Akay Tankut Hakki, Ozkan Süleyman, Gultekin Bahadir, Uguz Emrah, Varan Birgul, Sezgin Atilla, Tokel Kursad, Aslamaci Sait
Department of Cardiovascular Surgery, Baskent University, 06552, Ankara, Turkey.
Pediatr Surg Int. 2006 Apr;22(4):341-6. doi: 10.1007/s00383-006-1663-2. Epub 2006 Mar 4.
Diaphragmatic paralysis (DP) after cardiac surgery is an important complication especially in infants. We analyzed the incidence, clinical course, surgical management and follow up of the patients with DP, retrospectively. Between 1996 and 2005, 3,071 patients underwent cardiac surgery. Total number of patients with DP was 152 (4.9%). Out of 152 patients, 42 were surgically treated with transthoracic diaphragm plication (1.3%). The overall incidence of diaphragm paralysis was higher in correction of tetralogy of Fallot (31.5%), Blaloc-Taussig (B-T) shunt (11.1%) and VSD closure with pulmonary artery patch plasty (11.1). The incidence of DP which require plication was higher in B-T shunt (23.8%) arterial switch (19%) and correction of tetralogy of Fallot (11.9%). Mean and median age at the time of surgery were 17.8 +/- 3.6 and 6 months, respectively. Median time from cardiac surgery to surgical plication was 12 days. Indications for plication were repeated reintubations (n = 22), failure to wean from ventilator (n = 12), recurrent lung infections (n = 5) and persistent respiratory distress (n = 3). Mortality rate was 19.1%. Being under 1 year of age, pneumonia and plication 10 days after mechanical ventilation were associated with higher incidence mortality (P < 0.05). Phrenic nerve injury is a serious complication of cardiac surgery. It is more common after some special procedures. Spontaneous recovery is very rare. Being under 1 year of age, plication after 10 days from the surgery and pneumonia are major risk factors for mortality even in plicated patients. Transthoracic plication is helpful if performed early.
心脏手术后膈神经麻痹（DP）是一种重要的并发症，尤其在婴儿中。我们回顾性分析了DP患者的发病率、临床病程、手术治疗及随访情况。1996年至2005年间，3071例患者接受了心脏手术。DP患者总数为152例（4.9%）。在152例患者中，42例接受了经胸膈肌折叠术治疗（1.3%）。法洛四联症矫正术（31.5%）、布莱洛克-陶西格（B-T）分流术（11.1%）以及室间隔缺损修补并肺动脉补片成形术（11.1%）后膈神经麻痹的总体发病率较高。需要进行折叠术的DP发病率在B-T分流术（23.8%）、动脉调转术（19%）和法洛四联症矫正术（11.9%）中较高。手术时的平均年龄和中位年龄分别为17.8±3.6个月和6个月。从心脏手术到手术折叠的中位时间为12天。折叠术的指征为反复重新插管（n = 22）、脱机失败（n = 12）、反复肺部感染（n = 5）和持续性呼吸窘迫（n = 3）。死亡率为19.1%。年龄小于1岁、肺炎以及机械通气10天后进行折叠术与较高的死亡率相关（P < 0.05）。膈神经损伤是心脏手术的严重并发症。在一些特殊手术之后更为常见。自发恢复非常罕见。即使是接受了折叠术的患者，年龄小于1岁、手术后10天进行折叠术以及肺炎也是死亡的主要危险因素。早期进行经胸折叠术是有帮助的。
