Beran Elisabeth, Marzouk Joseph F K, Dimitri Wade R
Department of Cardiothoracic Surgery, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
J Card Surg. 2008 Nov-Dec;23(6):691-2. doi: 10.1111/j.1540-8191.2008.00753.x.
Bilateral phrenic nerve palsy is an extremely rare but serious complication of open cardiac surgery. We report the case of a 78-year-old female who underwent elective aortic valve replacement and coronary artery bypass grafting under hypothermic cardiopulmonary bypass. Despite otherwise unremarkable postoperative recovery, the patient could not be weaned off ventilatory support. A chest radiograph and radiological screening of the diaphragm confirmed the diagnosis of bilateral phrenic nerve palsy. Following bilateral hemi diaphragm placation and extensive respiratory rehabilitation the patient was discharged several months after initial surgery breathing independently. Literature review revealed only two similar cases. Many contributing factors have been described but the etiology of bilateral phrenic nerve palsy following open cardiac surgery still remains unclear. Raised awareness of this condition is essential.
双侧膈神经麻痹是心脏直视手术中一种极其罕见但严重的并发症。我们报告一例78岁女性患者，她在低温体外循环下接受了择期主动脉瓣置换术和冠状动脉搭桥术。尽管术后恢复情况在其他方面并无异常，但患者无法撤掉通气支持。胸部X线片和膈肌的影像学检查确诊为双侧膈神经麻痹。在进行双侧半膈肌折叠术和广泛的呼吸康复治疗后，患者在初次手术后数月出院，能够自主呼吸。文献回顾仅发现两例类似病例。虽然已经描述了许多促成因素，但心脏直视手术后双侧膈神经麻痹的病因仍不明确。提高对这种情况的认识至关重要。
