先天性心脏病术后膈肌麻痹的诊断治疗进展_West China Medical Journal

Authors：

 邓妮 , 詹凯 , 邓丽静

四川大学华西医院重症医学科（成都 610041）;

Corresponding author：

Keywords：

先天性心脏病; 膈肌麻痹; 诊断; 治疗

DOI：

10.7507/1002-0179.20150052

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单侧甚至双侧膈肌麻痹是先天性心脏病术后的重要并发症，是导致患者康复延迟和病死率增加的常见原因。膈肌麻痹的早期诊断和治疗可明显缩短患者通气时间和住院时间。但是临床实际工作中膈肌麻痹通常不容易被察觉，误诊率、漏诊率高，现就膈肌麻痹的病因、临床特征、诊断及治疗进展作一综述。

Citation： 邓妮, 詹凯, 邓丽静. 先天性心脏病术后膈肌麻痹的诊断治疗进展. West China Medical Journal, 2015, 30(1): 171-174. doi: 10.7507/1002-0179.20150052 Copy

1.	Gayan-Ramirez G, Gosselin N, Troosters TA, et al. Functional recovery of diaphragm paralysis:a long-term follow-up study[J]. Respir Med, 2008, 102(5):690-698.
2.	Qureshi A. Diaphragm paralysis[J]. Semin Respir Crit Care Med, 2009, 30(3):315-320.
3.	Dagan O, Nimri R, Katz Y, et al. Bilateral diaphragm paralysis following cardiac surgery in children:10-years' experience[J]. Intensive Care Med, 2006, 32(8):1222-1226.
4.	Lemmer J, Stiller B, Heise G, et al. Postoperative phrenic nerve palsy:early clinical implications and management[J]. Intensive Care Med, 2006, 32(8):1227-1233.
5.	Akay TH, Ozkan S, Gultekin B, et al. Diaphragmatic paralysis after cardiac surgery in children:incidence, prognosis and surgical management[J]. Pediatr Surg Int, 2006, 22(4):341-346.
6.	Joho-Arreola AL, Bauersfeld U, Stauffer UG, et al. Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children[J]. Eur J Cardiothorac Surg, 2005, 27(1):53-57.
7.	Watanabe T, Trusler GA, Williams WG, et al. Phrenic nerve paralysis after pediatric cardiac surgery. Retrospective study of 125 cases[J]. J Thorac Cardiovasc Surg, 1987, 94(3):383-388.
8.	Mickell JJ, Oh KS, Siewers RD, et al. Clinical implications of post-operative unilateral phrenic-nerve paralysis[J]. J Thorac Cardiovascr Surg, 1978, 76(3):297-304.
9.	Groth SS, Andrade RS. Diaphragm plication for eventration or paralysis:a review of the literature[J]. Ann Thorac Surg, 2010, 89(6):S2146-S2150.
10.	Davis J, Goldman M, Loh L, et al. Diaphragm function and alveolar hypoventilation[J]. Q J Med, 1976, 45(177):87-100.
11.	Robotham JL. A physiological approach to hemidiaphragm paralysis[J]. Crit Care Med, 1979, 7(12):563-566.
12.	Kodric M, Trevisan R, Torregiani C, et al. Inspiratory muscle training for diaphragm dysfunction after cardiac surgery[J]. J Thorac Cardiovasc Surg, 2013, 145(3):819-823.
13.	Wang CS, Josenhaus WT. Contribution of diaphragmatic-abdominal displacement to ventilation in supine man[J]. J Appl Physiol, 1971, 31(4):576-580.
14.	Amin Z, Mcelhinney DB, Strawn JK, et al. Hemidiaphragmatic paralysis increases postoperative morbidity after a modified Fontan operation[J]. J Thorac Cardiovasc Surg, 2001, 122(5):856-862.
15.	Ovroutski S, Alexi-Meskishvili V, Stiller B, et al. Paralysis of the phrenic nerve as a risk factor for suboptimal Fontan hemodynamics[J]. Eur J Cardiothorac Surg 2005, 27(4):561-565.
16.	Talwar S, Agarwala S, Mittal CM, et al. Diaphragmatic palsy after cardiac surgical procedures in patients with congenital heart[J]. Ann Pediatr Cardiol, 2010, 3(1):50-57.
17.	Chetta A, Rehman AK, Moxham J, et al. Chest radiography cannot predict diaphragm function[J]. Respir Med, 2005, 99(1):39-44.
