Onders Raymond P, Elmo Mary Jo, Ignagni Anthony R
Department of Surgery, Case Medical Center of University Hospitals and Case Western Reserve University, Cleveland, Ohio, 44106-5047, USA.
J Spinal Cord Med. 2007;30 Suppl 1(Suppl 1):S25-9. doi: 10.1080/10790268.2007.11753965.
Children with cervical spinal cord injury and chronic respiratory insufficiency face the risks and stigma associated with mechanical ventilators. The Diaphragm Pacing Stimulation (DPS) System for electrical activation of the diaphragm is a minimally invasive alternative to mechanical ventilation.
Review of patients in a prospective Food and Drug Administration trial of the DPS System in individuals who were injured at age 18 years or younger. The procedure involved laparoscopic mapping to locate the diaphragm motor points with electrode implantation. Two weeks after surgery, stimulus/output characteristics of each electrode were determined to obtain an adequate tidal volume for ventilation. A home-based weaning protocol from the ventilator was used.
Of 28 patients implanted with the DPS System, 10 had sustained cervical SCI as children or adolescents. Average age at injury was 13 years (range 1.5 to 17 y). Age at implantation ranged from 18 to 34 years. Length of time from injury to implantation averaged 9.7 years (0.8 to 19 y). All patients tolerated the implantation procedure. Four patients utilize DPS continuously (24/7), 4 patients pace daytime only, and 2 patients are still actively conditioning their diaphragms. Two patients required surgical correction of scoliosis prior to implantation. All patients prefer breathing with the DPS and would recommend it to others; 4 patients specifically identified that attending college or church without a ventilator eases their integration into society.
The results show that the laparoscopic DPS system can be safely implanted in tetraplegics injured as children and used in a home-based environment to wean them off of mechanical ventilation.
患有颈脊髓损伤和慢性呼吸功能不全的儿童面临与机械通气相关的风险和污名。用于电激活膈肌的膈肌起搏刺激（DPS）系统是机械通气的一种微创替代方案。
回顾美国食品药品监督管理局对18岁及以下受伤个体进行的DPS系统前瞻性试验中的患者。该手术包括腹腔镜定位以确定膈肌运动点并植入电极。术后两周，确定每个电极的刺激/输出特性以获得足够的通气潮气量。采用基于家庭的呼吸机撤机方案。
在28例植入DPS系统的患者中，10例在儿童或青少年时期患有持续性颈脊髓损伤。受伤时的平均年龄为13岁（范围1.5至17岁）。植入时的年龄范围为18至34岁。从受伤到植入的平均时间为9.7年（0.8至19年）。所有患者均耐受植入手术。4例患者持续（全天候）使用DPS，4例患者仅在白天起搏，2例患者仍在积极锻炼其膈肌。2例患者在植入前需要进行脊柱侧弯的手术矫正。所有患者都更喜欢使用DPS呼吸，并会向他人推荐；4例患者特别指出，在没有呼吸机的情况下上大学或去教堂使他们更容易融入社会。
结果表明，腹腔镜DPS系统可安全植入儿童期受伤的四肢瘫痪患者体内，并可在家庭环境中使用，帮助他们脱离机械通气。
