Zimmer M Beth, Nantwi Kwaku, Goshgarian Harry G
Department of Anatomy and Cell Biology, Wayne State University, Detroit, Michigan 48201, USA.
J Spinal Cord Med. 2007;30(4):319-30. doi: 10.1080/10790268.2007.11753947.
Spinal cord injury (SCI) often leads to an impairment of the respiratory system. The more rostral the level of injury, the more likely the injury will affect ventilation. In fact, respiratory insufficiency is the number one cause of mortality and morbidity after SCI. This review highlights the progress that has been made in basic and clinical research, while noting the gaps in our knowledge. Basic research has focused on a hemisection injury model to examine methods aimed at improving respiratory function after SCI, but contusion injury models have also been used. Increasing synaptic plasticity, strengthening spared axonal pathways, and the disinhibition of phrenic motor neurons all result in the activation of a latent respiratory motor pathway that restores function to a previously paralyzed hemidiaphragm in animal models. Human clinical studies have revealed that respiratory function is negatively impacted by SCI. Respiratory muscle training regimens may improve inspiratory function after SCI, but more thorough and carefully designed studies are needed to adequately address this issue. Phrenic nerve and diaphragm pacing are options available to wean patients from standard mechanical ventilation. The techniques aimed at improving respiratory function in humans with SCI have both pros and cons, but having more options available to the clinician allows for more individualized treatment, resulting in better patient care. Despite significant progress in both basic and clinical research, there is still a significant gap in our understanding of the effect of SCI on the respiratory system.
脊髓损伤（SCI）常导致呼吸系统功能障碍。损伤平面越高，越有可能影响通气功能。事实上，呼吸功能不全是脊髓损伤后死亡和发病的首要原因。本综述强调了基础研究和临床研究取得的进展，同时指出了我们在知识方面的差距。基础研究主要集中在半横断损伤模型，以研究改善脊髓损伤后呼吸功能的方法，但也使用了挫伤损伤模型。增加突触可塑性、加强保留的轴突通路以及解除膈运动神经元的抑制，均可激活潜在的呼吸运动通路，使动物模型中先前瘫痪的半膈肌恢复功能。人体临床研究表明，脊髓损伤会对呼吸功能产生负面影响。呼吸肌训练方案可能改善脊髓损伤后的吸气功能，但需要更全面、精心设计的研究来充分解决这一问题。膈神经和膈肌起搏是帮助患者脱离标准机械通气的可选方法。旨在改善脊髓损伤患者呼吸功能的技术都有其优缺点，但临床医生有更多选择可实现更个性化的治疗，从而为患者提供更好的护理。尽管基础研究和临床研究都取得了显著进展，但我们对脊髓损伤对呼吸系统影响的理解仍存在重大差距。