18.	李永青, 李守军, 吕小东, 等.婴幼儿心脏手术后膈肌麻痹的超声诊断[J].中国超声医学杂志, 2010, 26(7):631-633.
19.	Lerolle N, Guérot E, Dimassi S, et al. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery[J]. Chest, 2009, 135(2):401-407.
20.	Jammes Y, Budin-Poirier C, Brégeon F. Electromyographic tools to assess hemidiaphragm paralysis[J]. Clin Physiol Funct Imaging, 2010, 30(2):107-115.
21.	Bordessoule A, Emeriaud G, Delnard N, et al. Recording diaphragm activity by an oesophageal probe:a new tool to evaluate the recovery of diaphragmatic paralysis[J]. Intensive Care Med, 2010, 36(11):1978-1979.
22.	Wilcox PG, Paré PD, Pardy RL. Recovery after unilateral phrenic injury associated with coronary artery revascularization[J]. Chest, 1990, 98(3):661-666.
23.	Cohen AJ, Katz MG, Katz R, et al. Phrenic nerve injury after coronary artery grafting:is it always benign?[J]. Ann Thorac Surg, 1997, 64(1):148-153.
24.	Mehta Y, Vats M, Singh A, et al. Incidence and management of diaphragmatic palsy in patients after cardiac surgery[J]. Indian J Crit Care Med, 2008, 12(3):91-95.
25.	Iverson L, Mittal A, Dugan DJ, et al. Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma[J]. Am J Surg, 1976, 132(2):263-269.
26.	van Meeteren NLU, Brakee JH, Hamers FTP, et al. Exercise training improves functional recovery and motor nerve conduction velocity after sciatic nerve crush lesion in the rat[J]. Arch Phys Med Rehab, 1997, 78(1):70-77.
27.	Kovacikova L, Dobos D, Zahorec M. Non-invasive positive pressure ventilation for bilateral diaphragm paralysis after pediatric cardiac surgery[J]. Interact Cardiovasc Thorac Surg, 2009, 8(1):171-172.
28.	Oktem S, Cakir E, Uyan ZS, et al. Diaphragmatic paralysis after pediatric heart surgery:usefulness of non-invasive ventilation[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(4):430-431.
29.	Versteegh M, Braun J, Voigt PG, et al. Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea[J]. Eur J Cardiothorac Surg, 2007, 32(3):449-456.
30.	Freeman RK, van Woerkom J, Vyverberg AA. Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis[J]. Ann Thorac Surg, 2009, 88(4):1112-1117.
31.	Stauffer UG, Rickham PP. Acquired eventration of the diaphragm in the newborn[J]. J Pediatr Surg, 1972, 7(6):635-640.
32.	Schwartz MZ, Filler RM. Plication of the diaphragm for symptomatic phrenic nerve paralysis[J]. J Pediatr Surg, 1978, 13(3):259-263.
33.	Hamilton JR, Tocewicz K, Elliott MJ, et al. Paralysed diaphragm after cardiac surgery in children:value of plication[J]. Eur J Cardiothorac Surg, 1990, 4(9):487-490.
34.	Georgiev S, Konstantinov G, Latcheva A, et al. Phrenic nerve injury after paediatric heart surgery:is aggressive plication of the diaphragm beneficial?[J]. Eur J Cardiothorac Surg, 2013, 44(5):808-812.
35.	Ko MA, Darling GE. Acquired paralysis of the diaphragm[J]. Thorac Surg Clin, 2009, 19(4):501-510.
36.	DiMarco AF, Onders RP, Ignagni A, et al. Phrenic nerve pacing via intramuscular diaphragm electrodes in tetraplegic subjects[J]. Chest, 2005, 127(2):671-678.
37.	Kaufman MR, Elkwood AI, Rose MI, et al. Reinnervation of the paralyzed diaphragm application of nerve surgery techniques following unilateral phrenic nerve injury[J]. Chest, 2011, 140(1):191-197.

