DIAPHRAGM PARALYSIS FOLLOWING CARDIAC-SURGERY - ROLE OF PHRENIC-NERVE COLD INJURY
DIAPHRAGM PARALYSIS FOLLOWING CARDIAC-SURGERY - ROLE OF PHRENIC-NERVE COLD INJURY
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DOI：
10.1016/0003-4975(91)91268-z
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发表时间：
1991-10-01
影响因子：
4.6
通讯作者：
WESTABY, S
中科院分区：
文献类型：
--
作者：
EFTHIMIOU, J;BUTLER, J;WESTABY, S
心脏手术后放射学报告了膈肌麻痹，发生率为30%至75%。我们研究了连续100例接受心脏直视手术的患者，其中一半接受冰/雪泥局部低温（第1组），另一半不接受（第2组）。所有横隔抬高的患者均在1周、1个月和此后每6个月进行一次胸部放射学和横隔筛查。测量术后1周有膈肌麻痹放射学证据的所有患者的膈神经传导时间。两组在年龄和性别方面相似。组1（61.5 ± 15.6分钟）的主动脉阻断时间短于组II（74.4 ± 20.8分钟），但差异不显著。然而，在术后第一周内，左下叶部分萎陷的放射学证据（第1组82% vs第2组32%; p < 0.01）和膈肌麻痹的放射学证据（第1组32% vs第2组2%; p < 0.001）存在显著差异。第1组16例患者（15例左侧，1例右侧）发生单侧膈肌麻痹，而第2组仅1例患者发生。在这16例第1组患者中，12例（75%）在术后1个月时仍存在膈肌麻痹，5例（31.3%）在术后1年时仍存在膈肌麻痹。两组在术后心律失常、心肌梗死或死亡率方面无显著差异。膈神经传导时间是反映膈神经冷损伤及恢复的敏感指标。在心脏直视手术中使用冰/雪泥局部低温与膈肌麻痹的高发生率相关，其心肌保护价值可以更有选择性地应用。
Diaphragm paralysis has been reported radiologically after cardiac surgery with an incidence ranging from 30% to 75% of patients. We studied 100 consecutive patients undergoing open heart operations, half of whom received ice/slush topical hypothermia (group 1) and half of whom did not (group 2). Chest radiology and diaphragm screening were performed at 1 week, 1 month, and every 6 months thereafter in all patients with an elevated diaphragm. Phrenic nerve conduction time was measured in all patients in whom there was radiological evidence of diaphragm paralysis 1 week postoperatively. The two groups were similar in terms of age and sex. Aortic cross-clamp time was less in group 1 (61.5 +/- 15.6 minutes) compared with group II (74.4 +/- 20.8 minutes), although this difference was not significant. Significant differences, however, were found for radiological evidence of partial left lower lobe collapse (82% in group 1 versus 32% in group 2; p < 0.01) and for radiological evidence of diaphragm paralysis (32% in group 1 versus 2% in group 2; p < 0.001) within the first postoperative week. Unilateral diaphragm paralysis developed in 16 group 1 patients (15 left sided, 1 right sided) compared with only 1 patient in group 2. In these 16 group 1 patients, diaphragm paralysis was still present in 12 (75%) at 1 month and in 5 (31.3%) at 1 year postoperatively. There were no significant differences between the two groups in terms of postoperative arrhythmias, myocardial infarction, or mortality. Phrenic nerve conduction time was found to be a sensitive indicator of phrenic nerve cold injury and recovery. The use of ice/slush topical hypothermia during open heart operations is associated with a high rate of diaphragm paralysis, and its myocardial protective value could be more selectively applied.