肺叶切除术中行膈神经压扎对肺功能的影响

目的探讨肺叶切除术中膈神经压扎对肺功能的影响。方法40例行肺叶切除的患者,其中20例在行肺叶切除后加行膈神经压扎,另外20例未行膈神经压扎,分别测定其膈肌活动度、肺功能及术后发生并发症情况。结果两组患者比较,膈神经压扎组患者的膈肌活动度及肺功能均较未压扎组差,膈肌活动度分别为（1.17±0.41）cm和（2.11±0.42）cm（P〈0.05）;肺功能方面,压扎组患者肺活量、最大分钟通气量及第1秒用力呼气量分别为（70.25±5.25）%、（71.42±7.15）%和（65.50±4.51）%,未压扎组分别为（81.24±4.78）%、（80.87±8.65）%和（76.97±6.26）%,两组比较差异均有统计学意义（P〈0.05）。但术后并发症的发生率,两组之间并无差别。结论肺叶切除时行膈神经压扎将进一步降低患者的肺功能,膈神经压扎在肺叶切除术中并非绝对必要。     

Stimulation of Phrenic nerve activity by an acetylcholine releasing drug: 4-aminopyridine

The effect of the acetylcholine releaser 4-aminopyridine on ventilation was studied by recording and quantifying the efferent phrenic nerve activity in 40 paralysed and vagotomized cats; with arterialP _{O 2},P _{CO 2} and pH kept constant.4-Aminopyridine, given intravenously or in the vertebral artery, stimulates the phrenic nerve activity in a dose dependent manner. The stimulatory effects of 4-aminopyridine on the phrenic nerve activity could be abolished completely by administration of high doses of atropine. We conclude that 4-aminopyridine, which is used clinically for the reversal of a neuromuscular block, stimulates the phrenic nerve activity. Since the role of cholinergic mechanisms in the central chemorecptionn has been well established, the effect on the phrenic nerve activity is most probably by an increased release of acetylcholine at the site of the central chemoreceptors.This study was carried out in the Department of Physiology University of Nijmegen. The Netherlands     

The role of the fusimotor system with respect to the contribution of the diaphragm and the intercostal muscles to the respiratory tidal volume

Summary The efferent electrical activity in the phrenic nerve can be quantified in such a way that it gives a good correlation to tidal volume. After administration of the drug benzoctamine this relationship changes: more phrenic nerve activity is needed for the same tidal volume. No changes were found in the neuro-muscular transmission from the phrenic nerve to the diaphragm. There was no alteration in dynamic compliance of the lungs or in airway resistance. The afferent phrenic nerve activity from proprioceptors in the diaphragm did not change. It seems unlikely that respiratory neurons in the brainstem were affected since the sensitivity of the respiratory system to CO₂ did not change.It is known that the tonic fusimotoneuron activity is suppressed at a supraspinal level by benzoctamine. Since intercostal muscles have muscle spindles and the diaphragm hardly has any, the intercostal muscle activity will be affected more than diaphragmatic activity by benzoctamine. This could actually be shown by quantifying the electromyogram of inspiratory external intercostal muscles.The tidal volume regulation is controlled by the vagal feedback loop. In order to reach a certain tidal volume after administration of benzoctamine, the contribution of the diaphragm has to increase because the activity of the intercostal muscles is diminished.     

大鼠迷走神经和膈神经的解剖相关性实验研究

目的 为大鼠迷走神经移位膈神经重建高位颈髓损伤大鼠的膈肌功能提供显微解剖学依据。 方法　10只健康雌性SD大鼠在10倍手术显微镜下解剖双侧膈神经、迷走神经及其分支。用数显卡尺测量迷走神经与膈神经在“膈神经主干起始平面”、“锁骨上平面”、“入膈肌平面”的相对距离,用读数显微镜测量各平面迷走神经和膈神经的直径。 结果　在颈部,迷走神经直径为（0.3284±0.0247）mm,膈神经直径为（0.2267±0.0164）mm,二者的相对距离很接近,无论是在“膈神经主干起始平面”还是“锁骨上平面”,平均都不超过2.5 mm;在“入膈肌平面”平面,迷走神经直径为（0.2912±0.0326）mm,膈神经直径为（0.2794±0.0282）mm,二者的相对距离较颈部远,左侧为（8.71±0.804）mm,右侧为（6.203±0.952） mm。 结论　(1)在颈部,迷走神经与膈神经的直径相差不大,相对距离很接近,二者可直接无张力缝合。(2)在入膈肌平面,迷走神经与膈神经的直径大致相同,相对距离稍远,但将膈神经和迷走神经向上游离一段距离后仍可实现二者的直接无张力缝合。     

