植入式膈肌起搏器在高位颈髓损伤患儿中应用的远期疗效及并发症:病例报告及文献复习  

Long-term efficacy and complications of implantable diaphragm pacer in children with high cervical spinal cord injury:case report and literature review

作　　者：谢咏祺 宫慧明[1,2] 杨德刚[1,2] 陈亮[1,2] 贾彦梅[2] 谢杨[1,3] 郭霜 张良 彭润 杨明亮 Xie Yongqi;Gong Huiming;Yang Degang;Chen Liang;Jia Yanmei;Xie Yang;Guo Shuang;Zhang Liang;Peng Run;Yang Mingliang(School of Rehabilitation Medicine,Capital Medical University,Beijing 100068,China;Department of Spinal and Neural Functional Reconstruction,China Rehabilitation Research Center(Beijing Boai Hospital),Beijing 100068,China;Department of Imaging,China Rehabilitation Research Center(Beijing Boai Hospital),Beijing 100068,China;Center of Neural Injury and Repair,Beijing Institute for Brain Disorders,Beijing 100068,China;Beijing Key Laboratory of Neural Injury and Rehabilitation,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院,北京100068 [2]中国康复研究中心(北京博爱医院)脊柱脊髓神经功能重建科,北京100068 [3]中国康复研究中心(北京博爱医院)影像科,北京100068 [4]北京脑重大疾病研究院神经损伤与修复研究所,北京100068 [5]北京市神经损伤与康复重点实验室,北京100068

出　　处：《中华实用儿科临床杂志》2024年第2期134-137,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：首都临床特色诊疗技术研究及转化应用(Z221100007422024)。

摘　　要：回顾性研究2022年9月中国康复研究中心脊柱脊髓神经功能重建科收治的1例C2颈髓损伤(CSCI)患儿使用植入式膈肌起搏器(IDP)的远期疗效及并发症。患儿,男,12岁时无明显诱因出现四肢瘫痪,后完全依赖呼吸机通气。14岁在单侧膈肌起搏模式下可完全脱离呼吸机。术后5年因肺炎使用呼吸机数月后,再次使用IDP,自感起搏效果下降。再次入院后评估发现患儿膈肌轻度萎缩,继发扁平胸及轻度脊柱侧弯。经膈肌起搏阈值优化及康复治疗,患者呼吸功能较前好转。提示IDP可在CSCI患儿长期使用,但需考虑扁平胸、脊柱侧弯限制肺部扩张,同时腹部痉挛加重影响腹部顺应性,从而导致膈肌做功效率降低。The long-term efficacy and complications of implantable diaphragm pacer(IDP)in a child with cervical spinal cord injury(CSCI)in the Department of Spinal and Neural Functional Reconstruction,China Rehabilitation Research Center in September 2022 were retrospective analyzed.A male child had quadriplegia without an obvious cause at the age of 12 years,and he was then lived completely with the assistance of mechanical ventilation.At the age of 14 years,he could wean off the ventilator in unilateral diaphragmatic pacing mode.However,mechanical ventilation was re-given for months after 5 years due to pneumonia,and then the IDP was re-given with the self-felt decreased pacing effect.After hospitalization,the patient was examined with mild diaphragmatic atrophy,secondary flat chest,and mild scoliosis.After optimization of the transdiaphragmatic pacing threshold and rehabilitation,his respiratory function improved.IDP can be used in CSCI for long time,while flat chest and scoliosis that limited the expansion of the lungs should be considered.At the meantime,the increased abdominal spasm affected the abdominal compliance,leading to the decrease in the efficiency of the diaphragm.

关 键 词：儿童 颈髓损伤 植入式膈肌起搏器 并发症 

分 类 号：R726.5[医药卫生—儿科]