PHRENIC-NERVE PACING IN INFANTS AND CHILDREN - A REVIEW OF EXPERIENCE AND REPORT ON THE USEFULNESS OF PHRENIC-NERVE STIMULATION STUDIES
PHRENIC-NERVE PACING IN INFANTS AND CHILDREN - A REVIEW OF EXPERIENCE AND REPORT ON THE USEFULNESS OF PHRENIC-NERVE STIMULATION STUDIES
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DOI：
10.1016/s0022-3476(83)80282-0
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发表时间：
1983-01-01
影响因子：
5.1
通讯作者：
HUNT, CE
中科院分区：
文献类型：
--
作者：
BROUILLETTE, RT;ILBAWI, MN;HUNT, CE
婴儿和儿童（9），参考膈神经起搏器，测量膈神经传导时间和肌电动作电位振幅。在这些儿科患者中，膈神经传导时间从2.7到7.8 ms不等，具有很好的重现性，并且短于成人的膈神经传导时间;膈神经传导时间随着年龄的增长以及刺激电极和膈肌之间距离的增加而增加。膈肌动作电位振幅在0.08-4.1 mV之间变化，大致相当于成人的振幅，但在不同日期患者之间和患者内是可变的。经皮刺激后获得的幅度低于膈神经刺激后。5例患者接受术前经皮膈神经刺激。3例患者强烈的血管收缩表明需要植入起搏器; 2例患者弱或无血管收缩禁忌植入起搏器。术后，无创测量O2，CO2，潮气量和呼吸动作电位振幅用于调整膈神经起搏器设置。膈神经起搏器促进了7名患者中6名患者从医院出院到家庭通气计划。膈神经起搏是一种支持精心挑选的婴儿和儿童通气的实用方法。膈神经刺激研究有助于选择起搏患者和调整起搏器设置。
Infants and children (9), referred for phrenic nerve pacemakers, had measurements of phrenic nerve conduction times and diaphragmatic action potential amplitudes. In these pediatric patients, phrenic nerve conduction times varied from 2.7 to 7.8 ms, were quite reproducible and were shorter than phrenic nerve conduction times in adults; phrenic nerve conduction time increased with age and with increasing distance between the stimulating electrode and the diaphragm. Diaphragmatic action potential amplitudes varied from 0.08-4.1 mV, roughly equivalent to amplitudes in adults, but were variable between patients and within patients on different days. Lower amplitudes were obtained after percutaneous stimulation than after phrenic nerve stimulation. Five patients underwent preoperative, percutaneous phrenic nerve stimulation. Strong diaphragmatic contractions indicated the need for pacemaker insertion in 3 patients; weak or absent diaphragmatic contractions contraindicated pacemaker insertion in 2 patients. Posteroperatively, noninvasive measurements of O2, CO2, tidal volume and diaphragmatic action potential amplitudes were used to adjust the phrenic nerve pacemaker settings. Phrenic nerve pacemakers have facilitated discharge from the hospital to a home-based ventilation program in 6 of the 7 patients in whom they were inserted. Phrenic nerve pacing is a practical method of supporting ventilation in carefully selected infants and children. Phrenic nerve stimulation studies are useful in selecting patients for pacing and in adjusting the pacemaker settings.