Somers Tim, Iskander Sandy, Verhagen Ad F T M, Li Wilson W L
Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, Netherlands.
Braz J Cardiovasc Surg. 2025 Jun 4;40(4):e20230239. doi: 10.21470/1678-9741-2023-0239.
Diaphragm elevation is commonly seen after cardiac surgery, mostly due to phrenic nerve injury. However, only historical data is available on the incidence of diaphragm elevation and its consequences during recovery.
We aim to provide contemporary insights into the incidence of diaphragm dysfunction in patients undergoing cardiac surgery and its effect on postoperative outcomes.
Records of all patients undergoing cardiac surgery through sternotomy between 2015 and 2016 at the Radboud University MedicalCentre were retrospectively reviewed. Diaphragm position and elevation were evaluated on available chest radiography. Right-sided diaphragm elevation was defined as the right diaphragm being > 3.0 cm above the left diaphragm; left-sided diaphragm elevation was defined as < 0.5 cm below or above the level of the right diaphragm.
A total of 1510 patients have undergone cardiac surgery through sternotomy during the study period, of which 1316 patients were included in the final analysis. Of these 1316 patients, 13% (n = 179) had pre-existing diaphragm elevation, 27% (n = 351) had a new diaphragm elevation postoperative-y, and 60% (n = 786) had no diaphragm elevation. No statistically significant differences were found between the groups in the occurrence of postoperative (pulmonary) complications or mortality. Of patients who developed new diaphragm elevation postoperatively, 65% recovered in the follow-up period.
New postoperative diaphragm elevation occurs in 27% of patients undergoing cardiac surgery. However, new postoperative diaphragm elevation is not associated with a higher incidence of postoperative complications and spontaneous recovery is seen in most patients.
心脏手术后常见膈肌抬高，主要原因是膈神经损伤。然而，关于膈肌抬高的发生率及其恢复过程中的后果，仅有历史数据。
我们旨在提供关于心脏手术患者膈肌功能障碍发生率及其对术后结局影响的当代见解。
回顾性分析2015年至2016年在拉德堡德大学医学中心接受胸骨切开术的所有心脏手术患者的记录。根据现有的胸部X线片评估膈肌位置和抬高情况。右侧膈肌抬高定义为右侧膈肌比左侧膈肌高>3.0 cm；左侧膈肌抬高定义为比右侧膈肌水平低或高<0.5 cm。
在研究期间，共有1510例患者接受了胸骨切开术心脏手术，其中1316例患者纳入最终分析。在这1316例患者中，13%（n = 179）术前存在膈肌抬高，27%（n = 351）术后出现新的膈肌抬高，60%（n = 786）无膈肌抬高。各组在术后（肺部）并发症或死亡率的发生方面未发现统计学显著差异。术后出现新的膈肌抬高的患者中，65%在随访期间恢复。
27%的心脏手术患者术后出现新的膈肌抬高。然而，术后新的膈肌抬高与术后并发症的较高发生率无关，大多数患者可自发恢复。
