功能性电刺激在呼吸功能重建中的应用进展  

Research progress on functional electrical stimulation for reconstruction of respiratory function

作　　者：于贝贝 陆洋[1,2] 王劲[1,2] 王贵怀[1,2] Yu Beibei;Lu Yang;Wang Jin;Wang Guihuai(School of Clinical Medicine,Tsinghua University,Beijing 100084,China;Department of Neurosurgery,Beijing Tsinghua Changgeng Hospital Affiliated to Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学临床医学院,北京100084 [2]清华大学附属北京清华长庚医院神经外科,北京102218

出　　处：《中华解剖与临床杂志》2021年第2期232-235,共4页Chinese Journal of Anatomy and Clinics

基　　金：北京市科技新星计划(Z181100006218129)。

摘　　要：目的总结功能性电刺激技术在呼吸功能重建方面的应用进展。方法以"膈神经刺激器""膈肌起搏""呼吸起搏器""脊髓电刺激""脊髓损伤""功能性电刺激""呼吸功能不全"以及"phrenic nerve stimulator""diaphragm pacing""respiratory pacemaker""spinal cord stimulation""spinal cord injury""functional electrical stimulation""respiratory insufficiency"等为中、英文关键词,在中国知网、万方数据库、PubMed等中英文数据库中检索2019年12月前发表的与重建呼吸功能的功能性电刺激技术相关的文献822篇,剔除无法获取全文、重复性研究以及存在设计缺陷的文献,最终纳入33篇文献(中文文献3篇、英文文献30篇)进行总结和分析。结果同机械通气相比,体内膈肌起搏对脊髓损伤伴呼吸功能障碍患者是一种更为安全有效的呼吸支持疗法,然而只有50%的受试者能够完全获得呼吸支持。在上胸段脊髓腹侧面施加高频率(300 Hz)电刺激可导致肋间肌和膈肌的协同激活,从而产生更大的潮气量和更强的抗疲劳性。结论不同于传统的膈肌起搏装置,高频脊髓电刺激技术可提供更加有效的呼吸支持治疗。未来,需要进一步的动物实验和最终的临床试验来确定这种电刺激疗法在脊髓损伤人群中的适用性。Objective This study aimed to summarize the progress of related research on functional electrical stimulation in respiratory function reconstruction.Methods The Chinese keywords"膈神经刺激器""膈肌起搏""呼吸起搏器""脊髓电刺激""脊髓损伤""功能性电刺激"and"呼吸功能不全"and the English keywords"phrenic nerve stimulator""diaphragm pacing""respiratory pacemaker""spinal cord stimulation""spinal cord injury""functional electrical stimulation"and"respiratory insufficiency"were used to conduct a search on CNKI,Wanfang Database,and PubMed.A total of 822 papers related to functional electrical stimulation technology for rebuilding respiratory function published before December 2019 were found.Literatures without full text,with repetitive research,and with design flaws were excluded.Thirty-three articles were finally included for summarization and analysis.Results Compared with mechanical ventilation,internal diaphragm pacing is a safer and more effective respiratory support therapy for patients with spinal cord injury and respiratory dysfunction.However,this approach has significant limitations;only 50%of the subjects were able to fully obtain respiratory support.Recent studies have shown that applying high-frequency(300 Hz)electrical stimulation to the ventral surface of the upper thoracic spinal cord can lead to the synergistic activation of the intercostal and diaphragm muscles,which results in greater tidal volume and fatigue resistance.Conclusions Unlike traditional diaphragm pacing devices,high-frequency spinal cord electrical stimulation technology can provide a more effective respiratory support therapy.However,more animal experiments and final clinical trials are needed to determine the applicability of this electrical stimulation therapy to patients with spinal cord injury.

关 键 词：呼吸障碍 脊髓损伤 功能性电刺激 膈肌起搏 脊髓电刺激 机械正压通气 腹侧神经根刺激 

分 类 号：R651.2[医药卫生—外科学]