Rouen University Hospital, Department of Physiology, 76031 Rouen Cedex, France.
Respir Physiol Neurobiol. 2011 Apr 30;176(1-2):68-71. doi: 10.1016/j.resp.2010.11.003. Epub 2010 Nov 10.
In humans, anatomy indicates that the phrenic nerve mainly arises from the C4 cervical root, with variable C3 and C5 contributions. How this translates into functional innervation is unknown. The diaphragm response to electrical stimulation of C3, C4 and C5 was described in three patients undergoing surgical laryngeal reinnervation with an upper phrenic root (surface chest electrodes at anterior, lateral and posterior sites; oesophageal and gastric pressures (Pes and Pga) to derive transdiaphragmatic pressure (Pdi)). Anatomically, the phrenic nerve predominantly originated from C4. Phrenic stimulation elicited motor responses at the three sites in the three patients, as did C4 stimulation. It produced Pdi values of 9, 11, and 14cmH(2)O in the three patients, respectively, vs. 9, 9, and 7cmH(2)O for C4. C3 stimulation produced modest Pdi responses, whereas C5 stimulation could produce Pdi responses close to those observed with C4 stimulation. These singular observations confirm the dominance of C4 in diaphragm innervation but suggest than C5 can be of importance.
在人类中，解剖学表明膈神经主要起源于 C4 颈椎根，并有可变的 C3 和 C5 贡献。这如何转化为功能性神经支配尚不清楚。在 3 名接受上膈神经根（前、侧和后胸壁表面电极；食管和胃压（Pes 和 Pga）以获得膈压（Pdi））喉返神经再支配手术的患者中，描述了 C3、C4 和 C5 电刺激对膈的反应。解剖上，膈神经主要起源于 C4。膈神经刺激在 3 名患者的 3 个部位引起运动反应，C4 刺激也是如此。它在 3 名患者中分别产生 9、11 和 14cmH(2)O 的 Pdi 值，而 C4 产生 9、9 和 7cmH(2)O 的 Pdi 值。C3 刺激产生适度的 Pdi 反应，而 C5 刺激可以产生接近 C4 刺激时观察到的 Pdi 反应。这些单一的观察结果证实了 C4 在膈神经支配中的主导地位，但也表明 C5 可能很重要。
