 0.044) and it remained significantly higher than that of the Vent rat (P= 0.017). Remarkably, diaphragm thickness (Fig. 2) of animals subjected to mechanical ventilation was significantly reduced (802 μm) compared with both control (937 μm, P= 0.027) and Vent+ EMS rat (967 μm, P= 0.006).
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影响因子：
8.8
作者：
Reynolds, Steven;Ebner, Adrian;Hoffer, Joaquin A.
通讯作者：
Hoffer, Joaquin A.
影响因子：
3.4
作者：
Yang, Meirong;Wang, Haitao;Li, Shitong
通讯作者：
Li, Shitong
影响因子：
158.5
作者：
Levine, Sanford;Nguyen, Taitan;Shrager, Joseph B.
通讯作者：
Shrager, Joseph B.
DOI：
10.1186/cc9296
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Heunks LM;van der Hoeven JG
通讯作者：
van der Hoeven JG
影响因子：
8.8
作者：
Gayan-Ramirez, G;Testelmans, D;Decramer, M
通讯作者：
Decramer, M