Starkova E Yu, Vladimirova N N, Tsvetkova E M, Litau V Yu, Melnikova E A
M.F. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia.
«Central Clinical Hospital with Polyclinic» of the Administrative Directorate of the President of the Russian Federation, Moscow, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2024;101(5):57-65. doi: 10.17116/kurort202410105157.
Diaphragm dysfunction develops in central nervous system damage, chest injuries, complications of cardiac surgery, long-term artificial lung ventilation, respiratory diseases. Anatomical morphological features of phrenic nerves allow to effectively use electromagnetic stimulation methods for functional recovery of the diaphragm in different pathological conditions. Invasive and non-invasive, electric and magnetic methods of stimulation are used depending on the severity of manifestations of the diaphragm dysfunction and its genesis.
To perform a review and comparison of modern methods of electromagnetic stimulation of the diaphragm; to determine the role of repetitive peripheral magnetic stimulation (rPMS) in the diaphragm dysfunction as a result of stroke.
An analysis of publications from the Pubmed and Elibrary databases for 2008-2024 years was conducted. The search was done by the following keywords: diaphragm dysfunction, repetitive peripheral magnetic stimulation of phrenic nerve, stroke, hemiparesis.
There is a real possibility of effective diaphragm stimulation for recovery of its function due to the innervation of the diaphragm strictly by the phrenic nerves, their large diameter, presence of myelinated fibers as well as anatomical location of the phrenic nerves. Direct electric stimulation of the phrenic nerve is usually applied in the case of long-term continuous support of respiratory function. Non-invasive techniques of electric or magnetic stimulation of the phrenic nerve or directly of the diaphragmatic muscle are used in the case of temporary respiratory support or recovery of diaphragm function. The motor neurons of the brain and peripheral nerves are activated, thus a peak strength of the variable magnetic field usually reachs 1-2 T in rPMS. Application of rPMS affects the efferent nerve fibers, causing muscle contractions, and activates sensory afferent fibers, creating a stimulating effect on the superjacent nervous structures. It is advisable to use rPMS of the phrenic nerve in the cervical segment or rPMS of one of the segments of the diaphragmatic muscle in the case of unilateral diaphragm lesion during the recovery period after stroke. It is important to consider the frequency of exposure in the 10-30 Hz range, the closest location of the coil to the stimulation area, the choice of the coil shape depending on the localization when adjusting parameters of rPMS.
The use of rPMS of the phrenic nerve and diaphragm allows to preserve and recover motor and contractile functions of the diaphragm in different pathological conditions, including its unilateral lesion as a result of stroke. The method of rPMS of the phrenic nerves has a number of advantages over electric stimulation and repetitive transcranial magnetic stimulation, since it allows to achieve an effective motor response with less intensity of exposure, is painless and non-contact, better tolerated by patients.
膈肌功能障碍在中枢神经系统损伤、胸部损伤、心脏手术并发症、长期人工肺通气、呼吸系统疾病中都会出现。膈神经的解剖形态学特征使得在不同病理情况下能够有效地运用电磁刺激方法来恢复膈肌功能。根据膈肌功能障碍表现的严重程度及其病因，采用侵入性和非侵入性、电刺激和磁刺激方法。
对现代膈肌电磁刺激方法进行综述和比较；确定重复外周磁刺激（rPMS）在中风导致的膈肌功能障碍中的作用。
对2008 - 2024年Pubmed和Elibrary数据库中的出版物进行分析。通过以下关键词进行检索：膈肌功能障碍、膈神经重复外周磁刺激、中风、偏瘫。
由于膈神经对膈肌的严格支配、其较大的直径、有髓纤维的存在以及膈神经的解剖位置，确实有可能有效地刺激膈肌以恢复其功能。在长期持续支持呼吸功能的情况下，通常采用膈神经直接电刺激。在临时呼吸支持或恢复膈肌功能时，采用膈神经或直接对膈肌进行电刺激或磁刺激的非侵入性技术。大脑和外周神经的运动神经元被激活，因此在rPMS中可变磁场的峰值强度通常达到1 - 2T。应用rPMS会影响传出神经纤维，引起肌肉收缩，并激活感觉传入纤维，对上层神经结构产生刺激作用。在中风恢复期单侧膈肌病变的情况下，建议对颈段膈神经进行rPMS或对膈肌的某一段进行rPMS。在调整rPMS参数时，重要的是要考虑10 - 30Hz范围内的暴露频率、线圈与刺激区域的最接近位置、根据定位选择线圈形状。
使用膈神经和膈肌的rPMS能够在不同病理情况下，包括中风导致的单侧膈肌病变，保留和恢复膈肌的运动和收缩功能。膈神经rPMS方法相对于电刺激和重复经颅磁刺激具有许多优势，因为它能够以较低的暴露强度实现有效的运动反应，无痛且非接触，患者耐受性更好。
