膈神经

颈丛的一混合神经分支,供应和支配对应侧的膈肌

膈神经,为颈丛的一混合(运动和感觉)神经分支,左右各一,供应和支配对应侧的膈肌[1]

膈神经(Phrenic nerve)
膈神经穿过胸腔支配和供应膈肌
膈神经起自颈丛,图示右侧臂丛
基本信息
来源颈丛C3–C5
支配膈肌
标识字符
拉丁文nervus phrenicus
MeSHD010791
TA98A14.2.02.028
TA26380
FMAFMA:6191
格雷氏p.928
神经解剖学术语英语Anatomical terms of neuroanatomy

结构

膈神经属于周围神经系统,起源于颈部的C3-C5脊神经,主要来自 C4 的腹侧支。[2][1][3]发出后膈神经在前斜角肌的上端外侧下行,后沿前斜角肌前面下降至内侧。于锁骨下静脉锁骨下动脉之间经胸廓上口进入胸腔;在胸内,膈神经与心包膈血管伴行,经由肺根前方,纵膈胸膜壁层和心包之间到达隔肌。[2]

行经心包附近,膈神经发出膈神经心包支支配心包纤维层[4]。由于脏层心包对疼痛不敏感,故心包的疼痛主要由膈神经传导。[5]

变异

膈神经可能走行至锁骨下静脉前方,而不是典型地位于静脉后方(锁骨下静脉和动脉之间,锁骨下静脉走行于锁骨下动脉前侧)。[6]

此外,据尸体解剖报道,常有副膈神经英语Accessory phrenic nerve起自脊神经C3或C5[7],主要由C5贡献[8],中国约有48%的人拥有副膈神经。副膈神经可能起自颈袢锁骨下神经[9](分别具有来自 C3 或 C5 的纤维),行走在膈神经外侧,于锁骨下静脉附近加入膈神经。[10][11]

有一案例报道,膈神经和臂丛神经上干之间存在通讯。[3]

临床意义

呼吸

由于膈肌是人体重要的呼吸肌,膈神经的损伤会导致对应侧的膈肌功能障碍,进而导致呼吸障碍。双侧膈肌瘫痪的病人需要通过刺激膈神经、肋间神经转移或具有通气依赖性的永久性气管切开术以维持呼吸。[12]

呃逆

呃逆,通常也被称为打嗝,可能与膈神经运动纤维的不当放电导致的膈肌痉挛有关。[13]横隔膜的痉挛会导致声带突然闭合,进而发出类似于“嗝”的声音[14],亦有观点认为尚不清楚声带是否在此过程中闭合[15]。 膈神经是打嗝反射的传出支:打嗝反射由传入支(膈神经、迷走神经或胸交感纤维)、中枢(无特定中枢)和传出支(主要是膈神经)组成。[16]

Kehr征

传统上,kehr征被描述为当病人躺下抬高双腿时,轻触诊腹部时左肩疼痛,通常与脾破裂有关。这是因为支配左肩的锁骨上神经与膈神经同源(C3-C4),当膈神经受到刺激时左肩亦会感受到疼痛。[17][18]新英格兰医学杂志》的一篇文章提出:当左侧外伤后出现上腹部压痛、左肩疼痛和白细胞增多的三联征时,可强烈提示脾破裂。[18]

