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膈神经电刺激在重症康复方面的应用进展胡正永'马明刘文学^
膈神经由C 4发出，C 3、C 5亦有参与，发出后为椎前筋膜
所覆盖，从前斜角肌t 外侧缘垂直下降于肌的浅面，然后从
前斜角肌内侧缘、锁骨下动静脉之间、经胸廓入口进人胸腔,
与心包膈动脉伴行，经肺丨’]前方沿心包两侧下降，分布于膈
肌和胸膜m ，支配膈肌收缩而吸气的主要肌肉是膈肌，膈肌
提供了 60%—70%的吸气功能，在重症领域有很多疾病存
在或伴有呼吸功能障碍，包括急性呼吸窘迫综合征(acute  re ­spiratory  distress  syndrome , ARDS ) 、 慢性阻 塞性 肺疾病 (chronic  obstructive  pulmonary  disease , COPD )、心力衰竭'
肺动脉高压等，可能导致低氧血症、心律失常、撤机时间延
DOI: 10.3969/j.issn. 1001-1242.2020.02.028
1东南大学附属中大医院，南京,210009: 2通讯作者
第一作者简介：胡正永，男，初级师:1收稿日期= 2018-04-08
长、肺部感染等带来一系列临床问题及社会负担：膈神经电 刺激应用在补偿机械通气|21、帮助撤机w 、改善通气状况等方 面的临床价值已得到证实。自1786年Caldani 提出电刺 激能引起膈肌收缩至今已经有200多年历史几经发展分 为体内膈肌起搏和体外膈肌起搏，两种膈神经刺激方法虽然 因各自优缺点而应用在不同领域：但本文重点不在于选择 何种方式，而是总结国内外近期膈神经刺激在重症康复
方面的应用现状及进展，及膈神经刺激的具体应用方法，综
述如下:habi