心内直视术后膈肌麻痹原因分析

Reason analysis of diaphragm paralysis after open-heart surgery with cardiopulmonary bypass

目的 :探讨体外循环心内直视术后膈肌麻痹的原因和防治对策。方法 :对 1 1 7例心脏手术病人进行回顾性分析。结果 :膈肌麻痹发生率为 1 1 .1 % ( 1 3/1 1 7) ,均为左侧膈肌麻痹 ,病人年龄为 1 6～ 5 4岁。小于 1 6岁的无膈肌麻痹发生。膈肌麻痹多发生在手术时间长、阻断时间长、需多次灌注冷晶体液和多次心包内放置冰泥的病人。结论 :膈肌麻痹与术中心包内放置冰泥 ,导致膈神经冻伤有关。避免冰泥直接接触膈神经 。

Objective: To study the reasons of postoperative diaphragm paralysis of open-heart surgery. Methods: 117 patients undergoing open-heart surgery were given a retrospective analysis. Results: The incidence of diaphragm paralysis was 11.1%(13/117). All patients with diaphragm paralysis were left-sided, 16～54 years old. There was no patient having diaphragm paralysis under 16 years of age. Phrenic nerve damage was more frequent with the patients undergoing long time operation, long time aortic cross clamping,repeated cold crystal solution perfusion,repeated ice/slush topical hypothermia. Conclusion: Diaphragm paralysis is associated with phrenic nerve cold damage resulting from the ice/slush in the pericardium. Avoiding phrenic nerve touching ice slush directly can reduce the incidence of diaphragm paralysis.