心脏直视手术后膈肌麻痹的预防及对策

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。

The prevention and countermeasurs of phrenoparalysis after open-heart surgery

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 han been performed under cardiopulmonary bypass in our hospital. Phrenoparalysis occurred in 11 patients, including 8 median and 3 lateral sternotomies. All patients were below the age of 3 years and failed in departing mechanical ventilation. Diaphragmatic plication was performed via intercostals incisions. Results Ten cases succeeded in depart mechanical ventilation and were discharged. 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 plication during the early postoperative period can improve the respiratory function significantly.