Zhao H X, D'Agostino R S, Pitlick P T, Shumway N E, Miller D C
Ann Thorac Surg. 1985 May;39(5):445-9. doi: 10.1016/s0003-4975(10)61954-6.
Phrenic nerve injury (PNI) with resulting hemidiaphragmatic paralysis occurred in 19 (2.1 +/- 0.5%) of 891 closed cardiac surgical procedures during a twenty-three-year period. Diagnosis was confirmed by standard radiographic criteria. Phrenic nerve injury was most commonly noted following systemic-pulmonary artery anastomosis, ligation of persistent ductus arteriosus plus pulmonary artery banding, and atrial septectomy. Most patients were managed conservatively (nasotracheal or orotracheal intubation and positive end-expiratory pressure). Although no deaths were a direct result of PNI, major complications occurred in 15 of the 19 instances of PNI (79% +/- 10%). The serious morbidity and the hospital costs associated with this complication, however, underscore the cardinal importance of prevention. If injury does occur, early surgical intervention (diaphragmatic plication) in very young infants may reduce the attendant morbidity, but the complete role of diaphragmatic plication remains to be defined.
在23年期间，891例心脏直视手术中有19例（2.1%±0.5%）发生膈神经损伤（PNI）并导致半侧膈肌麻痹。诊断通过标准影像学标准得以证实。膈神经损伤最常发生在体肺动脉吻合术、动脉导管未闭结扎术加肺动脉环扎术以及房间隔切除术之后。大多数患者采用保守治疗（鼻气管或口气管插管及呼气末正压通气）。虽然没有死亡直接归因于PNI，但19例PNI中有15例（79%±10%）出现了严重并发症。然而，这种并发症所带来的严重发病率和医院费用凸显了预防的至关重要性。如果确实发生损伤，对非常年幼的婴儿进行早期手术干预（膈肌折叠术）可能会降低随之而来的发病率，但膈肌折叠术的完整作用仍有待确定。
