膈肌肌电图引导用于一名机械通气撤机困难的肺移植受者：一例报告
Diaphragm electromyography guidance for a lung transplant recipient with difficult weaning from mechanical ventilation: A case report.
作者信息
Xu Yuanda, Qing Qi, Liang Minyong, Liang Weibo, Lin Zhimin, Wu Weiliang, He Weiqun, Liu Xiaoqing, Luo Yuanming, Li Yimin, He Jianxing
机构信息
Department of Critical Care Medicine, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Department of Respiratory and Critical Care Medicine, People's Hospital of Xiangxi Tujia Autonomous Prefecture, Jishou State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
出版信息
Medicine (Baltimore). 2018 Jun;97(23):e10989. doi: 10.1097/MD.0000000000010989.
RATIONALE
Many factors contribute to a complicated postoperative course following difficult weaning off a ventilator after lung transplantation.
PATIENT CONCERNS
A female patient underwent a successful surgery but received a size-mismatched lung graft. The graft had been pruned before transplantation. She experienced delayed ventilator weaning 3 days after lung transplantation.
DIAGNOSES
A postoperative X-ray revealed a normal mediastinal structure and diaphragm position. Diaphragmatic function was assessed by diaphragm electromyography (EMGdi) via esophageal and surface electrodes. EMGdi showed decreased left compound motor action potentials (CMAPs), prolonged left phrenic nerve conduction time (PNCT), failure to induce right CMAPs and PNCT under bilateral magnetic stimulation, and right phrenic nerve injury.
INTERVENTIONS
She was treated with neural nutritional support and prescribed rehabilitation measures such as strengthening limb activities on the bed.
OUTCOMES
The patient finally achieved satisfactory outcomes after an early diagnosis and medical interventions.
LESSONS
Lung size mismatch before transplantation and phrenic nerve injury during surgery should be avoided wherever possible.
原理
肺移植后撤离呼吸机困难会导致术后病程复杂，多种因素均可促成这一情况。
患者情况
一名女性患者手术成功，但接受了大小不匹配的肺移植。移植前对移植物进行了修剪。肺移植术后3天，她出现了延迟撤离呼吸机的情况。
诊断
术后X线显示纵隔结构和膈肌位置正常。通过食管和表面电极，采用膈肌肌电图（EMGdi）评估膈肌功能。EMGdi显示左侧复合运动动作电位（CMAP）降低，左侧膈神经传导时间（PNCT）延长，双侧磁刺激下未能诱发出右侧CMAP和PNCT，提示右侧膈神经损伤。
干预措施
对她进行了神经营养支持治疗，并制定了康复措施，如在床上加强肢体活动。
结果
经过早期诊断和医学干预，患者最终取得了满意的结果。
经验教训
应尽可能避免移植前肺大小不匹配以及手术过程中膈神经损伤。
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