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目的回顾性分析阜外心血管医院应用膈肌折叠术治疗婴儿心脏手术术后膈肌麻痹资料,讨论膈肌折叠术适应证及其使患儿脱离呼吸机的益处。方法1996年10月～2005年10月完成9个月以下婴儿心内直视手术2310例,同期术后经B超或/和X线透视诊断膈肌麻痹12例,患儿平均手术年龄3个月(5d～9个月),平均体重5.1(4～8)kg,其中轻度营养不良者7例,中度营养不良者2例。均行膈肌折叠术,对这些患儿的临床资料进行回顾分析。结果心脏手术术后38(5～73)d诊断膈肌麻痹;术后41(5～73)d接受膈肌折叠术。1例全身感染、感染中毒性休克死亡。ICU滞留时间54(2～106)d,住院时间65(29～159)d。结论9个月以下、低体重、营养不良等高危患儿行膈肌折叠术,有利于脱离呼吸机或改善呼吸状态。
Objective To retrospectively analyze the data of diaphragmatic paralysis after cardiac surgery in infants at Cardiovascular Institute of Fu Wai District by using diaphragmatic folds and to discuss the indications of diaphragmatic folds and the benefits of removing diaphragms from ventilators. Methods From October 1996 to October 2005, 2,310 infants under 9 months of age underwent open heart surgery. 12 cases of diaphragmatic paralysis were diagnosed by B-mode ultrasonography or X-ray and the mean operation time was 3 months (5d ~ 9 months), the average body weight of 5.1 (4 ~ 8) kg, of which 7 cases of mild malnutrition, moderate malnutrition in 2 cases. Accompanied by diaphragmatic folding, the clinical data of these children were retrospectively analyzed. Results Diaphragmatic paralysis was diagnosed 38 (5-73) days after cardiac surgery; diaphragmatic fold was performed 41 (5-73) days after operation. One case of systemic infection died of toxic shock infection. ICU stay 54 (2 ~ 106) d, hospital stay 65 (29 ~ 159) d. Conclusions Diaphragmatic folding is performed in high-risk children under 9 months of age, with low body weight and malnutrition, which is good for escaping the ventilator or improving the respiratory status.