1. Gayan-Ramirez G, Gosselin N, Troosters TA, et al. Functional recovery of diaphragm paralysis:a long-term follow-up study[J]. Respir Med, 2008, 102(5):690-698.
2. Qureshi A. Diaphragm paralysis[J]. Semin Respir Crit Care Med, 2009, 30(3):315-320.
3. Dagan O, Nimri R, Katz Y, et al. Bilateral diaphragm paralysis following cardiac surgery in children:10-years' experience[J]. Intensive Care Med, 2006, 32(8):1222-1226.
4. Lemmer J, Stiller B, Heise G, et al. Postoperative phrenic nerve palsy:early clinical implications and management[J]. Intensive Care Med, 2006, 32(8):1227-1233.
5. Akay TH, Ozkan S, Gultekin B, et al. Diaphragmatic paralysis after cardiac surgery in children:incidence, prognosis and surgical management[J]. Pediatr Surg Int, 2006, 22(4):341-346.
6. Joho-Arreola AL, Bauersfeld U, Stauffer UG, et al. Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children[J]. Eur J Cardiothorac Surg, 2005, 27(1):53-57.
7. Watanabe T, Trusler GA, Williams WG, et al. Phrenic nerve paralysis after pediatric cardiac surgery. Retrospective study of 125 cases[J]. J Thorac Cardiovasc Surg, 1987, 94(3):383-388.
8. Mickell JJ, Oh KS, Siewers RD, et al. Clinical implications of post-operative unilateral phrenic-nerve paralysis[J]. J Thorac Cardiovascr Surg, 1978, 76(3):297-304.
9. Groth SS, Andrade RS. Diaphragm plication for eventration or paralysis:a review of the literature[J]. Ann Thorac Surg, 2010, 89(6):S2146-S2150.
10. Davis J, Goldman M, Loh L, et al. Diaphragm function and alveolar hypoventilation[J]. Q J Med, 1976, 45(177):87-100.
11. Robotham JL. A physiological approach to hemidiaphragm paralysis[J]. Crit Care Med, 1979, 7(12):563-566.
12. Kodric M, Trevisan R, Torregiani C, et al. Inspiratory muscle training for diaphragm dysfunction after cardiac surgery[J]. J Thorac Cardiovasc Surg, 2013, 145(3):819-823.
13. Wang CS, Josenhaus WT. Contribution of diaphragmatic-abdominal displacement to ventilation in supine man[J]. J Appl Physiol, 1971, 31(4):576-580.
14. Amin Z, Mcelhinney DB, Strawn JK, et al. Hemidiaphragmatic paralysis increases postoperative morbidity after a modified Fontan operation[J]. J Thorac Cardiovasc Surg, 2001, 122(5):856-862.
15. Ovroutski S, Alexi-Meskishvili V, Stiller B, et al. Paralysis of the phrenic nerve as a risk factor for suboptimal Fontan hemodynamics[J]. Eur J Cardiothorac Surg 2005, 27(4):561-565.
16. Talwar S, Agarwala S, Mittal CM, et al. Diaphragmatic palsy after cardiac surgical procedures in patients with congenital heart[J]. Ann Pediatr Cardiol, 2010, 3(1):50-57.
17. Chetta A, Rehman AK, Moxham J, et al. Chest radiography cannot predict diaphragm function[J]. Respir Med, 2005, 99(1):39-44.
18. 李永青, 李守军, 吕小东, 等.婴幼儿心脏手术后膈肌麻痹的超声诊断[J].中国超声医学杂志, 2010, 26(7):631-633.
19. Lerolle N, Guérot E, Dimassi S, et al. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery[J]. Chest, 2009, 135(2):401-407.
20. Jammes Y, Budin-Poirier C, Brégeon F. Electromyographic tools to assess hemidiaphragm paralysis[J]. Clin Physiol Funct Imaging, 2010, 30(2):107-115.
