先天性心脏病心脏直视术后膈肌麻痹的诊断与外科治疗  

Diagnosis and surgical treatment of diaphragmatic paralysis after open heart surgery for congenital heart disease

作　　者：刘承虎[1] 程沛[1] 刘爱军[1] 李斌[1] 王执一 苏俊武[1] LIU Chenghu;CHENG Pei;LIU Aijun;LI Bin;WANG Zhiyi;SU Junwu(Department of the Pediatric Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所北京市儿童心血管病中心小儿心脏中心

出　　处：《心肺血管病杂志》2019年第5期504-509,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨先天性心脏病(CHD)心脏直视术后并发膈肌麻痹(DP)的诊断、病因与膈肌折叠术(DPP)的适应证及术后效果。方法:回顾性分析2010年1月至2019年3月,安贞医院小儿心脏中心,CHD术后因DP行膈肌折叠手术13例患儿的临床资料。其中男性7例,女性6例,患儿中位手术年龄3(1,105)个月,中位体质量5.1(4.1,34)kg,心脏直视手术术后中位天数20(5,42)d接受DPP术,其中行单侧DPP术10例,左侧3例,右侧7例;行双侧DPP术3例;行CHD根治手术8例,其中完全性肺静脉异位引流(心上型)3例,室间隔完整的肺动脉闭锁3例,合并室间隔缺损的主动脉弓离断1例,合并室间隔缺损的主动脉弓缩窄1例;姑息手术5例,包括上腔静脉右肺动脉吻合术(Gleen)2例,升主动脉主-肺动脉人工血管吻合术(B-T)2例,肺动脉环缩术(PAB)1例。CHD术后均不能脱离呼吸机辅助或脱机后有严重呼吸困难,多次气管插管,经胸X线片和/或B超确断。结果:住院死亡2例,均死于全身感染、感染中毒性休克死亡。ICU中位滞留时间54(2,106)d,中位住院时间65(29,159)d。余11例患儿心肺功能得到恢复,顺利脱离呼吸机。随访9例,中位随访时间26.2(1,62)个月,胸X线检查膈肌位置正常。结论:先心病患儿术后发生膈肌麻痹时,经胸DPP术是安全有效的治疗方法,术中预防是避免发生的关键。Objective:To Investigate the cause and diagnosis of diaphragmatic paralysis after open heart surgery for congenital heart disease(CHD),and the indications、postoperative effects of diaphragm plication procedure.Methods:Retrospective analysis the clinical data of 13 cases of children undergoing the diaphragmatic plication procedure(DPP)due to diaphragmatic paralysis(DP)after CHD surgery in the pediatric heart center of anzhen hospital from January 2010 to March 2019.The median age of surgery was 3(1,105)months,and the mediam body weight was 5.1(4.1,34)kg.The patients underwent diaphragm plication after open heart surgery about 15(5,43)days,there were 10 cases of unilateral diaphragm plication,including 3 cases on the left and 7 cases on the right,and 3 cases of Bilateral diaphragmatic plication.Among them,8 cases underwent radical CHD surgery.3 cases of TAPVC,3 cases PAT,1 case Co-a,and 1 case IAA.There were 5 cases of palliative surgery,including 2 cases of Gleen,2 cases of B-T and 1 case of PAB.All of the patients could not be separated from the ventilator and had severe dyspnea after off-line operation,multiple endotracheal intubation,and confirmed by X-ray and/or B-ultrasound.Results:Two patients died in hospital,both from systemic infection and toxic shock.ICU residence time was 54(2,106)d,and hospitalization time was 65(29,159)d.The other11 cases recovered their cardiopulmonary function and successfully got off the ventilator.Follow up 26.2 months(1,62 months),chest x-ray examination of the location of the diaphragm is normal,Conclusions:The Diaphragmatic plication is a safe and effective treatment method,and intraoperative prevention is the key to avoid the occurrence.

关 键 词：膈肌折叠术 膈神经麻痹 心脏直视手术 先天性心脏病 

分 类 号：R54[医药卫生—心血管疾病]