DeVita M A, Robinson L R, Rehder J, Hattler B, Cohen C
Montefiore Hospital, Pittsburgh.
Chest. 1993 Mar;103(3):850-6. doi: 10.1378/chest.103.3.850.
To study the incidence of phrenic neuropathy following coronary artery bypass grafting and determine long-term outcome.
Prospective observational.
Surgical ICU in a university hospital, out-patient follow-up.
Ninety-two consecutive patients undergoing open heart surgery.
None.
Chest radiographs (CXR) 48 to 72 h post-operatively, ultrasonography of diaphragm, phrenic nerve conduction studies, diaphragmatic electromyogram, each repeated every 1 to 3 months until normal.
Seventy-eight of 92 (78 percent) patients had abnormal radiographs, 42 of 78 (54 percent) with abnormal CXRs had abnormal diaphragm motion, 24 of 42 (57 percent) with abnormal motion had phrenic neuropathy. Patients with normal diaphragm motion improved faster than those without; patients with normal nerve conduction (and abnormal motion) improved faster than those with abnormal nerve conduction.
Phrenic neuropathy is relatively common if sensitive tests are utilized for diagnosis. Nerve conduction studies can predict duration of morbidity. Most patients have low morbidity and recover fully. Abnormal diaphragm motion alone is not diagnostic of phrenic nerve injury.
研究冠状动脉搭桥术后膈神经病变的发生率并确定其长期预后。
前瞻性观察研究。
大学医院的外科重症监护病房、门诊随访。
92例连续接受心脏直视手术的患者。
无。
术后48至72小时的胸部X线片（CXR）、膈肌超声检查、膈神经传导研究、膈肌肌电图，每1至3个月重复一次，直至结果正常。
92例患者中有78例（78%）X线片异常，78例X线片异常的患者中有42例（54%）膈肌运动异常，42例运动异常的患者中有24例（57%）存在膈神经病变。膈肌运动正常的患者比运动异常的患者恢复得更快；神经传导正常（但运动异常）的患者比神经传导异常的患者恢复得更快。
如果采用敏感的检查方法进行诊断，膈神经病变相对常见。神经传导研究可以预测发病持续时间。大多数患者发病率低且能完全康复。仅膈肌运动异常不能诊断为膈神经损伤。
