Marzocchi M, Brouillette R T, Weese-Mayer D E, Morrow A S, Conway L P
Department of Pediatrics, Northwestern University Medical School, Children's Memorial Hospital Chicago, Illinois.
Pediatr Pulmonol. 1990;8(1):29-32. doi: 10.1002/ppul.1950080109.
Patients using diaphragm pacemakers have several respiratory-related problems placing them at high risk for death during sleep, including central hypoventilation, abnormal arousal responses, upper airway and/or tracheostomy obstruction, and, in the case of high quadriplegia, lack of motor response to airway obstruction. The recent death from airway obstruction of a patient using diaphragm pacemakers prompted us to re-evaluate both the need for home monitoring and the type of monitor to prescribe. We compared the performance of a transthoracic impedance/heart rate (TI/HR) monitor with that of a pulse oximeter in six patients with central hypoventilation syndrome whose treatment included diaphragm pacing. Polygraphic recordings of airflow, ECG, SaO2, transthoracic impedance, heart rate, and breath detection were obtained during brief tracheostomy occlusion during patient sleep. Although none of 13 occlusions was detected by the TI/HR monitor, the pulse oximeter identified 13 of 13 occlusions. Three reasons for TI/HR monitor failure included 1) the breath detection circuit consistently registered a breath with each obstructed, paced diaphragmatic contraction; 2) bradycardia did not occur during any airway occlusion; and 3) pacemaker stimuli were misinterpreted as additional heart beats, increasing apparent heart rate. Thus, pulse oximetry, but not TI/HR monitoring, can detect life-threatening airway obstruction in children using diaphragm pacemakers.
使用膈神经起搏器的患者存在一些与呼吸相关的问题，使他们在睡眠期间面临高死亡风险，这些问题包括中枢性通气不足、异常觉醒反应、上呼吸道和/或气管造口阻塞，以及在高位四肢瘫痪的情况下，对气道阻塞缺乏运动反应。最近，一名使用膈神经起搏器的患者因气道阻塞死亡，这促使我们重新评估家庭监测的必要性以及所开监测仪的类型。我们比较了经胸阻抗/心率（TI/HR）监测仪与脉搏血氧仪在6名中枢性通气不足综合征患者中的性能，这些患者的治疗包括膈神经起搏。在患者睡眠期间短暂的气管造口阻塞期间，记录了气流、心电图、血氧饱和度、经胸阻抗、心率和呼吸检测的多导记录。尽管TI/HR监测仪未检测到13次阻塞中的任何一次，但脉搏血氧仪识别出了13次阻塞中的13次。TI/HR监测仪失败的三个原因包括：1）呼吸检测电路在每次阻塞的、起搏的膈肌收缩时都持续记录一次呼吸；2）在任何气道阻塞期间都未发生心动过缓；3）起搏器刺激被误判为额外的心跳，从而增加了表观心率。因此，脉搏血氧测定法而非TI/HR监测能够检测出使用膈神经起搏器的儿童中危及生命的气道阻塞。
