Department of Physiology and Biophysics, Case Western Reserve University and MetroHealth Medical Center, Rammelkamp Center for Education & Research, Cleveland, OH 44109-1998, United States.
Respir Physiol Neurobiol. 2009 Nov 30;169(2):200-9. doi: 10.1016/j.resp.2009.09.008. Epub 2009 Sep 26.
Phrenic nerve pacing (PNP) is a clinically useful technique to restore inspiratory muscle function in patients with respiratory failure secondary to cervical spinal cord injury. In this review, patient evaluation, equipment, methods of implementation, clinical outcomes, and the complications and side effects of PNP are discussed. Despite considerable technical development, and clinical success, however, current PNP systems have significant limitations. Even in patients with intact phrenic nerve function, PNP is successful in achieving full-time support in approximately 50% of patients. Inadequate inspired volume generation may arise secondary to incomplete diaphragm activation, reversed recruitment order of motor units, fiber type conversion resulting in reduced force generating capacity and lack of coincident intercostal muscle activation. A novel method of pacing is under development which involves stimulating spinal cord tracts which synapse with the inspiratory motoneuron pools. This technique results in combined activation of the intercostal muscles and diaphragm in concert and holds promise to provide a more physiologic and effective method of PNP.
膈神经起搏（PNP）是一种临床有用的技术，可恢复因颈椎脊髓损伤导致呼吸衰竭的患者的吸气肌功能。在这篇综述中，讨论了患者评估、设备、实施方法、临床结果以及 PNP 的并发症和副作用。然而，尽管有相当大的技术发展和临床成功，当前的 PNP 系统仍存在显著的局限性。即使在膈神经功能完整的患者中，PNP 也只能成功地为大约 50%的患者提供全时支持。吸气量产生不足可能是由于膈神经不完全激活、运动单位募集顺序逆转、纤维类型转换导致肌力生成能力降低以及肋间肌协同激活缺失引起的。一种新的起搏方法正在开发中，该方法涉及刺激与吸气运动神经元池突触的脊髓束。这种技术可以协同地激活肋间肌和膈肌，有望提供一种更生理和有效的 PNP 方法。
