Respiratory Medicine, NHS Forth Valley, Stirling, UK
Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK.
Thorax. 2022 Aug;77(8):834-838. doi: 10.1136/thoraxjnl-2021-218257. Epub 2022 Apr 22.
This study characterised the hemidiaphragm elevation on 3-month interval chest X-rays (CXRs) of patients post COVID-19 pneumonia. 467 CXRs were screened; 19 (4.1%) had an elevated hemidiaphragm. There were 15 (3.2%) patients of interest with new hemidiaphragm elevation, persisting on average 7 months post COVID-19 diagnosis. Symptomatic patients underwent diaphragm ultrasound (n=12), pulmonary function test (n=10), muscle function test (n=6) and neurophysiology (n=5), investigating phrenic nerve function. Ultrasound demonstrated reduced/paradoxical diaphragmatic movements in eight; four of eight had reduced thickening fraction. Neurophysiology peripheral limb studies did not support the differential diagnoses of critical illness neuropathy/myopathy. We propose that, in selected patients, COVID-19 may cause phrenic nerve mononeuritis.
本研究描述了 COVID-19 肺炎患者在 3 个月间隔胸部 X 射线（CXR）中的半膈肌抬高。共筛选了 467 份 CXR，其中 19 份（4.1%）存在半膈肌抬高。有 15 名（3.2%）感兴趣的患者存在新的半膈肌抬高，平均在 COVID-19 诊断后持续 7 个月。有症状的患者接受了膈肌超声（n=12）、肺功能测试（n=10）、肌肉功能测试（n=6）和神经生理学（n=5），以调查膈神经功能。超声显示 8 例膈肌运动减弱/反常；8 例中有 4 例膈肌增厚分数降低。神经生理学肢体周围研究不支持危重病性神经病/肌病的鉴别诊断。我们提出，在一些特定的患者中，COVID-19 可能导致膈神经单神经炎。
