新型冠状病毒感染后膈肌功能障碍2例

Diaphragmatic dysfunction post-COVID-19 infection:report of two cases

随着新冠病毒感染大流行后,新冠病毒导致的并发症和长期后遗症困扰着很多患者,其中呼吸困难较为常见,国外已报道少数病例是由新冠病毒感染后膈肌功能障碍引起,然而国内尚未见相关报道。本文报道了2例新冠病毒感染后呼吸困难患者,入院后通过动态X线胸片发现患者存在膈肌功能障碍,进一步完善膈肌超声、神经电生理检查、跨膈压测定、头颅MRI以及自身免疫性疾病的抗体检测等检查后,最终确定病因分别是新冠病毒感染诱发的重症肌无力以及新冠病毒感染导致的膈神经和膈肌病变。经过治疗,2例患者症状均有所改善。本文结合相关文献回顾对该病的进行总结分析,旨在提高临床医生对该病诊治的认识。

Following the global outbreak of COVID-19,many patients have suffered from multi-system complications and long-term sequelae caused by the virus.Diaphragm dysfunction is an obscure post-COVID-19 symptom.Although a few cases of diaphragm dysfunction caused by COVID-19 infection have been reported abroad,there are no relevant reports in China.Herein,we present two cases of patients with respiratory distress after COVID-19 infection.On admission,dynamic chest radiographs revealed diaphragm dysfunction in these patients.Further investigations including diaphragm ultrasound,neurophysiological examinations,transdiaphragmatic pressure measurements cranial MRI,and antibody testing for autoimmune diseases,were conducted.The final diagnoses were severe myasthenia gravis induced by COVID-19 infection and diaphragmatic nerve and muscle involvement caused by COVID-19 infection.Both patients showed improvement in symptoms after treatment.Therefore,we summarized our case,with a review of the relevant literature to improve the understanding of the disease and to provide clinical evidence for future diagnosis and treatment.