心脏直视手术后膈肌麻痹的预防及对策

The prevention and countermeasurs of phrenoparalysis after open-heart surgery

目的探讨心脏直视手术后膈肌麻痹的预防及对策。方法2003年1月￣2006年7月我中心在体外循环下共完成心脏直视手术2434例,术后并发膈肌麻痹11例(正中开胸8例,侧开胸3例),均为3岁以下患儿,难于脱离呼吸机,后均经肋间切口行膈肌折叠治疗。结果膈肌折叠术后10例顺利脱离呼吸机,治愈出院,1例死亡(并发肺部感染、呼吸衰竭)。讨论术中良好的膈神经保护可减少心脏直视术后膈肌麻痹的发生,术后早期积极的膈肌折叠治疗可明显地改善患儿的呼吸功能。

Objective To explore the prevention and treatment of phrenoparalysis after open-heart surgery. Methods From January 2003 to July 2006, 2434 cases of open-heart surgery ban been performed under cardiopulmonary bypass in our hospital. Phrenoparalysis occurred in 11 patients, including 8 median and 3 lateral stemotomies. All patients were below the age of 3 years and failed in departing mechanical ventilation. Diaphragmatic plication was performed via intereostals incisions, Results Ten cases succeeded in depart mechanical ventilation and were dis- charged. One dead of complication of pulmonary infection and respiratory failure. Conclusion Adequate preservation of phrenic nerve would reduce the incidence of phrenoparalysis after open-heart surgery. Aggressive diaphragmatic plieation during the early postoperative period can improve the rospiratory function significantly.