参考文献

  1. ^ 1.0 1.1 Patterson, S. K. Phrenic Nerve. Aminoff, Michael J. (编). Encyclopedia of the Neurological Sciences (Second Edition). Oxford: Academic Press. 2014-01-01: 894–896. ISBN 978-0-12-385158-1. doi:10.1016/b978-0-12-385157-4.00687-4. 
  2. ^ 2.0 2.1 Oliver, Kaitlin A.; Ashurst, John V. Anatomy, Thorax, Phrenic Nerves. StatPearls. Treasure Island (FL): StatPearls Publishing. 2024 [2024-03-31]. PMID 30020697. (原始内容存档于2023-04-11). 
  3. ^ 3.0 3.1 Goyal, Neeru; Jain, Anjali. Variant communication of phrenic nerve in neck. Surgical and Radiologic Anatomy. 2019-02, 41 (2). ISSN 0930-1038. doi:10.1007/s00276-018-2123-0 (英语). 
  4. ^ Pericardial Branch of Phrenic Nerve (Left) | Complete Anatomy. www.elsevier.com. [2024-03-31]. (原始内容存档于2024-03-31) (美国英语). 
  5. ^ Rehman, Ibraheem; Nassereddin, Ali; Rehman, Afzal. Anatomy, Thorax, Pericardium. StatPearls. Treasure Island (FL): StatPearls Publishing. 2024 [2024-03-31]. PMID 29489245. (原始内容存档于2021-10-15). 
  6. ^ Prakash, null; Prabhu, L. V.; Madhyastha, S.; Singh, G. A variation of the phrenic nerve: case report and review. Singapore Medical Journal. 2007-12, 48 (12) [2024-03-31]. ISSN 2737-5935. PMID 18043847. (原始内容存档于2023-11-15). 
  7. ^ Banneheka, Shyama. Morphological study of the ansa cervicalis and the phrenic nerve. Anatomical Science International. 2008-03, 83 (1). ISSN 1447-6959. doi:10.1111/j.1447-073X.2007.00201.x (英语). 
  8. ^ Loukas, Marios; Kinsella, Christopher R.; Louis, Robert G.; Gandhi, Sagar; Curry, Brian. Surgical Anatomy of the Accessory Phrenic Nerve. The Annals of Thoracic Surgery. 2006-11, 82 (5) [2024-03-31]. ISSN 0003-4975. doi:10.1016/j.athoracsur.2006.05.098. (原始内容存档于2024-04-07). 
  9. ^ Graves, Matthew J.; Henry, Brandon Michael; Hsieh, Wan Chin; Sanna, Beatrice; PĘkala, PrzemysŁaw A.; Iwanaga, Joe; Loukas, Marios; Tomaszewski, Krzysztof A. Origin and prevalence of the accessory phrenic nerve: A meta‐analysis and clinical appraisal. Clinical Anatomy. 2017-11, 30 (8) [2024-03-31]. ISSN 0897-3806. doi:10.1002/ca.22956. (原始内容存档于2024-03-31) (英语). 
  10. ^ Sharma, Manish S.; Loukas, Marios; Spinner, Robert J. Accessory phrenic nerve: A rarely discussed common variation with clinical implications. Clinical Anatomy. 2011, 24 (5): 671–673 [2024-03-31]. PMID 21374726. S2CID 20001098. doi:10.1002/ca.21142. (原始内容存档于2024-03-31) (英语). 
  11. ^ Oliver, Kaitlin A.; Ashurst, John V. Anatomy, Thorax, Phrenic Nerves. StatPearls. Treasure Island (FL): StatPearls Publishing. 2024 [2024-03-31]. PMID 30020697. (原始内容存档于2023-04-11). 
  12. ^ Oliver, Kaitlin A.; Ashurst, John V. Anatomy, Thorax, Phrenic Nerves. StatPearls. Treasure Island (FL): StatPearls Publishing. 2024 [2024-03-31]. PMID 30020697. (原始内容存档于2023-04-11). 
  13. ^ Wood, Jackie D. Hiccups (Singultus). Johnson, Leonard R. (编). Encyclopedia of Gastroenterology. New York: Elsevier. 2004-01-01: 386–388 [2024-03-31]. ISBN 978-0-12-386860-2. doi:10.1016/b0-12-386860-2/00372-5. (原始内容存档于2024-04-01). 
  14. ^ 打嗝 - 症状与病因 - 妙佑医疗国际. Mayo Clinic. [2024-04-07]. (原始内容存档于2024-04-06) (中文(简体)). 
  15. ^ Stopping hiccups. Harvard Health. 2006-02-01 [2024-04-07]. (原始内容存档于2024-04-06) (英语). 
  16. ^ Quiroga, Juan Brañuelas; García, José Urbano; Guedes, Julio Bolaños. Hiccups: a common problem with some unusual causes and cures. British Journal of General Practice. 2016-11, 66 (652) [2024-04-07]. ISSN 0960-1643. doi:10.3399/bjgp16X687913. (原始内容存档于2024-04-07) (英语). 
  17. ^ Rastogi, Vaibhav; Singh, Devina; Tekiner, Halil; Ye, Fan; Mazza, Joseph J.; Yale, Steven H. Abdominal Physical Signs of Inspection and Medical Eponyms. Clinical Medicine & Research. 2019-12, 17 (3-4) [2024-04-01]. ISSN 1554-6179. PMC 6886890 . PMID 31308022. doi:10.3121/cmr.2019.1420. (原始内容存档于2024-04-01). 
  18. ^ 18.0 18.1 Lowenfels, Albert B. Kehr's Sign — A Neglected Aid in Rupture of the Spleen. New England Journal of Medicine. 1966-05-05, 274 (18) [2024-04-01]. ISSN 0028-4793. doi:10.1056/NEJM196605052741810. (原始内容存档于2024-04-01) (英语).