脊髓休克期大鼠迷走神经、膈神经和主动脉神经放电的动态变化

目的：寻找大鼠颈髓横断（CSCT）后脊髓休克期间迷走神经、膈神经和主动脉神经放电的动态变化规律。方法：将50只SD大鼠随机平均分为5组（n=10）：假手术组（A组）、CSCT后0~3h组（B组）、3~6h组（C组）、6~9h组（D组）、9~12h组（E组）。在C7~T1节段完全切断脊髓,建立颈脊髓横断模型,用电生理技术同步记录迷走神经、膈神经和主动脉神经放电、动脉血压和呼吸流量。结果：迷走神经、膈神经和主动脉神经放电呈群集性。B、C、D组迷走神经、膈神经放电周期延长、群集内放电增强、呼吸流量增加,与A组比较,差异有统计学意义（P〈0.05）,其中C组群集内放电最强。B、C、D、E组主动脉神经放电周期延长、群集内放电减弱,B、C、D组的平均动脉压降低,与A组比较,差异有统计学意义（P〈0.05）,其中B、C组主动脉神经群集内放电最弱,平均动脉压最低（P〈0.05）。结论：大鼠颈脊髓横断后,在脊髓休克期间迷走神经、膈神经群集放电活动增强,主动脉神经群集放电减弱,其动态变化与呼吸循环功能的改变有关。     

大鼠膈神经移位迷走神经支配心脏的实验解剖学研究

目的：为大鼠膈神经移位迷走神经支配心脏提供显微解剖学依据。方法：20只健康雄性SD大鼠在10倍手术显微镜下解剖双侧膈神经、迷走神经及其分支。用游标卡尺（精确度为0．02mm）测量膈神经分支直径、长度，迷走神经各段的直径、长度及其与膈神经起始端的距离。结果：（1）大鼠膈神经分支有胸骨支、前外侧支、后支，迷走神经分支有咽支、喉前神经、返神经、心支和胸腹腔支。（2）大鼠膈神经主干起始端直径为（0．22±0．04）mm，其与迷走神经咽支、喉前神经、左侧返神经、右侧返神经、心支、锁骨上水平部的距离分别是（8．46±0．06）mm、（35．98±0．06）mm、（25．66±0．04）mm、（22．88±0．06）mm、（42．06±0．04）mm、（2．46±0．82）mm。结论：迷走神经锁骨上水平发出的主干与膈神经主干起始端较接近，可以与膈神经直接缝合。     

胸腔镜下切取膈神经的应用解剖

目的对胸段膈神经的解剖关系进行了研究。为电视胸腔镜下切取全长膈神经进行移位治疗臂丛损伤奠定解剖学基础。方法选用新鲜尸体6具12侧,对膈神经及其周围器官进行解剖观察。结果胸腔内覆盖膈神经的胸膜较疏松,易于分离;膈神经从锁骨下缘到入肌点的长度为右侧(16.50±2.17)cm,左侧(23.00±2.50)cm;膈神经的血供主要来源于心包膈动脉,心包膈动脉的直径为(1.30±0.15)mm;在胸廓入口处膈神经、心包膈动脉及胸廓内动脉之间的解剖关系不恒定。结论膈神经在胸腔内的解剖特点适合进行电视胸腔镜下的全长游离。但在胸廓入口处,膈神经、胸廓内动脉及由胸廓内动脉发出的心包膈动脉解剖位置不恒定。在临床操作时,该区域的处理是整个手术的关键。     

