乳児心臓手術後横隔神経麻痺の検討

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Between 1983 and 1990, 7 out of 374 pediatric patients(1.9%) who underwent cardiovascular surgeries at our institution developed phrenic nerve palsy. All 7 patients were less than 3 months of age(mean: 33.6 ±18.3 days) and had complex congenital cardiac anomalies. Severity of the phrenic nerve palsy was investigated by magnitude of elevation and disturbed excursion of the diseased diaphragm. Two patients, in whom excursion of diaphragm had been fluoroscopically preserved, underwent conservative therapy and successfully weaned from the respirator following continuous positive airway pressure(CPAP) management. Remaining 5 patients, who had disclosed paradoxical movement of diaphragm on fluoroscopy, failed to wean from the respirator and underwent diaphragmatic plication procedures. Periods of respirator management after the previous surgery ranged from 22 to 65 days(mean: 48.6 days). Two patients who underwent plication procedures were successfully extubated within 7 postoperative days. The other three, however, required long term ventilatory support despite the procedures. Deaths occurred in three of the five patients who underwent hemidiaphragmatic plication procedures. The one with 18-trisomy died of chronic lung disease and the other two with total anomalous pulmonary venous return of pulmonary venous obstruction. These clinical experiences draw us to the following conclusions.: (1) Mortality rate of postoperative eventration of hemidiaphragm remains high in neonates and young infants with major associated cardiac anomalies. (2) Diaphragmatic plication procedure is urgently needed in these patient group, should postoperative mechanical ventilatory support extend beyond 2-6 weeks. (3) Failure to achieve extubation within a week after the procedure is an ominous prognostic sign.
日本小児外科学会の論文
1992-10-20

乳児心臓手術後横隔神経麻痺の検討

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