Division of General Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
J Pediatr Surg. 2011 Jan;46(1):72-6. doi: 10.1016/j.jpedsurg.2010.09.071.
Diaphragm pacing (DP) has been shown to successfully replace mechanical ventilators for adult tetraplegic patients with chronic respiratory insufficiency. This is the first report of DP in ventilator-dependent children.
This was a prospective interventional experience under institutional review board approval. Diaphragm pacing involves outpatient laparoscopic diaphragm motor point mapping to identify the site where stimulation causes maximum diaphragm contraction with implantation of 4 percutaneous intramuscular electrodes. Diaphragm conditioning ensues to wean the child from the ventilator.
Six children were successfully implanted ranging from 5 to 17 years old with the smallest 15 kg in weight. Length of time on mechanical ventilation ranged from 11 days to 7.6 years with an average of 3.2 years. In all patients, DP provided tidal volumes above basal needs. Five of the patients underwent a home-based weaning program, whereas one patient who was implanted only 11 days post spinal cord injury never returned to the ventilator with DP use. Another patient was weaned from the ventilator full time but died of complications of his underlying brain stem tumor. The remaining patients weaned from the ventilator for over 14 hours a day and/or are actively conditioning their diaphragms.
Diaphragm pacing successfully replaced mechanical ventilators, which improves quality of life.
膈肌起搏（DP）已被证明可成功替代机械通气，为慢性呼吸功能不全的成年四肢瘫痪患者提供支持。这是首次报告 DP 在依赖呼吸机的儿童中的应用。
这是一项在机构审查委员会批准下进行的前瞻性干预性经验。膈肌起搏涉及门诊腹腔镜膈肌运动点测绘，以确定刺激引起最大膈肌收缩的部位，并植入 4 个经皮肌内电极。随后进行膈肌调理以帮助儿童逐渐脱离呼吸机。
6 名儿童成功植入，年龄从 5 岁到 17 岁不等，体重最小为 15 公斤。机械通气时间从 11 天到 7.6 年不等，平均为 3.2 年。在所有患者中，DP 提供的潮气量均高于基本需求。5 名患者接受了家庭为基础的脱机计划，而另一名仅在脊髓损伤后植入 11 天的患者，使用 DP 后从未再次回到呼吸机。另一名患者完全脱离呼吸机，但死于其脑干肿瘤的并发症。其余患者每天脱机 14 小时以上，或正在积极调理他们的膈肌。
膈肌起搏成功替代了机械通气，提高了生活质量。
