Biering-Sørensen F, Jacobsen E, Hjelms E, Fodstad H, Trojaborg W
Fysiurgisk Hospital, Hornbaek, Rigshospitalet, København.
Ugeskr Laeger. 1990 Apr 16;152(16):1143-5.
Artificial ventilation by electric stimulation of the phrenic nerves has become clinically significant within the past 20 years and, in the world as a whole, approximately 700 patients have been treated with implanted diaphragmatic pacemakers. The two first patients in whom diaphragmatic pacemakers were implanted in Denmark, had sustained accidental fractures of the second cervical vertebra with subsequent high cervical spinal cord lesions with not only tetraplegia but also respiratory arrest. In both patients, diaphragmatic pacemakers were implanted bilaterally and these were employed for 12-14 hours daily while ventilation with a respirator was employed at night. The main indications for diaphragmatic pacing are paralysis of respiration following high cervical spinal traumata and the chronic central hypoventilation syndrome (sleep apnoea of Undine's curse). Diaphragmatic pacing may improve the mode of ventilation and the quality of life for patients with tetraplegia and respiratory insufficiency. On account of the potential technical problems, the risk of complications and the limited number of patients in whom this operation is suitable, implantation of diaphragmatic pacemakers should be concentrated in a few centres and probably only one in Denmark.
在过去20年里，通过电刺激膈神经进行人工通气已具有临床意义，在全球范围内，约有700名患者接受了植入式膈肌起搏器治疗。丹麦首批接受膈肌起搏器植入的两名患者，均因意外导致第二颈椎骨折，随后出现高位颈脊髓损伤，不仅四肢瘫痪，还呼吸骤停。两名患者均双侧植入膈肌起搏器，每天使用12至14小时，夜间则使用呼吸机通气。膈肌起搏的主要适应症是高位颈脊髓损伤后呼吸麻痹以及慢性中枢性通气不足综合征（原发性肺泡低通气综合征的睡眠呼吸暂停）。膈肌起搏可改善四肢瘫痪和呼吸功能不全患者的通气方式和生活质量。鉴于潜在的技术问题、并发症风险以及适合该手术的患者数量有限，膈肌起搏器植入手术应集中在少数几个中心进行，在丹麦可能仅由一个中心开展。
