Long-term efficacy and complications of implantable diaphragm pacer in children with high cervical spinal cord injury: case report and literature review
Long-term efficacy and complications of implantable diaphragm pacer in children with high cervical spinal cord injury: case report and literature review
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.
Abstract
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.
万方数据