Krieger A J, Gropper M R, Adler R J
Section of Neurological Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark.
Neurosurgery. 1994 Oct;35(4):760-3; discussion 763-4. doi: 10.1227/00006123-199410000-00028.
Long-term positive pressure mechanical ventilation has been the standard of care for patients with respiratory insufficiency caused by high cervical spine injury. Stimulation of the phrenic nerves, and thus the diaphragm, with an implanted phrenic nerve pacemaker has provided adequate ventilation and an alternative to the standard. Diaphragmatic pacing, also known as electrophrenic respiration, requires an intact phrenic nerve to act as a conduit for the applied stimulus. Propagation of the stimulus is impossible if the injury sustained has led to axonal loss in the phrenic nerve. This may be expected if the damage to the spinal cord is at the C3-C5 level. If the cell bodies of the motor neurons in this region have been damaged, or direct injury to the phrenic nerve has occurred, then diaphragmatic pacing is not feasible by the traditional method. Microsurgical repair of peripheral nerves and nerve grafting have provided the impetus for research into anastomosis of a viable intercostal nerve to a nonfunctional phrenic nerve, with subsequent reinnervation of the diaphragm. Once successful axonal regeneration and diaphragmatic reinnervation have occurred, the distal phrenic nerve may then be paced. This case documents the first successful institution of electrophrenic respiration after intercostal to phrenic nerve anastomosis.
长期正压机械通气一直是高位颈椎损伤所致呼吸功能不全患者的标准治疗方法。植入膈神经起搏器刺激膈神经，进而刺激膈肌，可提供足够的通气，是标准治疗方法的一种替代方案。膈神经起搏，也称为电膈呼吸，需要完整的膈神经作为施加刺激的传导途径。如果所受损伤导致膈神经轴突损失，则刺激无法传导。如果脊髓损伤位于C3 - C5水平，可能会出现这种情况。如果该区域运动神经元的细胞体受损，或者膈神经发生直接损伤，那么传统方法的膈神经起搏就不可行。周围神经显微外科修复和神经移植推动了将有活力的肋间神经与无功能的膈神经进行吻合，随后使膈肌重新获得神经支配的研究。一旦成功实现轴突再生和膈肌重新获得神经支配，就可以对膈神经远端进行起搏。本病例记录了肋间神经与膈神经吻合术后首次成功实施电膈呼吸的情况。