21. Bordessoule A, Emeriaud G, Delnard N, et al. Recording diaphragm activity by an oesophageal probe:a new tool to evaluate the recovery of diaphragmatic paralysis[J]. Intensive Care Med, 2010, 36(11):1978-1979.
22. Wilcox PG, Paré PD, Pardy RL. Recovery after unilateral phrenic injury associated with coronary artery revascularization[J]. Chest, 1990, 98(3):661-666.
23. Cohen AJ, Katz MG, Katz R, et al. Phrenic nerve injury after coronary artery grafting:is it always benign?[J]. Ann Thorac Surg, 1997, 64(1):148-153.
24. Mehta Y, Vats M, Singh A, et al. Incidence and management of diaphragmatic palsy in patients after cardiac surgery[J]. Indian J Crit Care Med, 2008, 12(3):91-95.
25. Iverson L, Mittal A, Dugan DJ, et al. Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma[J]. Am J Surg, 1976, 132(2):263-269.
26. van Meeteren NLU, Brakee JH, Hamers FTP, et al. Exercise training improves functional recovery and motor nerve conduction velocity after sciatic nerve crush lesion in the rat[J]. Arch Phys Med Rehab, 1997, 78(1):70-77.
27. Kovacikova L, Dobos D, Zahorec M. Non-invasive positive pressure ventilation for bilateral diaphragm paralysis after pediatric cardiac surgery[J]. Interact Cardiovasc Thorac Surg, 2009, 8(1):171-172.
28. Oktem S, Cakir E, Uyan ZS, et al. Diaphragmatic paralysis after pediatric heart surgery:usefulness of non-invasive ventilation[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(4):430-431.
29. Versteegh M, Braun J, Voigt PG, et al. Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea[J]. Eur J Cardiothorac Surg, 2007, 32(3):449-456.
30. Freeman RK, van Woerkom J, Vyverberg AA. Long-term follow-up of the functional and physiologic results of diaphragm plication in adults with unilateral diaphragm paralysis[J]. Ann Thorac Surg, 2009, 88(4):1112-1117.
31. Stauffer UG, Rickham PP. Acquired eventration of the diaphragm in the newborn[J]. J Pediatr Surg, 1972, 7(6):635-640.
32. Schwartz MZ, Filler RM. Plication of the diaphragm for symptomatic phrenic nerve paralysis[J]. J Pediatr Surg, 1978, 13(3):259-263.
33. Hamilton JR, Tocewicz K, Elliott MJ, et al. Paralysed diaphragm after cardiac surgery in children:value of plication[J]. Eur J Cardiothorac Surg, 1990, 4(9):487-490.
34. Georgiev S, Konstantinov G, Latcheva A, et al. Phrenic nerve injury after paediatric heart surgery:is aggressive plication of the diaphragm beneficial?[J]. Eur J Cardiothorac Surg, 2013, 44(5):808-812.
35. Ko MA, Darling GE. Acquired paralysis of the diaphragm[J]. Thorac Surg Clin, 2009, 19(4):501-510.
36. DiMarco AF, Onders RP, Ignagni A, et al. Phrenic nerve pacing via intramuscular diaphragm electrodes in tetraplegic subjects[J]. Chest, 2005, 127(2):671-678.
37. Kaufman MR, Elkwood AI, Rose MI, et al. Reinnervation of the paralyzed diaphragm application of nerve surgery techniques following unilateral phrenic nerve injury[J]. Chest, 2011, 140(1):191-197.

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West China Medical Journal

先天性心脏病术后膈肌麻痹的诊断治疗进展

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