Abstract：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.
于贝贝, 陆洋, 王劲, 王贵怀. 功能性电刺激在呼吸功能重建中的应用进展[J]. 中华解剖与临床杂志, 2021, 26(2): 232-235.
Yu Beibei, Lu Yang, Wang Jin, Wang Guihuai. Research progress on functional electrical stimulation for reconstruction of respiratory function. Chinese Journal of Anatomy and Clinics, 2021, 26(2): 232-235.
Kumar R, Lim J, Mekary RA, et al. Traumatic spinal injury: global epidemiology and worldwide volume[J]. World Neurosurg, 2018, 113: e345-e363. DOI:10.1016/j.wneu.2018.02.033.
[2]
王荣, 马鑫文, 杨涛, 等. 急性创伤性颈髓损伤患者术前机械通气的危险因素分析[J]. 中国骨伤, 2019, 32(10): 919-922. DOI:10.3969/j.issn.1003-0034.2019.10.009.Wang R, Ma XW, Yang T, et al. Analysis of risk factors for preoperative mechanical ventilation in patients with acute traumatic cervical spinal cord injury[J]. Chin J Orthopa Trauma, 2019, 32(10): 919-922. DOI:10.3969/j.issn.1003-0034.2019.10.009.
[3]
Hachmann JT, Grahn PJ, Calvert JS, et al. Electrical neuromodu-lation of the respiratory system after spinal cord injury[J]. Mayo Clin Proc, 2017, 92(9): 1401-1414. DOI:10.1016/j.mayocp.2017.04.011.
[4]
DiMarco AF.Phrenic nerve stimulation in patients with spinal cord injury[J]. Respir Physiol Neurobiol, 2009, 169(2): 200-209. DOI:10.1016/j.resp.2009.09.008.
[5]
McCool FD, Manzoor K, Minami T.Disorders of the diaphragm[J]. Clin Chest Med, 2018, 39(2): 345-360. DOI:10.1016/j.ccm.2018.01.012.
[6]
Glenn WW, Hageman JH, Mauro A, et al. Electrical stimulation of excitable tissue by radio-frequency transmission[J]. Ann Surg, 1964, 160: 338-350.
[7]
Glenn WW, Phelps ML, Elefteriades JA, et al. Twenty years of experience in phrenic nerve stimulation to pace the diaphragm[J]. Pacing Clin Electrophysiol, 1986, 9(6): 780-784. DOI:10.1111/j.1540-8159.1986.tb06627.x.
[8]
Morélot-Panzini C, Nierat MC, Tanguy ML, et al. No benefit of diaphragm pacing in upper motor neuron-dominant forms of amyotrophic lateral sclerosis[J]. Am J Respir Crit Care Med, 2018, 198(7): 964-968. DOI:10.1164/rccm.201803-0601LE.
[9]
陈睿, 李建军, 孟宪国.膈肌起搏技术在颈髓损伤患者呼吸功能重建方面的应用综述[J]. 中国康复理论与实践, 2015, (2): 157-162. DOI:10.3969/j.issn.1006-9771.2015.02.008.Chen R, Li JJ, Meng XG.Application of diaphragm pacing technology in respiratory function reconstruction in patients with cervical spinal cord injury (review)[J]. Chinese Journal of Rehabilitation Theory and Practice, 2015, (2): 157-162. DOI:10.3969/j.issn.1006-9771.2015.02.008.
[10]
Nicholson KJ, Nosanov LB, Bowen KA, et al. Thoracoscopic placement of phrenic nerve pacers for diaphragm pacing in congenital central hypoventilation syndrome[J]. J Pediatr Surg, 2015, 50(1): 78-81. DOI:10.1016/j.jpedsurg.2014.10.002.
[11]
DiMarco AF, Onders RP, Ignagni A, et al. Inspiratory muscle pacing in spinal cord injury: case report and clinical commentary[J]. J Spinal Cord Med, 2006, 29(2): 95-108. DOI:10.1080/10790268.2006.11753863.
[12]
Elefteriades JA, Quin JA, Hogan JF, et al. Long-term follow-up of pacing of the conditioned diaphragm in quadriplegia[J]. Pacing Clin Electrophysiol, 2002, 25(6): 897-906. DOI:10.1046/j.1460-9592.2002.00897.x.
[13]
Onders RP, Dimarco AF, Ignagni AR, et al. Mapping the phrenic nerve motor point: the key to a successful laparoscopic diaphragm pacing system in the first human series[J]. Surgery, 2004, 136(4): 819-826. DOI:10.1016/j.surg.2004.06.030.
[14]
DiMarco AF, Onders RP, Ignagni A, et al. Phrenic nerve pacing via intramuscular diaphragm electrodes in tetraplegic subjects[J]. Chest, 2005, 127(2): 671-678. DOI:10.1378/chest.127.2.671.
[15]
Verin E, Morelot-Panzini C, Gonzalez-Bermejo J, et al. Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damage[J]. ERJ Open Res, 2017, 3(4) DOI:10.1183/23120541.00052-2017.
