Postsurgical inflammatory neuropathy should be considered in the differential diagnosis of diaphragm paralysis after surgery.
Postsurgical inflammatory neuropathy should be considered in the differential diagnosis of diaphragm paralysis after surgery.
复制标题
术后膈肌麻痹的鉴别诊断应考虑术后炎症性神经病。
DOI：
10.1097/aln.0000000000000130
复制
发表时间：
2014
期刊：
影响因子：
8.8
通讯作者：
Warner,MarkA
中科院分区：
文献类型：
--
作者：
Staff,NathanP;Dyck,PJamesB;Warner,MarkA
我们饶有兴趣地阅读了Kaufman等人关于术中斜角肌阻滞后膈神经病变发展的文章。虽然这些病例在粘连导致膈神经病变的作用方面得到了很好的描述和指导，但这只是炎症可能导致围手术期神经病变发展的一种潜在机制。神经微血管的局部或全身性炎症和随后的缺血性损伤可在多种神经病变中观察到，包括糖尿病和非糖尿病不对称神经病2,3以及特发性和遗传性臂丛神经病4，后者也有报道称偏爱膈神经。这些情况可能首先成为围手术期的症状，并可能具有重要的医学意义。我们以前报道过手术后出现各种神经病变的患者，包括膈神经病变5。在33例患者中，有21例对远离手术部位的浅表感觉神经进行了活检，我们在所有这些患者中观察到异常数量的神经炎症，其中71%的患者有神经微血管炎的迹象。我们的研究发现，类固醇免疫疗法通常可以改善与这些神经病变相关的疼痛和虚弱。总之，虽然Kaufman等人报道了局部粘连是术后膈神经病变的一个重要原因，但临床医生应该考虑术后神经病变的多种潜在病因，包括神经微血管炎。
We read with interest the article by Kaufman et al. on the development of phrenic neuropathies after intraoperative scalene block1. While these cases are well-described and instructive in the role of adhesions contributing to phrenic neuropathy, this is but one potential mechanism by which inflammation may contribute to the development of perioperative neuropathies. Local or generalized inflammation of the microvessels in nerve and subsequent ischemic injury is observed in a variety of neuropathy conditions, including diabetic and nondiabetic asymmetrical neuropathies 2, 3 and idiopathic and hereditary brachial plexus neuropathy4, the latter of which is also reported to have a predilection for the phrenic nerve. These conditions may first become symptomatic perioperatively, and can have significant medicolegal implications.We have previously reported on patients who developed a variety of neuropathies, including phrenic neuropathy, following surgeries5. In 21 of the 33 patients, superficial sensory nerves distant from the site of surgery were biopsied, and we observed abnormal amounts of nerve inflammation in all of these and signs of nerve microvasculitis in 71% of these. Our study found that immunotherapy with steroids often can improve the pain and weakness associated with these neuropathies. In summary, while Kaufman et al. have reported localized adhesions as one important cause of postsurgical phrenic neuropathy, clinicians should consider diverse potential etiologies of postsurgical neuropathies, including nerve microvasculitis.