摘要目的 探讨婴幼儿先天性心脏病(CHD)术后膈肌麻痹的临床表现、诊断与外科治疗经验.方法 回顾性分析首都医科大学附属北京安贞医院小儿心脏中心2006年1月至2012年6月31例CHD术后膈肌麻痹患儿的临床资料.男23例,女8例；年龄20 d ～ 25个月,平均(8.0±5.5)个月；体质量3.1～ 12.2 kg[(6.8±2.3) kg].患儿均行呼吸机辅助呼吸,脱离呼吸机困难.全身麻醉气管插管下行膈肌折叠手术.侧卧位,健侧在下,取胸后外侧切口或胸前外侧切口,经第6～8肋间进胸.切除松弛、薄弱膈肌或直接折叠后予以缝合.对患儿的临床表现和诊断进行总结并评估膈肌折叠手术效果.结果 31例患儿中,左侧膈肌麻痹15例,右侧膈肌麻痹12例,双侧膈肌麻痹4例.31例患儿均脱离呼吸机困难,再次气管插管28例,呼吸机相关性肺炎23例,气管切开10例.28例患儿行膈肌折叠手术,术后患儿全部脱离呼吸机.术前呼吸机辅助时间119～827 h[(447±225)h],术后呼吸机辅助时间12 ～206 h[(71±52) h],二者比较差异有统计学意义(P＜0.05).余3例经保守治疗,症状改善,逐渐脱离呼吸机,恢复良好.结论 婴幼儿CHD术后膈肌麻痹影响术后患儿恢复,膈肌折叠手术是安全、有效的治疗方式.

abstractsObjective To investigate the clinical manifestations,diagnosis and treatment of diagrammatic paralysis in infants with congenital heart disease (CHD) after cardiac surgery.Methods Thirty-one cases of diaphragmatic paralysis after cardiac surgery were selected from Jan.2006 to Jun.2012,including 23 cases were male and 8 cases were female.The age at operation was 20 days to 25 months,(8.0 ± 5.5) months on the average.The body weight at operation was 3.1-12.2 kg,(6.8 ± 2.3) kg on the average.All children received machine auxiliary breathing,and they had breathing difficulty without the machine.Diaphragmatic plication via 6-8 intercostal was performed under general anesthesia and endotracheal intubation.Lateral position,with uninjured side downward,was taken to perform chest posterolateral incision or chest lateral incision.Relaxing and weak diaphragm muscles were resected or directly sutured after folding.The clinical manifestations and diagnosis of children were summarized,and the effectiveness of diaphragmatic plication was evaluated.Results In 31 cases with diaphragmatic paralysis,there were 15 cases with left diaphragmatic paralysis,12 cases with right diaphragmatic paralysis,and 4 cases with bilateral diaphragmatic paralysis.Thirty-one cases had dyspnea after weaning of ventilator,and 28 cases received reintubation,23 cases with ventilator-as-sociated pneumonia,and 10 cases with tracheotomy.Diaphragmatic plication was performed in 28 cases,and all of them were weaned off ventilator successfully after the placation.The time of preoperative mechanical ventilation lasted 119-827 hours [(447 ± 225) hours],postoperative ventilator assistance time was 12-206 hours [(71 ± 52) hours],which showed significant difference in time of ventilation(P ＜0.05).Conservative treatment was given to the remaining 3 cases,and they were weaned off ventilation successfully with a better recovery.Conclusions Diaphragmatic paralysis in infants after CHD surgery affects their recovery.Diaphragm plication is a safe and effective method to treat the diaphragm paralysis.