Morphological study of the ansa cervicalis and the phrenic nerve

Morphological features of ansa cervicalis and phrenic nerve were studied in 106 cadavers. Ansa cervicalis was located medial to the internal jugular vein in 63% (medial type) and lateral to the vein in 33.7% (lateral type). Ansa cervicalis was derived from a combination of C1-C4 spinal segments, with C1-C3 being the most frequent pattern (87.5%). In >60% the ansa was bilaterally symmetrical. The distribution of medial and lateral types was equal on left and right sides of the body. The segmental composition of the inferior root was higher in the medial type and also on the left side of the body. In the lateral type the branches that formed the inferior root frequently (75%) formed a common trunk before joining the superior root, but in 74.8% of the medial type they joined the superior root independently. The phrenic nerve was derived from C4 and C5 in 52%. The C4 segment was present in the phrenic nerve in all cases except one. Additional phrenic components that pass anterior to the subclavian vein were defined as accessory phrenic nerves and found in 28.7%, while those passing posterior to the same vein were defined as secondary phrenic nerves (19.8%). Most of the accessory phrenic nerves contained a C5 segment and the nerve to subclavius was the commonest source. Various relationships between the ansa cervicalis and the phrenic nerve are investigated and, based on these findings, two separate classifications for the two nerves are suggested.     

Facilitation of inspiration by intracerebroventricular injection of thyrotropin-releasing hormone in rabbits

Effects of fourth cerebroventricular injection of thyrotropin-releasing hormone (TRH) on respiration were studied in vagotomized rabbits. Phrenic neural activity was recorded and integrated. TRH (1.0 microgram) injection facilitated phrenic neural activity and increased respiratory rate. Peak phrenic nerve activity increased slightly or showed no apparent changes when tonic activity appeared. Tidal phrenic neural activity either increased or decreased, depending on relations between peak phrenic activity and tonic activity. Results suggest that TRH facilitates central respiratory activity to induce tonic activity and increase respiratory rate.     

The Contribution of the Left Phrenic Nerve to Innervation of the Esophagogastric Junction

The contribution of the left phrenic nerve to innervation of the esophagogastric junction. The esophagogastric junction is part of the barrier preventing gastroesophageal reflux. We have investigated the contribution of the phrenic nerves to innervation of the esophagogastric junction in humans and piglets by dissecting 30 embalmed human specimens and 14 piglets. Samples were microdissected and nerves were stained and examined by light and electron microscopy. In 76.6% of the human specimens, the left phrenic nerve participated in the innervation of the esophagogastric junction by forming a neural network together with the celiac plexus (46.6%) or by sending off a distinct phrenic branch, which joined the anterior vagal trunk (20%). Distinct left phrenic branches were always accompanied by small branches of the left inferior phrenic artery. In 10% there were indirect connections with a distinct phrenic nerve branch joining the celiac ganglion, from which celiac plexus branches to the esophagogastric junction emerged. Morphological examination of phrenic branches revealed strong similarities to autonomic celiac plexus branches. There was no contribution of the left phrenic nerve or accompanying arteries from the caudal phrenic artery in any of the piglets. The right phrenic nerve made no contribution in any of the human or piglet samples. We conclude that the left phrenic nerve in humans contributes to the innervation of the esophagogastric junction by providing ancillary autonomic nerve fibers. Experimental studies of the innervation in pigs should consider that neither of the phrenic nerves was found to contribute. Clin. Anat. 33:265–274, 2020. © 2019 Wiley Periodicals, Inc.     

Pre-inspiratory burst in the caudal medulla of rabbits

The activity of 48 respiratory units in the paraolivary region from the middle to the rostral end of the hypoglossal cranial nerve root, and the effect of electrical stimulation and L-glutamate applied to the region on phrenic nerve activity was investigated in 14 rabbits. Electrical stimulation (50 Hz, 0.2 ms current pulses at intensities 5-20 microA) and L-glutamate (30-100 ng) shortened the expiratory time and increased the respiratory rhythm with no change in tidal phrenic nerve activity. Rhythmic activity preceding the phrenic nerve activity (pre-inspiratory burst) was recorded in the paraolivary region. The temporal relationship between the pre-inspiratory (pre-I) burst and the phrenic activity remained constant even when the respiratory frequency was altered by passive lung inflation. These results suggest that structures in the paraolivary region may influence the respiratory rhythm in rabbits and that pre-I burst neurons may play a role in triggering periodic phrenic activity.     

