MacBruce D, Safdar S, Katpally K, Shaaban Hamid, Adelman M
Department of Internal Medicine, Newark, NJ, An Affiliate of New York Medical College, NY, USA; Department of Pulmonary and Critical Care Medicine, Saint Michael's Medical Center, Newark, NJ, An Affiliate of New York Medical College, NY, USA.
Lung India. 2016 May-Jun;33(3):330-2. doi: 10.4103/0970-2113.180919.
Diaphragmatic paralysis is an unusual and often underrecognized cause of dyspnea. We present a case of bilateral diaphragmatic paralysis with no identifiable etiology. Our patient is a 73-year-old female with a history of smoking who presented with dyspnea and orthopnea. She was treated for obstructive lung disease with no improvement in dyspnea despite adequate therapy. She had pulmonary function tests (PFTs) that revealed marked decrease in vital capacity and was unable to perform lung volume maneuvers supine due to marked dyspnea. The maximal inspiratory pressure was 37 in the upright position and decreased to 27 in the supine position. She was given a presumptive diagnosis of idiopathic bilateral diaphragmatic dysfunction. Given the history, physical exam, and PFT findings, we felt that the patient did not need further invasive testing. The patient was treated with noninvasive mechanical ventilation due to hypercapnia and her symptoms improved.
膈肌麻痹是一种不常见且常未被充分认识的呼吸困难原因。我们报告一例双侧膈肌麻痹且病因不明的病例。我们的患者是一名73岁有吸烟史的女性，因呼吸困难和端坐呼吸就诊。她因阻塞性肺疾病接受治疗，尽管治疗充分，但呼吸困难并无改善。她进行了肺功能测试（PFTs），结果显示肺活量显著下降，且由于明显的呼吸困难无法仰卧位进行肺容积动作。最大吸气压力在直立位时为37，仰卧位时降至27。她被初步诊断为特发性双侧膈肌功能障碍。鉴于病史、体格检查和PFT结果，我们认为该患者无需进一步的侵入性检查。由于高碳酸血症，该患者接受了无创机械通气治疗，症状得到改善。
