Liebscher Thomas, Schauer Thomas, Stephan Ralph, Prilipp Erik, Niedeggen Andreas, Ekkernkamp Axel, Seidl Rainer O
a Centre for Spinal Cord Injuries, Unfallkrankenhaus , Berlin , Germany.
b Control Systems Group, Technische Universität , Berlin , Germany.
J Spinal Cord Med. 2016 Nov;39(6):628-637. doi: 10.1179/2045772315Y.0000000054. Epub 2016 Apr 8.
To examine whether, by enhancing breathing depth and expectoration, early use of breathing-synchronised electrical stimulation of the abdominal muscles (abdominal functional electrical stimulation, AFES) is able to reduce pulmonary complications during the acute phase of tetraplegia.
Prospective proof-of-concept study.
Spinal cord unit at a level 1 trauma center.
Following cardiovascular stabilisation, in addition to standard treatments, patients with acute traumatic tetraplegia (ASIA Impairment Scale A or B) underwent breathing-synchronised electrical stimulation of the abdominal muscles to aid expiration and expectoration. The treatment was delivered in 30-minute sessions, twice a day for 90 days. The target was for nine of 15 patients to remain free of pneumonia meeting Centers for Disease Control and Prevention (CDC) diagnostic criteria.
Eleven patients were recruited to the study between October 2011 and November 2012. Two patients left the study before completion. None of the patients contracted pneumonia during the study period. No complications from electrical stimulation were observed. AFES led to a statistically significant increase in peak inspiratory and expiratory flows and a non-statistically significant increase in tidal volume and inspiratory and expiratory flow. When surveyed, 6 out of 9 patients (67%) reported that the stimulation procedure led to a significant improvement in breathing and coughing.
AFES appears to be able to improve breathing and expectoration and prevent pneumonia in the acute phase of tetraplegia (up to 90 days post-trauma). This result is being validated in a prospective multicentre comparative study.
通过增强呼吸深度和咳痰能力，研究早期使用呼吸同步的腹部肌肉电刺激（腹部功能性电刺激，AFES）是否能够减少四肢瘫痪急性期的肺部并发症。
前瞻性概念验证研究。
一级创伤中心的脊髓病房。
在心血管功能稳定后，除标准治疗外，急性创伤性四肢瘫痪患者（美国脊髓损伤协会损伤分级A或B级）接受呼吸同步的腹部肌肉电刺激以辅助呼气和咳痰。治疗以30分钟为一个疗程，每天两次，共90天。目标是15名患者中有9名符合美国疾病控制与预防中心（CDC）诊断标准且未患肺炎。
2011年10月至2012年11月期间，11名患者被纳入研究。两名患者在研究完成前退出。研究期间所有患者均未患肺炎。未观察到电刺激的并发症。AFES使吸气和呼气峰值流量有统计学显著增加，潮气量以及吸气和呼气流量有非统计学显著增加。在接受调查时，9名患者中有6名（67%）报告刺激程序使呼吸和咳嗽有显著改善。
AFES似乎能够改善四肢瘫痪急性期（创伤后90天内）的呼吸和咳痰能力并预防肺炎。这一结果正在一项前瞻性多中心对照研究中得到验证。
