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目的探讨儿童先天性心脏病术后膈肌麻痹的临床表现、诊断及治疗。方法回顾性分析10 200例先天性心脏病手术后发生膈肌麻痹35例患儿的临床资料,对膈肌麻痹的典型临床表现及确诊方法进行总结,对膈肌折叠术的疗效进行评价。结果膈肌麻痹的发病率为0.34%;35例中左侧膈肌麻痹17例,右侧膈肌麻痹14例,双侧膈肌麻痹4例;脱离呼吸机通气困难35例,再次气管插管32例,呼吸机相关性肺炎29例,气管切开10例;32例行膈肌折叠术,术后均顺利脱离呼吸机辅助通气,膈肌折叠术后呼吸机使用时间较术前明显缩短(P<0.05);无死亡病例。结论先天性心脏病术后膈肌麻痹的发生率较低,膈肌折叠是膈肌麻痹有效的治疗手段。
Objective To investigate the clinical manifestations, diagnosis and treatment of diaphragmatic paralysis in children with congenital heart disease. Methods The clinical data of 35 children with diaphragmatic paralysis after operation of 10 200 congenital heart diseases were retrospectively analyzed. The typical clinical manifestation and diagnosis of diaphragmatic paralysis were summarized, and the curative effect of diaphragmatic fold was evaluated. Results The incidence of diaphragmatic paralysis was 0.34%. The left diaphragmatic paralysis in 17 cases, the right diaphragmatic paralysis in 14 cases and the bilateral diaphragmatic paralysis in 4 cases. Out of 35 ventilator ventilated patients, 32 cases of re-tracheal intubation, 29 cases of machine-related pneumonia, tracheotomy in 10 cases; 32 cases of diaphragmatic fold surgery, were successfully ventilator-assisted ventilation after diaphragmatic fold surgery was significantly shorter duration of ventilator (P <0.05); Deaths. Conclusion The incidence of diaphragmatic paralysis after congenital heart disease is low, and diaphragmatic muscle fold is an effective treatment for diaphragmatic paralysis.