ISSN:
1432-055X
Schlagwort(e):
Schlüsselwörter Elektrische Zwerchfellstimulation
;
Atemhilfe
;
Respiratorische Insuffizienz
;
Key words Electrical diaphragm stimulation
;
Assisted respiration
;
Respiratory distress
Quelle:
Springer Online Journal Archives 1860-2000
Thema:
Medizin
Beschreibung / Inhaltsverzeichnis:
Abstract Neoplastic or traumatic lesions of the brain stem or the upper spinal cord frequently cause respiratory insufficiency necessitating permanent mechanical ventilation. If the integrity of the diaphragm and its nerves is not affected, adequate ventilation can be achieved by electric stimulation of the phrenic nerves [1, 3, 5, 6]. Diaphragm pacing systems mean the patients can be independent of ventilator treatment. This is a psychological advantage for the patient, giving him or her the option of living in less specialized medical care units and perhaps even at home [4, 9]. Case report. We report the case of a 47-year-old man with a brain stem tumour, which was resected in large pieces. During the postoperative period an increasingly severe respiratory insufficiency developed, which finally made continuous mechanical ventilation necessary. After the viability of the phrenic nerves and contractility of the diaphragm had been shown by direct stimulation of the nerves to be still intact, it was decided that a diaphragm pacer system should be implanted. A “Diaphragm Pacer System S232 G” (Avery Laboratories, Glen Cove, N.Y., USA: external transmitter, antenna, implanted electrode and receiver) was implanted. Using a supraclavicular approach, phrenic nerve electrodes were placed around each nerve and connected with subcutaneous implants of radio signal receivers. Six days after implantation phrenic nerves were stimulated for a first short period. External antenna loops were taped to the skin over the implanted receiver sites (Fig. 3). The impulses produced by the transmitter were delivered via these antenna loops and led to contraction of the diaphragm, providing almost normal respiration. The duration of stimulation was increased stepwise from 1 h a day to full-time stimulation. Three weeks after implantation of the diaphragm pacer system the patient could be totally weaned from mechanical ventilation. After a further 2 weeks it was possible to discharge him from the intensive care unit, and he was then transferred to a rehabilitation centre.
Notizen:
Zusammenfassung Wir berichten über den Fall eines 47jährigen Patienten mit einer durch einen Stammhirntumor bedingten respiratorischen Insuffizienz, die eine vollständige maschinelle Beatmung erforderlich machte. Nachdem die volle Funktionsfähigkeit von Zwerchfellmuskulatur und der Nn. phrenici nachgewiesen worden war, wurde dem Patienten ein Phrenicus-Stimulationssystem implantiert. Der Patient konnte danach innerhalb von drei Wochen vollständig vom Respirator entwöhnt werden. Fünf Wochen nach Implantation des Systems wurde er aus der Betreuung einer neurochirurgischen Intensivstation in eine Rehabilitationsklinik verlegt.
Materialart:
Digitale Medien
URL:
http://dx.doi.org/10.1007/s001010050226
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