小儿心脏手术后膈神经麻痹的负压胸外通气

Negative extrathoracic pressure ventilation for phrenic nerve palsy after paediatric cardiac surgery.

作者信息

Raine J, Samuels M P, Mok Q, Shinebourne E A, Southall D P

机构信息

Department of Paediatrics, Royal Brompton National Heart and Lung Hospital, London.

出版信息

Br Heart J. 1992 Apr;67(4):308-11. doi: 10.1136/hrt.67.4.308.

DOI:10.1136/hrt.67.4.308

PMID:1389705

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1024838/

Abstract

OBJECTIVE

To investigate the feasibility of negative extrathoracic pressure ventilation as a respiratory support following phrenic nerve palsy after cardiac surgery.

DESIGN

An uncontrolled pilot study.

PATIENTS

14 patients aged one week to 30 months (median 5.3 months) with phrenic nerve palsy diagnosed by phrenic nerve conduction tests and diaphragmatic electromyograms. Four had bilateral and 10 unilateral palsy. Before treatment all required oxygen and 10 were receiving positive pressure ventilation. One of the patients with bilateral and four of the patients with unilateral palsies had undergone a plication before negative pressure ventilation was started.

INTERVENTION

Treatment was started 6-65 days (median 23) after operation with a newly designed system which included a Perspex chamber, which gave easy access to the child, and an elastic latex neck seal. Continuous negative pressure was used in conjunction with intermittent positive pressure ventilation while continuous or intermittent negative pressure ventilation was used in extubated infants.

RESULTS

All four patients with bilateral palsy survived with long-term intermittent negative pressure ventilation and did not require further surgery. Of the 10 with unilateral lesions, seven required no further surgery, two underwent plication, and one had a re-plication. Three patients with unilateral palsy died of non-respiratory causes. The duration of positive pressure ventilation after starting negative pressure ranged from 0 to 23 days (median 6). Treatment with negative pressure lasted for 3-241 days (median 32) and was predominantly administered off the intensive care unit, including at home.

CONCLUSIONS

Negative pressure ventilation may be an alternative to positive airway pressure ventilation in the management of phrenic nerve palsy. A multicentre randomised controlled trial is now required to assess further the role of negative pressure ventilation in phrenic nerve palsy.

摘要

目的

探讨体外负压通气作为心脏手术后膈神经麻痹后呼吸支持手段的可行性。

设计

一项非对照性初步研究。

患者

14例年龄在1周至30个月（中位数5.3个月）的患者，通过膈神经传导测试和膈肌肌电图诊断为膈神经麻痹。4例为双侧麻痹，10例为单侧麻痹。治疗前所有患者均需要吸氧，10例接受正压通气。在开始负压通气之前，双侧麻痹患者中有1例、单侧麻痹患者中有4例接受了折叠术。

干预措施

术后6 - 65天（中位数23天）开始治疗，采用新设计的系统，该系统包括一个便于接触患儿的有机玻璃腔室和一个弹性乳胶颈部密封装置。连续负压与间歇正压通气联合使用，而对于已拔管的婴儿则使用连续或间歇负压通气。

结果

4例双侧麻痹患者均在长期间歇负压通气下存活，无需进一步手术。10例单侧病变患者中，7例无需进一步手术，2例接受了折叠术，1例接受了再次折叠术。3例单侧麻痹患者死于非呼吸原因。开始负压通气后正压通气的持续时间为0至23天（中位数6天）。负压治疗持续3至241天（中位数32天），主要在重症监护病房外进行，包括在家中。