Thoma H, Girsch W, Holle J, Unger E
Institut für Biomedizinische Technik und Physik, Universität Wien.
Med Klin (Munich). 1997 Apr 28;92 Suppl 1:77-81.
Under certain conditions, phrenic pacing is a rare but most effective and attractive alternative for long-term ventilation. General indications concern diseases of the breathing center, for example Undine's disease (loss of CO2 sensitivity) in infants and high cervical spinal cord lesions in the level of C0 to C3. Despite of the advantage of physiologic respiration mode (no positive air pressure) compared to long-term ventilation, the phrenic pacemaker enables high life quality for the patients due to possibilities of closing of tracheostoma (Vienna system), an optimum in mobility and high cost effectiveness. International research and development in this area concerns 1. nerve transposition of an innervated nerve to a denervating phrenic nerve, 2. additional stimulation of thoracal muscles for inspiration, 3. additional stimulation of expiration, 4. endoscopic operative positioning of the electrodes, 5. development of a pacer with sensor input for an individual respiration rhythm (controlled by the vocal cord) and 6. development of a fully implantable system Improvements of the present pacemaker system may lead to enlargement of indications, for example use in patients with severe nocturnal arrhythmias in respiration.
在某些情况下，膈神经起搏是长期通气的一种罕见但极其有效且有吸引力的替代方法。一般适应症涉及呼吸中枢疾病，例如婴儿的翁丁氏病（二氧化碳敏感性丧失）以及C0至C3水平的高位颈脊髓损伤。尽管与长期通气相比，膈神经起搏器具有生理呼吸模式（无正气压）的优势，但由于存在关闭气管造口术（维也纳系统）的可能性、最佳的活动能力以及高成本效益，它能为患者带来较高的生活质量。该领域的国际研发涉及：1. 将受神经支配的神经移位至失神经支配的膈神经；2. 额外刺激胸部肌肉进行吸气；3. 额外刺激呼气；4. 电极的内镜手术定位；5. 开发具有传感器输入以实现个体呼吸节律（由声带控制）的起搏器；6. 开发完全可植入系统。当前起搏器系统的改进可能会扩大适应症范围，例如用于患有严重夜间呼吸心律失常的患者。
