頸椎脊髓損傷病人應用橫膈節律器輔助脫離呼吸器之病例報告

The Application of Diaphragm Pacing System for Weaning of Ventilator in a Cervical Spinal Cord Injury Patient

頸椎脊髓損傷常影響病人自主呼吸的能力而造成長期呼吸器依賴，依據國外的經驗，使用橫膈節律器（diaphragm pacing system，DPS）能幫助這類病人脫離呼吸器並改善生活品質。本個案為全台灣第一例使用DPS之頸椎脊髓受損病人，在置入DPS後個案從呼吸驅動不穩定到呼吸器脫離指數進步，甚至可以執行自主呼吸練習，然而因為DPS在短時間內快速及高強度的刺激，使橫膈膜出現疲乏現象，再加上個案肌肉無力，無法將痰液清除而引發肺炎，導致脫離呼吸器失敗。DPS的介入確實使頸椎脊髓損傷病人更有機會脫離呼吸器，但DPS的設定及訓練流程，仍未有標準指南，在此分享頸椎脊髓損傷病人，使用DPS的呼吸照護經驗，可以做為日後使用DPS的照護經驗參考。

Patients with cervical spinal cord injuries often develop long-term dependence on mechanical ventilation due to phrenic nerve damage. According to international experiences, the use of a diaphragm pacing system (DPS) can assist such patients in weaning from mechanical ventilation and improving their quality of life. This case report presents the first patient in Taiwan with cervical spinal cord injury who received DPS implantation. Following DPS insertion, the patient’s respiratory drive and weaning parameters showed significant improvement and the patient was able to engage in spontaneous breathing trial. However, rapid and high-intensity stimulation from the DPS led to diaphragmatic fatigue. Combined with the patient’s generalized muscle weakness and inability to effectively clear secretions, pneumonia developed, ultimately resulting in failure of ventilator weaning. Although DPS intervention offers cervical spinal cord injury patients greater potential for ventilator liberation, there are currently no standardized protocols for device settings and training procedures. This case report aims to share respiratory care experiences involving DPS use in a patient with cervical spinal cord injury, providing a valuable reference for future clinical applications.