Comparison of wire and disc leads to activate the expiratory muscles in dogs
Comparison of wire and disc leads to activate the expiratory muscles in dogs
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DOI：
10.1179/2045772311y.0000000039
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发表时间：
2011-11-01
影响因子：
1.7
通讯作者：
DiMarco, Anthony F.
中科院分区：
文献类型：
--
作者：
Kowalski, Krysztof E.;DiMarco, Anthony F.
目的：呼吸系统并发症是脊髓损伤（SCI）患者发病和死亡的主要原因，原因是由于呼气肌麻痹和随之而来的不能产生有效的咳嗽。我们之前已经证明，脊髓损伤患者可以通过脊髓刺激（SCS），通过椎板切开术将椎间盘导联置于下胸椎和上腰椎，从而恢复有效的咳嗽。在这项研究中，我们评估了可以使用微创技术放置导线来激活呼气肌的有效性。设计：动物实验。环境：研究实验室。动物：狗（n = 8）。干预措施：在单独的试验中，在T9、T11和L1脊髓水平将椎间盘和导线插入硬膜外间隙背侧。比较了盘状引线、单线引线和两线引线平行放置的电刺激效果。结果测量：比较椎间盘刺激和不同导线配置后气道压力的产生。结果：几种不同配置的导线所产生的气道压力与单极刺激圆盘导线（MSDLs）所产生的压力相似。例如，与MSDL相比，在T9 + T11和T9 + L1水平使用平行导线联合单极刺激可使气道压力分别达到103.5 +/- 6.4和101.9 +/- 7.0%。在T9-T11和T9-L1处使用平行导线进行双极刺激导致气道压力分别为MSDL达到的94.2 +/- 3.4和96.8 +/- 5.0%。其他电线配置也进行了评估，但通常效果较差。结论：这些结果表明，与椎间盘引线相比，可以通过微创技术放置特定配置的引线，导致类似的呼气肌激活，可能是一种有用的技术来恢复脊髓损伤患者的咳嗽。
Objective: Respiratory complications account for a major cause of morbidity and mortality in subjects with spinal cord injury (SCI) due to paralysis of the expiratory muscles and the consequent inability to generate effective cough. We demonstrated previously that effective cough can be restored in SCI via spinal cord stimulation (SCS) with disc leads positioned on the lower thoracic and upper lumbar spinal cord via laminotomy incisions. In this study, the effectiveness of wire leads, which can be placed using minimally invasive techniques, to activate the expiratory muscles was evaluated.Design: Animal study.Setting: Research laboratory.Animals: Dogs (n = 8).Interventions: In separate trials, disc and wire leads were inserted onto the dorsal epidural space at the T9, T11, and L1 spinal cord levels. Effects of electrical stimulation with disc, single wire, and two wire leads placed in parallel were compared.Outcome measures: Airway pressure generation following stimulation with disc and various configurations of wire leads were compared.Results: Several different configurations of wire leads resulted in airway pressures that were similar to those generated with monopolar stimulation with disc leads (MSDLs). For example, combined monopolar stimulation with parallel wire leads at the T9 + T11 and T9 + L1 levels resulted in airway pressures that were 103.5 +/- 6.4 and 101.9 +/- 7.0%, respectively, of those achieved with MSDL. Bipolar stimulation with parallel wire leads at T9-T11 and T9-L1 resulted in airway pressures that were 94.2 +/- 3.4 and 96.8 +/- 5.0%, respectively, of the pressures achieved with MSDL. Other wire configurations were also evaluated, but were generally less effective.Conclusion: These results suggest that specific configurations of wire leads, which can be placed via minimally invasive techniques, result in comparable activation of the expiratory muscles compared to disc leads and may be a useful technique to restore cough in persons with SCI.