Spectral Parameters of Phrenic Nerve Activity in Mature Rats during Electrical Stimulation of Retrotrapezoid Nucleus

In mature rats, electrical stimulation of the retrotrapezoid nucleus increased the amplitude and frequency of the high-frequency peak in the firing spectrum of the phrenic nerve, while the amplitude of medium-frequency peak and the amplitude ratio of medium- to high-frequency peaks decreased. These changes in spectral parameters were associated with accelerated increase in central inspiratory activity, decreased amplitude of phrenic nerve firing, and increased frequency of respiratory rhythm. It is hypothesized that being a relay structure of central chemosensitive mechanism, the retrotrapezoid nucleus regulates parameters of medium- and high-frequency spectral peaks of efferent electrical activity in the respiratory center together with the dorsal and ventral respiratory groups.     

膈神经的解剖及临床应用研究进展

目的:为膈神经移位治疗臂丛根性撕托伤,提供应用解剖学资料.方法:查阅与膈神经移位治疗臂丛根性撕托伤相关的解剖与临床文献资料,分析其应用价值和意义.结果:提供膈神经在颈部、胸腔内和膈肌内的走行、位置、毗邻及分支分布资料.结论:膈神经移位是用来治疗臂丛根性撕托伤的主要动力神经;臂丛探索仍是诊断臂丛损伤的全标准.     

The accessory phrenic nerve in the rat

Summary Reinnervation studies of the diaphragm led us to reinvestigate the normal anatomy of the phrenic nerve of the rat. The phrenic nerve originates from the cervical nerve roots C₄ and C₅. In 16 out of 19 normal rats an accessory phrenic nerve was observed receiving its segmental fibres from C₆. The number of myelinated axons of the accessory phrenic nerve varied from 41 to 101 (mean: 64.3, i.e. about 15% of the average number of axons in the common phrenic nerve). The accessory phrenic nerve innervates the dorsal part of the costal and the lateral part of the crural region, whereas the remaining parts of the hemidiaphragm are supplied by the segments C₄ and C₅. There is no evidence for any additional contribution to the motor innervation of the diaphragm from intercostal nerves.Direktor: Prof. Dr. W. ZenkerThis study was supported by the Fonds zur Förderung der wissenschaftlichen Forschung in Österreich.     

Left phrenic nerve anatomy relative to the coronary venous system: Implications for phrenic nerve stimulation during cardiac resynchronization therapy

The objective of this study was to quantitatively characterize anatomy of the human phrenic nerve in relation to the coronary venous system, to reduce undesired phrenic nerve stimulation during left‐sided lead implantations. We obtained CT scans while injecting contrast into coronary veins of 15 perfusion‐fixed human heart‐lung blocs. A radiopaque wire was glued to the phrenic nerve under CT, then we created three‐dimensional models of anatomy and measured anatomical parameters. The left phrenic nerve typically coursed over the basal region of the anterior interventricular vein, mid region of left marginal veins, and apical region of inferior and middle cardiac veins. There was large variation associated with the average angle between nerve and veins. Average angle across all coronary sinus tributaries was fairly consistent (101.3°–111.1°). The phrenic nerve coursed closest to the middle cardiac vein and left marginal veins. The phrenic nerve overlapped a left marginal vein in >50% of specimens. Clin. Anat. 28:621–626, 2015. © 2015 Wiley Periodicals, Inc.     

Substance P-like immunoreactivity in the phrenic nerve and diaphragm: axonal transport of substance P in the phrenic nerve

Substance P-like immunoreactivity was demonstrated in the phrenic nerve of rat in quantities similar to that found in vagus and sciatic nerves. In the diaphragm, the peptide was concentrated in the motor endplate zone. A surgical cut of the phrenic nerve was followed by disappearance of substance P from the motor endplate zone. In addition we could demonstrate axonal transport of substance P in the phrenic nerve after transection of the nerve.     

Control of respiratory and hypotensive response during hypoxic chemoreflex by A5 region neurons in rats

The responses of A5 region neurons, the phrenic nerve, and systemic blood pressure to short-term hypoxia were examined in rats under conditions of spontaneous respiration. Tonic and respiration-modulated neurons increasing their discharge activity during hypoxia were identified. This hypoxia-induced response was more pronounced in the neurons with baseline discharge rate of 0.1–4.5 Hz (electrical activity of neurons increased by 4–5 times) compared to neurons with the baseline activity of 5.4–49.6 Hz (discharge rate increased by 1.4–2.0 times). The latency and duration of activation of all types A5 neurons correlated with the parameters of activation of the phrenic nerve. During hypoxia, activation of A5 neurons corresponded to the period of blood pressure drop (one-third of the reaction time), but not to the period of plateau or recovery phase. Low-, middle, and high-frequency A5 neurons participated in the modulation of hypoxia-provoked respiratory and hypotensive responses. Modulation of the respiratory response by A5 neurons was observed during the entire period of phrenic nerve activation, while modulation of the hypotensive response occurred only during blood pressure decrease. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 142, No. 12, pp. 607–610, December, 2006     

