Armengaud M H, Trevoux-Paul J, Boucherie J C, Cousin M T
Département d'Anesthésie-Réanimation Chirurgicale, Hôpital Broussais, Paris.
Ann Fr Anesth Reanim. 1991;10(1):77-80. doi: 10.1016/s0750-7658(05)80274-6.
Two cases of paralysis of the diaphragm occurring after puncture of the internal jugular vein are reported. Both were old cancer patients, requiring an internal jugular venous catheter for intravenous feeding. Although the catheter was easily placed in both cases, the diagnosis of diaphragmatic paralysis was made postoperatively. The first patient remained asymptomatic, despite paradoxical breathing when lying supine; there was no change in her condition up to her death 4 months later. The second patient became increasingly breathless, with hypoxia and hypercapnia, during recovery from a gastrostomy under general anaesthesia. She required artificial ventilation, from which she could not be weaned and died 25 days later. A lesion of the phrenic nerve is possible when placing an internal jugular venous catheter, because they are closely related behind the sternocleidomastoid muscle. In the opposite to compression by a haematoma, or transient blockade following local anaesthetic infiltration, such a direct injury may be irreversible.
报告了两例颈内静脉穿刺后发生膈肌麻痹的病例。两名患者均为老年癌症患者，需要通过颈内静脉置管进行静脉营养。尽管两例置管操作均顺利完成，但膈肌麻痹的诊断是在术后作出的。首例患者虽仰卧时出现反常呼吸，但无任何症状，直至4个月后死亡，病情未发生变化。第二例患者在全身麻醉下胃造口术后恢复过程中，呼吸困难逐渐加重，出现低氧血症和高碳酸血症。她需要进行人工通气，无法撤机，25天后死亡。放置颈内静脉导管时有可能损伤膈神经，因为它们在胸锁乳突肌后方位置密切。与血肿压迫或局部麻醉药浸润后的短暂阻滞不同，这种直接损伤可能是不可逆的。
