臂丛神经根性损伤膈神经移位术对青壮年患者早期呼吸功能的影响

目的研究臂丛神经损伤膈神经移位术对青壮年患者早期呼吸功能的影响.方法对16例接受膈神经移位治疗的患者,在术前、术后（10 d）进行肺功能指标的比较,同时定期进行门诊随访,观察呼吸系统自觉症状程度.结果13例术后出现了不同程度的供氧不足症状,16例全部出现一侧膈肌抬高,术后第10天肺活量（VC）、肺活量预计值百分数（VC%）分别比术前减少37.98%和26.88%,两者差异有统计学意义（tvc=11.532、tvc%=0,P＜0.01）.其它项目如残气量（RV）较术前轻度下降,肺总量（TLC）下降值达到术前肺总量的36.49%,残气量/肺总量比值（RV/TLC%）较术前上升了4.75%,上述各指标的差值均有统计学意义.1 s用力呼气量/用力肺活量比值（FEV1/FVC）和术前比基本无改变,但其差值有统计学意义.膈神经移位右侧（10例）与左侧（6例）术前、术后肺活量比较差异有统计学意义.术后随访8个月～2年,所有患者均无明显呼吸困难和胸闷等症状.结论膈神经移位术后对青壮年患者肺容量有较大的丧失,肺通气功能减弱和小气道阻力增加,但其丧失程度在机体自身代偿耐受范围内,不会导致急剧发生的严重呼吸功能障碍.建议对右侧臂丛神经根性损伤的患者,术前进行严格的肺、心功能检查,避免发生较为严重的并发症.

Changes of pulmonary function at early postoperative stage of phrenic nerve transfer in young adults with brachial plexus injuries

To observe the impact of phrenic nerve transfer on pulmonary function at early postoperative stage in young adults. Methods 16 patients of brachial plexus injuries who had phrenic nerve transfer were involved in the study. Pulmonary function evaluation was carried out preoperatively and 10 days postoperatively. Those patients were as followed regularly to check the occurrence of respiratory symptoms. Results Postoperatively, 13 patients developed symptoms of respiratory insufficiency. All of them demonstrated unilateral diaphragm elevation on radiography at the operated side. Vital capacity (Vc) and percentage of predicted value of vital capacity (Vc%) decreased 7 . 98 % and 26. 88 % on average respectively. Those changes were statistically significant. Significant difference also existed among residual volume (RV), total lung capacity (FVC), forced expiratory volume at 1.0 second (FEV1), ratio of FEV1 and FVC (FEV1/FVC), when compared with those before the surgery. There was also a statistically significant difference when the variation of pre-and post-operative vital capacity (Vc) between right-sided and left-sided patients were compared. Conclusion Transfer of phrenic nerve in adults led to reduced lung volume and ventilation function and increased treacheole resistance, but which was not beyond the tolerance of the patients and might not give rise to urgent respiratory dysfunction. We suggest that when the right phrenic nerve is used as a donor in neurotization to treat patients with right-sided brachial plexus root avulsion, the pulmonary and cardiac function has to be carefully examined preoperatively to avoid any serious complication.