Tripp H F, Bolton J W
Department of Cardiothoracic Surgery, Wilford Hall USAF Medical Center/MKSC 59th Medical Wing (AETC), Lackland Air Force Base, Texas 78236-5300, USA.
J Card Surg. 1998 May;13(3):218-23. doi: 10.1111/j.1540-8191.1998.tb01265.x.
Phrenic nerve injury following cardiac surgery is variable in its incidence depending on the diligence with which it is sought. Definitive studies have shown this complication to be related to cold-induced injury during myocardial protection strategies and possibly to mechanical injury during internal mammary artery harvesting. The consequences are also variable and depend to a large extent on the underlying condition of the patient, particularly with regard to pulmonary function. The response of the patient may range from an asymptomatic radiographic abnormality to severe pulmonary dysfunction requiring prolonged mechanical ventilation and other associated morbidities and even mortality. Two cases are presented to demonstrate the variability in clinical responses to diaphragmatic dysfunction secondary to phrenic nerve injury from cardiac surgery. In addition, treatment strategies are reviewed including early tracheostomy and diaphragmatic plication, which appear to be the most effective options for patients who are compromised by phrenic injuries.
心脏手术后膈神经损伤的发生率因检查的仔细程度而异。权威研究表明，这种并发症与心肌保护策略期间的低温诱导损伤有关，也可能与乳内动脉采集过程中的机械损伤有关。其后果也各不相同，在很大程度上取决于患者的基础状况，尤其是肺功能。患者的反应范围可能从无症状的影像学异常到严重的肺功能障碍，需要长时间机械通气以及其他相关的发病情况甚至死亡。本文介绍两例病例，以说明心脏手术所致膈神经损伤继发膈肌功能障碍的临床反应的变异性。此外，还回顾了治疗策略，包括早期气管切开术和膈肌折叠术，这似乎是受膈神经损伤影响的患者最有效的选择。
