穿透性颈部创伤后膈肌麻痹导致的慢性呼吸功能障碍：病例报告。
Chronic respiratory dysfunction due to diaphragmatic paralysis following penetrating neck trauma: A case report.
机构信息
Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine.
Department of Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China.
出版信息
Medicine (Baltimore). 2021 Jan 29;100(4):e24043. doi: 10.1097/MD.0000000000024043.
RATIONALE
Respiratory dysfunction resulting from unilateral diaphragmatic paralysis during neck trauma is very rare in adults. We describe the symptoms, diagnosis and treatment of 1 patient with chronic respiratory insufficiency, in whom the diaphragmatic paralysis was associated with phrenic nerve injury due to penetrating neck trauma.
PATIENT CONCERNS
A 50-year-old worker was admitted because of left penetrating neck trauma. Imaging investigations demonstrated elevation of the left hemidiaphragm and the C5 and C6 roots avulsion. He complained of gradually worsening dyspnea on exertion 2 months later.
DIAGNOSES
The patient was diagnosed with chronic respiratory dysfunction secondary to diaphragmatic paralysis, which caused by phrenic nerve injury.
INTERVENTIONS
A conventional video-assisted thoracoscopic diaphragm plication was performed after failed conservative management.
OUTCOMES
The respiratory status improved markedly, and he did well without recurrence until 2 years' follow-up.
LESSONS
The possibilities of phrenic nerve palsy and diaphragmatic paralysis should not be overlooked during the evaluation of neck trauma.
背景
成人因颈部创伤导致单侧膈肌麻痹引起的呼吸功能障碍非常罕见。我们描述了 1 例慢性呼吸功能不全患者的症状、诊断和治疗，该患者的膈肌麻痹与穿透性颈部创伤导致的膈神经损伤有关。
关注点
一名 50 岁工人因左侧穿透性颈部创伤入院。影像学检查显示左半膈肌抬高和 C5 和 C6 神经根撕脱。他在 2 个月后逐渐出现活动时呼吸困难加重的症状。
诊断
患者被诊断为膈神经损伤引起的慢性呼吸功能障碍。
干预措施
在保守治疗失败后，进行了常规的电视辅助胸腔镜膈肌折叠术。
结果
呼吸状况明显改善，在 2 年的随访中，患者情况良好，无复发。
经验教训
在评估颈部创伤时，不应忽视膈神经麻痹和膈肌麻痹的可能性。
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