Department of Surgery, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, Netherlands.
Eur J Cardiothorac Surg. 2013 Oct;44(4):643-7. doi: 10.1093/ejcts/ezt094. Epub 2013 Feb 28.
Paralysis of the diaphragm is an uncommon condition, which may result in dyspnoea on excertion and in orthopnea. In patients who have symptoms, the paralysed diaphragm is often plicated to prevent its paradoxical movement on inspiration. This procedure brings relief to many patients, but the mechanism for this improvement is not well understood.
Nine symptomatic patients who underwent plication of a unilateral paralysed hemidiaphragm were prospectively evaluated. All patients underwent pulmonary function tests and cardiopulmonary exercise tests before surgery and repeated them after surgery.
Patients with hemidiaphragm paralysis before surgery were found to have lower tidal volumes at any given ventilation rate during exercise than normal subjects. A clear and consistent change was found in the manner in which patients increased their ventilation during exercise after surgery. All patients showed an increase in tidal volume for a given ventilation rate, which was significant. The plication procedure reduced the respiratory rate for any exercise level in all patients, and this effect was more pronounced during exercise.
In patients with hemidiaphragm paralysis who underwent a diaphragm plication exercise, tidal volumes increased and the ventilatory frequency decreased. Despite this improvement, maximal exercise capacity remained unaltered.
膈神经麻痹是一种罕见的病症，可能导致运动时呼吸困难和端坐呼吸。对于有症状的患者，常采用膈神经折叠术来防止其在吸气时反常运动。该手术可缓解许多患者的症状，但其改善机制尚不清楚。
前瞻性评估了 9 例单侧膈神经麻痹患者接受膈神经折叠术的情况。所有患者均在术前和术后进行了肺功能和心肺运动测试。
术前膈神经麻痹患者在运动时以任何给定通气率的潮气量均低于正常受试者。术后患者在运动中增加通气的方式发生了明显而一致的变化。所有患者在给定通气率下的潮气量均增加，且差异具有统计学意义。膈神经折叠术可降低所有患者在任何运动水平下的呼吸频率，在运动时更为明显。
膈神经折叠术可增加膈神经麻痹患者的潮气量并降低通气频率。尽管有这种改善，但最大运动能力仍未改变。
