Division of Asthma, Allergy and Lung Biology, King's College, London, UK.
Eur Respir J. 2011 Jan;37(1):143-9. doi: 10.1183/09031936.00007910. Epub 2010 Jun 1.
Measurement of the diaphragm electromyogram (EMGdi) elicited by phrenic nerve stimulation could be useful to assess neonates suffering from respiratory distress due to diaphragm dysfunction, as observed in infants with abdominal wall defects (AWD) or congenital diaphragmatic hernia (CDH). The study aims were to assess the feasibility of recording EMGdi using a multipair oesophageal electrode catheter and examine whether diaphragm muscle and/or phrenic nerve function was compromised in AWD or CDH infants. Diaphragm compound muscle action potentials elicited by magnetic phrenic nerve stimulation were recorded from 18 infants with surgically repaired AWD (n = 13) or CDH (n = 5), median (range) gestational age 36.5 (34-40) weeks. Diaphragm strength was assessed as twitch transdiaphragmatic pressure (TwP(di)). One AWD patient had prolonged phrenic nerve latency (PNL) bilaterally (left 9.31 ms, right 9.49 ms) and two CDH patients had prolonged PNL on the affected side (10.1 ms and 10.08 ms). There was no difference in left and right TwP(di) in either group. PNL correlated significantly with TwP(di) in CDH (r = 0.8; p = 0.009). Oesophageal EMG and magnetic stimulation of the phrenic nerves can be useful to assess phrenic nerve function in infants. Reduced phrenic nerve conduction accompanies the reduced diaphragm force production observed in infants with CDH.
膈神经刺激诱发的膈肌肌电图（EMGdi）的测量对于评估因膈肌功能障碍而导致呼吸窘迫的新生儿可能是有用的，如腹壁缺陷（AWD）或先天性膈疝（CDH）患儿中观察到的那样。本研究旨在评估使用多对食管电极导管记录 EMGdi 的可行性，并检查 AWD 或 CDH 婴儿的膈肌肌肉和/或膈神经功能是否受损。对 18 例接受手术修复的 AWD（n = 13）或 CDH（n = 5）婴儿进行了磁膈神经刺激诱发的膈复合肌动作电位记录，中位（范围）胎龄 36.5（34-40）周。膈肌力评估为膈肌 twitch 跨膈压（TwP(di)）。1 例 AWD 患者双侧膈神经潜伏期（PNL）延长（左侧 9.31ms，右侧 9.49ms），2 例 CDH 患者患侧 PNL 延长（10.1ms 和 10.08ms）。两组左、右侧 TwP(di)均无差异。PNL 与 CDH 中的 TwP(di)呈显著相关（r = 0.8；p = 0.009）。食管 EMG 和膈神经磁刺激可用于评估婴儿的膈神经功能。在 CDH 婴儿中，观察到膈神经传导减少伴随着膈肌力量产生减少。
