膈神经移位治疗产伤性臂丛神经麻痹对呼吸功能的影响

The Effect on Respiratory Function After Phrenic Nerve Translocation in Obstetric Brachial Paralysis

目的 提高对膈神经移位治疗产瘫术后对呼吸功能影响的认识。方法 对６８ 例产瘫患儿术后呼吸系统变化进行分组分析。结果 膈神经移位组术后摄胸片一侧膈肌均有抬高， 透视下随呼吸呈矛盾运动。术后呼吸窘迫、肺炎、肺不张等明显高于非膈神经移位组。按年龄划分小于６ 个月手术组并发症明显高于６ 个月以上组， 呼吸窘迫均出现在小于３ 个月的手术组中。结论 膈神经作为移位神经被广泛应用到治疗产瘫手术中。临床上６ 个月以下取膈神经应慎重， 尤其３ 个月龄左右手术的病例更应慎重。

Objective To improve the understanding of respiratory function after phrenic nerve translocation in the treatment for obstetric brachial plexus paralysis. Methods The changes of respiratory function after phrenic nerve translocation on 68 cases were analyzed. The age ranged from 2 months to 12 years. They were divided into Group Ⅰ. Phrenic nerve translocation (41 times) and Group Ⅱ. Non phrenic nerve translocation (40 times). Results All cases of Group Ⅰ had diaphragmatic elevation and paradoxical respiration. The incidence of respiratory distress, pneumonia, atelectasis in Group Ⅰ was obviously higher than that in Group Ⅱ. The complications in cases under 6 months of age was higher than that in the older group. The respiratory distress all occurred in patients less than 3 months of age. Conclusions The translocation of phrenic nerve is extensively applied to treat obstetric paralysis. It should be prudent in patients aging less than 6 months, especially those younger than 3 months.