膈肌折叠术治疗先天性心脏病术后膈肌麻痹的疗效评价

Clinical efficacy of diaphragmatic plication in the treatment of diaphragmatic paralysis after congenital heart defect operation

目的探究膈肌折叠术治疗先天性心脏病(先心病)术后膈肌麻痹的手术时机及疗效。方法收集2013年1月至2019年2月于阜外医院行膈肌折叠术患儿30例,男17例、女13例,年龄19.5(3,72)个月,其中双侧膈肌麻痹(双侧组)6例,单侧膈肌麻痹(单侧组)24例,比较两组患者的临床资料。结果双侧膈肌麻痹患者中2例行双侧膈肌折叠术,其余4例经单侧膈肌折叠后继续脱机锻炼。单侧组与双侧组比较,呼吸机使用时间较短[(266.77±338.34)h vs.(995.33±622.29)h,P=0.001],总ICU滞留时间较短[(33.21±23.97)d vs.(67.33±28.54)d,P=0.008],差异有统计学意义。双侧组死亡1例,两组差异无统计学意义(P=0.363)。两组患者膈肌折叠术后ICU滞留时间差异无统计学意义[(11.68±10.28)d vs.(29.83±27.73)d,P>0.05]。结论膈肌折叠术是先心病术后膈肌麻痹经保守治疗无效后的有效治疗手段,双侧膈肌麻痹经手术治疗其预后较单侧膈肌麻痹效果差,严格把握手术适应证有利于患儿早期康复。

Objective To investigate the timing and clinical efficacy of diaphragmatic plication in the treatment of diaphragmatic paralysis after congenital heart disease(CHD)operation.Methods From January 2013 to February2019,30 children with CHD who were treated in Fuwai Hospital were collected,including 17 males and 13 females with a median age of 19.5(3,72)months.There were 6 patients with bilateral diaphragmatic paralysis(bilateral group)and 24 patients with unilateral diaphragmatic paralysis(unilateral group).The clinical data of the two groups were compared.Results Among the 6 bilateral diaphragmatic paralysis patients,2 underwent bilateral diaphragmatic plication,and the other 4 patients continued their off-line exercise after unilateral diaphragmatic plication.Patients in the unilateral group had shorter ventilator use time(266.77±338.34 h vs.995.33±622.29 h,P=0.001)and total ICU stay time(33.21±23.97 d vs.67.33±28.54 d,P=0.008)than those in the bilateral group.One patient died in the bilateral group,and there was no statistical difference between the two groups(P=0.363).There was no statistical difference in the ICU stay time after diaphragm plication between the two groups(11.68±10.28 d vs.29.83±27.73 d,P>0.05).Conclusion Diaphragmatic plication is an effective treatment for diaphragmatic paralysis after CHD operation once the conservative treatment failed.The prognosis of bilateral diaphragmatic paralysis is worse than that of unilateral diaphragmatic paralysis.Strict control of indications for surgery is beneficial to the early recovery of patients.