Restoration of respiratory muscle function following spinal cord injury - Review electrical and magnetic stimulation techniques
Restoration of respiratory muscle function following spinal cord injury - Review electrical and magnetic stimulation techniques
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DOI：
10.1016/j.resp.2005.03.007
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发表时间：
2005-07-28
影响因子：
2.3
通讯作者：
DiMarco, AF
中科院分区：
文献类型：
--
作者：
DiMarco, AF
呼吸系统并发症是脊髓损伤患者发病和死亡的主要原因。目前可用或正在开发的几种技术能够恢复呼吸肌功能，使这些患者能够过上更正常的生活，并有望减少呼吸系统并发症的发生率。双侧膈神经起搏是一种临床公认的恢复吸气肌功能的技术，可使呼吸机依赖性四肢瘫痪患者完全摆脱机械通气。与机械通气相比，膈神经起搏为患者提供了更高的活动性、更好的语言能力、更高的舒适度和更低的医疗费用。腹腔镜下放置肌内膈肌电极的临床试验结果表明，也可以实现膈肌起搏，而不需要开胸手术和相关的长期住院时间，也不需要操纵膈神经（有膈神经损伤的风险）。正在进行其他临床试验以恢复吸气肋间功能。在仅单侧膈神经功能不适合膈神经起搏的患者中，肋间和单侧膈肌联合起搏似乎提供了与双侧膈肌起搏相似的受益。恢复呼气肌功能的临床试验也在进行中。呼气肌的磁刺激、表面刺激和脊髓刺激是恢复该患者人群有效咳嗽机制的有前景的技术。这些技术有望减少脊髓损伤患者呼吸道感染、肺不张和呼吸衰竭的发生率，并降低与这些并发症相关的发病率和死亡率。(C)2005 Elsevier B.V.保留所有权利。
Respiratory complications are a leading cause of morbidity and mortality in patients with spinal cord injury. Several techniques, currently available or in development, have the capacity to restore respiratory muscle function allowing these patients to live more normal lives and hopefully reduce the incidence of respiratory complications. Bilateral phrenic nerve pacing, a clinically accepted technique to restore inspiratory muscle function, allows patients with ventilator dependent tetraplegia complete freedom from mechanical ventilation. Compared to mechanical ventilation, phrenic nerve pacing provides patients with increased mobility, improved speech, improved comfort level and reduction in health care costs. The results of clinical trials of laparoscopically placed intramuscular diaphragm electrodes suggest that diaphragm pacing can also be achieved without the need for a thoracotomy and associated long hospital stay and without manipulation of the phrenic nerve which carries a risk of phrenic nerve injury. Other clinical trials are being performed to restore inspiratory intercostal function. In patients with only unilateral phrenic nerve function who are not candidates for phrenic nerve pacing, combined intercostal and unilateral diaphragm pacing appears to provide benefits similar to that of bilateral diaphragm pacing. Clinical trials are also underway to restore expiratory muscle function. Magnetic stimulation, surface stimulation and spinal cord stimulation of the expiratory muscles are promising techniques to restore an effective cough mechanism in this patient population. These techniques hold promise to reduce the incidence of respiratory tract infections, atelectasis and respiratory failure in patients with spinal cord injury and reduce the morbidity and mortality associated with these complications. (C) 2005 Elsevier B.V. All rights reserved.