Baer G A, Talonen P P, Shneerson J M, Markkula H, Exner G, Wells F C
Department of Anaesthesiology, Tampere University Central Hospital, Finland.
Pacing Clin Electrophysiol. 1990 Aug;13(8):1061-72. doi: 10.1111/j.1540-8159.1990.tb02153.x.
A multi-channel phrenic nerve stimulator developed in Tampere has been implanted into seven patients with C2-tetraplegia and into three patients with central sleep apneas. Six bipolar cuff electrodes were implanted bilaterally into the neck. Two four-pole cuff and 14 four-pole noncuff electrodes were used in seven patients and to replace one bipolar electrode. Four-pole electrodes were implanted within the thorax. Seven patients achieved total independence from conventional ventilators within 4 months of implantation, and one for 18 hours each day. Two patients died 12 days and 3 months after implantation and two patients after having achieved independence from mechanical ventilators from causes unrelated to the stimulators. Reoperations were necessary because of dislocation of receivers, electrodes, electrode lesions, nerve injuries, and technical failures in seven patients. Most of the problems appeared in two patients with obesity and in three patients with very thin phrenic nerves. Single unit prototypes failed technically more frequently than units of prototype serial fabrication. New electrode design, progress in the manufacture of receivers, and improved implantation technique should help to diminish failures in future.
在坦佩雷研发的一种多通道膈神经刺激器已植入7例C2四肢瘫痪患者和3例中枢性睡眠呼吸暂停患者体内。双侧在颈部植入了6个双极袖带电极。7例患者使用了2个四极袖带电极和14个四极非袖带电极，并替换了1个双极电极。四极电极植入胸腔内。7例患者在植入后4个月内完全摆脱了传统呼吸机，1例患者每天可摆脱18小时。2例患者在植入后12天和3个月死亡，2例患者在摆脱机械通气后因与刺激器无关的原因死亡。7例患者因接收器脱位、电极问题、电极损伤、神经损伤和技术故障而需要再次手术。大多数问题出现在2例肥胖患者和3例膈神经非常细的患者身上。单单元原型在技术上比原型系列制造的单元更频繁地出现故障。新的电极设计、接收器制造方面的进展以及改进的植入技术应有助于减少未来的故障。
