Akata T, Noda Y, Nagata T, Noda E, Kandabashi T
Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Acta Anaesthesiol Scand. 1997 Oct;41(9):1223-5. doi: 10.1111/j.1399-6576.1997.tb04871.x.
The right subclavian artery was inadvertently punctured during attempted preoperative insertion of a right subclavian venous catheter in a 59-yr-old woman undergoing radical hysterectomy. Large supraclavicular swelling became apparent soon after the arterial puncture. The postoperative chest X-ray obtained approximately 24 h after the catheterization revealed significant elevation of the right hemidiaphragm, which was further augmented on the 2nd to 4th postoperative days; oxygenation was concurrently impaired during these days. It was clinically judged that the hemidiaphragmatic paralysis was responsible for the elevated diaphragm. Both chest roentogenogram and arterial blood gas analyses started to improve on the 5th day, finally returning to normal on the 6th day. It is unlikely that the surgical procedure caused the paralysis, because it dealt only with the lower abdomen. Rather, the attempts at the subclavian venous catheterization probably caused the phrenic nerve paralysis, because the phrenic nerve travels very close to the subclavian vessels. Both the large haematoma formation following the arterial puncture and the time course of the paralysis suggest that compression of the right phrenic nerve by the haematoma, rather than needle trauma, was responsible for the paralysis.
在一名59岁接受根治性子宫切除术的女性患者术前试图插入右锁骨下静脉导管时，不慎穿刺了右锁骨下动脉。动脉穿刺后不久，锁骨上出现明显的肿胀。导尿术后约24小时的胸部X线片显示右半膈明显抬高，术后第2至4天进一步加重；在此期间，氧合同时受损。临床判断膈麻痹是导致膈肌抬高的原因。胸部X线片和动脉血气分析在第5天开始改善，最终在第6天恢复正常。手术操作不太可能导致麻痹，因为手术仅涉及下腹部。相反，锁骨下静脉置管尝试可能导致了膈神经麻痹，因为膈神经走行非常靠近锁骨下血管。动脉穿刺后形成的大血肿以及麻痹的时间进程表明，是血肿压迫右膈神经而非针头创伤导致了麻痹。