Spectral parameters of phrenic nerve activity in mature rats during electrical stimulation of retrotrapezoid nucleus

In mature rats, electrical stimulation of the retrotrapezoid nucleus increased the amplitude and frequency of the high-frequency peak in the firing spectrum of the phrenic nerve, while the amplitude of medium-frequency peak and the amplitude ratio of medium- to high-frequency peaks decreased. These changes in spectral parameters were associated with accelerated increase in central inspiratory activity, decreased amplitude of phrenic nerve firing, and increased frequency of respiratory rhythm. It is hypothesized that being a relay structure of central chemosensitive mechanism, the retrotrapezoid nucleus regulates parameters of medium-and high-frequency spectral peaks of efferent electrical activity in the respiratory center together with the dorsal and ventral respiratory groups. Translated fromByulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 138, No. 8, pp. 139–143, August, 2004     

人膈肌内神经分支分布

目的：探讨人膈的神经支配和肌内神经分支分布特点。方法：改良Sihler’s肌内神经分支染色法。结果：(1)一侧膈神经入肌后一般分为3—4支(3支型4例,4支型2例),1支(前支)向前内侧走行,支配胸部,1～2支(前外侧支)向外侧走行,支配肋部,最后1支(后支)最粗大,向后下走行,分为后外侧支和后脚支,分别支配膈中心腱外侧叶后外侧的肋部和腰部,各级神经的分支在肌束中部密集排列成神经丛。(2)6例标本均未发现左侧或右侧膈神经越过中线至对侧。(3)2例带肋间肌的标本肉眼未见有肋间神经分支进入膈。结论：(1)左、右膈神经分布于膈,未见左右侧膈神经重叠支配和优势支配。(2)膈神经的终末分支在肌束中部密集排列形成似“肾形”的神经丛带。     

Somatostatin selectively ablates post-inspiratory activity after injection into the Bötzinger complex

Somatostatin (SST) neurons in the ventral respiratory column (VRC) are essential for the generation of normal breathing. Little is known about the neuromodulatory role of SST on ventral respiratory neurons other than that local administration induces apnoea. Here, we describe the cardiorespiratory effects of microinjecting SST into the preBötzinger and Bötzinger complexes which together elaborate a normal inspiratory augmenting and expiratory respiratory pattern, and on spinally projecting respiratory subnuclei (rostral ventral respiratory group; rVRG). Microinjections (20–50 nl) of SST (0.15, 0.45, 1.5 mM) were made into respiratory subnuclei of urethane-anaesthetized, paralysed, vagotomized and artificially ventilated Sprague–Dawley rats (n=46). Unilateral microinjection of SST into the Bötzinger complex converted the augmenting activity of phrenic nerve discharge into a square-wave apneustic pattern associated with a lengthening of inspiratory period and shortening of expiratory time. Following bilateral microinjection the apneusis became pronounced and was associated with a dramatic variability in inspiratory duration. Microinjection of SST into the Bötzinger complex also abolished the post-inspiratory (post-I) motor activity normally observed in vagal and sympathetic nerves. In the preBötzinger complex SST caused bradypnoea and with increasing dose, apnoea. In the rVRG SST reduced phrenic nerve amplitude, eventually causing apnoea. In conclusion, SST powerfully inhibits respiratory neurons throughout the VRC. Of particular interest is the finding that chemical inhibition of the Bötzinger complex with SST ablates the post-I activity that is normally seen in respiratory activity and leads to apneusis. This loss of post-I activity is a unique feature of inhibition with SST and is not seen following inhibition with other agents such as galanin, GABA and endomorphin. The effect seen on post-I activity is similar to the effect of inhibiting the Kölliker–Fuse nucleus in the pons. The mechanism by which SST exerts this effect on Bötzinger neurons remains to be determined.