喉起搏器治疗喉麻痹动物模型的研究  

Investigation of larygeal pacemaker in treating the cat of laryngeal paralysis

作　　者：景江华[1] 迟放鲁[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科,上海200031

出　　处：《中华耳鼻咽喉科杂志》2003年第5期351-354,T001,共5页Chinese Journal of Otorhinolaryngology

基　　金：卫生部科研项目 (98 1 1 61 )

摘　　要：目的　研制呼吸频率调节型喉起搏器 ,在单侧喉返神经麻痹的动物模型中实验其是否能引起与呼吸同步的声带功能性外展运动。方法　喉起搏器带有感受呼吸信号的压力传感器 ,以气体压力的变化作为失神经环杓后肌的起搏信号来源 ,经电刺激使声带外展与呼吸同步。健康猫 6只 ,切断左侧喉返神经。将喉起搏器的刺激电极植入猫左侧环杓后肌。分别于术后即刻、1、2、4、8、1 2周间歇性刺激 ,刺激频率 30Hz ,脉宽 0 6ms ,刺激强度 0～ 8mA。在直接喉镜下观察声带活动情况。术后 1 2周摄录不同的刺激强度下声门图像 ,测量刺激与非刺激时相对声门面积。结果　在喉起搏器作用下 ,麻痹的声带外展与呼吸同步 ,相对声门面积增加 1 8%。喉麻痹 1周后 ,所需刺激强度阈值增大 ,1 2周时接近失神经初始时刺激阈值。结论　本实验研制的呼吸频率调节型喉起搏器 ,能感知动物呼吸节律的改变 ,依呼吸频率调节起搏频率 ,发放吸气期电刺激脉冲使患侧声带外展 。Objective In order to rehabilitate patients with bilateral vocal cord paralysis, we develop a stimulus delivery system for the posterior cricoarytenoid muscle a respiratory frequency regulation laryngeal pacing, to reconstruct the physiological function of the paralysed larynx Methods After left recurrent laryngeal nerve of the six cats were cut,the stimulated electrode was inserted the posterior cricoarytenoid muscle Laryngeal muscles were stimulated at 0,1,2,4,8 and 12 weeks intervals A effective stimulus paradigm in denervated muscle was a 2 millisecond duration pulse, delivered at tetanizing frequency of 30 Hz and an amplitude of 0-8 mA Vocal cord activity with direct laryngoscope was observed at 12 weeks postoperation Results Functional electrical stimulation paced vocal cord abduction in synchrony with inspiration was successfully demonstrated Direct laryngoscope examination of the vocal cords 12 weeks after section confirmed glottis area increase in the stimulus duration The stimulus parameters were identified appropriate Conclusion Laryngeal pacing with stimulation of the posterior cricoarytenoid muscle, paced in synchrony with the inspiratory phase of respiration, restores glottal opening and allows ventilation This is a new technique

关 键 词：喉起搏器 治疗 喉麻痹 动物模型 声带功能 电刺激 喉肌 

分 类 号：R767[医药卫生—耳鼻咽喉科]