[16]
Grandjean PA, Mortimer JT.Recruitment properties of monopolar and bipolar epimysial electrodes[J]. Ann Biomed Eng, 1986, 14(1): 53-66. DOI:10.1007/BF02364648.
[17]
Peckham PH, Mortimer JT, Marsolais EB.Alteration in the force and fatigability of skeletal muscle in quadriplegic humans following exercise induced by chronic electrical stimulation[J]. Clin Orthop Relat Res, 1976, 114: 326-333.
[18]
Ayas NT, McCool FD, Gore R, et al. Prevention of human diaphragm atrophy with short periods of electrical stimulation[J]. Am J Respir Crit Care Med, 1999, 159(6): 2018-2020. DOI:10.1164/ajrccm.159.6.9806147.
[19]
Pette D, Vrbová G.What does chronic electrical stimulation teach us about muscle plasticity?[J]. Muscle Nerve, 1999, 22(6): 666-677. DOI:10.1002/(sici)1097-4598(199906)22:6<666::aid-mus3>3.0.co;2-z.
[20]
Gater DR Jr, Dolbow D, Tsui B, et al. Functional electrical stimulation therapies after spinal cord injury[J]. NeuroRehabilitation, 2011, 28(3): 231-248. DOI:10.3233/NRE-2011-0652.
[21]
DiMarco AF, Altose MD, Cropp A, et al. Activation of the inspiratory intercostal muscles by electrical stimulation of the spinal cord[J]. Am Rev Respir Dis, 1987, 136(6): 1385-1390. DOI:10.1164/ajrccm/136.6.1385.
[22]
DiMarco AF, Budzinska K, Supinski GS.Artificial ventilation by means of electrical activation of the intercostal/accessory muscles alone in anesthetized dogs[J]. Am Rev Respir Dis, 1989, 139(4): 961-967. DOI:10.1164/ajrccm/139.4.961.
[23]
DiMarco AF, Kowalski KE.High-frequency spinal cord stimulation of inspiratory muscles in dogs: a new method of inspiratory muscle pacing[J]. J Appl Physiol (1985), 2009, 107(3): 662-669. DOI:10.1152/japplphysiol.00252.2009.
[24]
DiMarco AF, Kowalski KE.Intercostal muscle pacing with high frequency spinal cord stimulation in dogs[J]. Respir Physiol Neurobiol, 2010, 171(3): 218-224. DOI:10.1016/j.resp.2010.03.017.
[25]
DiMarco AF, Kowalski KE.Activation of inspiratory muscles via spinal cord stimulation[J]. Respir Physiol Neurobiol, 2013, 189(2): 438-449. DOI:10.1016/j.resp.2013.06.001.
[26]
Henneman E, Somjen G, Carpenter DO.Functional significance of cell size in spinal motoneurons[J]. J Neurophysiol, 1965, 28: 560-580. DOI:10.1152/jn.1965.28.3.560.
[27]
Levy M, Mizrahi J, Susak Z.Recruitment, force and fatigue characteristics of quadriceps muscles of paraplegics isometrically activated by surface functional electrical stimulation[J]. J Biomed Eng, 1990, 12(2): 150-156. DOI:10.1016/0141-5425(90)90136-b.
[28]
DiMarco AF, Supinski GS, Petro JA, et al. Evaluation of intercostal pacing to provide artificial ventilation in quadriplegics[J]. Am J Respir Crit Care Med, 1994, 150(4): 934-940. DOI:10.1164/ajrccm.150.4.7921466.
[29]
Dimarco AF, Kowalski KE.Spinal pathways mediating phrenic activation during high frequency spinal cord stimulation[J]. Respir Physiol Neurobiol, 2013, 186(1): 1-6. DOI:10.1016/j.resp.2012.12.003.
[30]
Hultborn H.Spinal reflexes, mechanisms and concepts: from Eccles to Lundberg and beyond[J]. Prog Neurobiol, 2006, 78(3-5): 215-232. DOI:10.1016/j.pneurobio.2006.04.001.
[31]
Moens M, Goudman L, Brouns R, et al. Return to work of patients treated with spinal cord stimulation for chronic pain: a systematic review and meta-analysis[J]. Neuromodulation, 2019, 22(3): 253-261. DOI:10.1111/ner.12797.
[32]
Hachmann JT, Calvert JS, Grahn PJ, et al. Review of epidural spinal cord stimulation for augmenting cough after spinal cord injury[J]. Front Hum Neurosci, 2017, 11: 144. DOI:10.3389/fnhum.2017.00144.
[33]
杨明亮, 赵红梅, 李建军, 等. 植入式膈肌起搏器在高位颈髓损伤患者中的应用经验及文献分析[J]. 中华结核和呼吸杂志, 2018, 41(9): 718-723. DOI:10.3760/cma.j.issn.1001-0939.2018.09.013.Yang ML, Zhao HM, Li JJ, et al. The clinic experience of implantable diaphragm pacer in a patient with high cervical spinal cord injury and literature review[J]Chin J Tubere Respir Dis, 2018, 41(9): 718-723. DOI:10.3760/cma.j.issn.1001-0939.2018.09.013.
2021, Vol. 26 
