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題 名 | Diaphragmatic Paralysis after Pediatric Cardiac Surgery--A Retrospective Study=兒科心臟手術後之橫膈膜麻痺--一回顧性的研究 |
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作 者 | 黃大誠; 謝凱生; 劉萬雄; 林竹川; 郭樹民; 潘俊彥; 康沛倫; 鄭國琪; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 13:1 民86.01-03 |
頁 次 | 頁38-46 |
分類號 | 417.522 |
關鍵詞 | 橫膈膜麻痺; 開心手術; 兒科; Diaphragmatic paralysis; Cardiac surgery; |
語 文 | 英文(English) |
中文摘要 | 背景:橫膈膜麻痺在先天性心臟病手術的術後照顧中並不少見,並且會造成術後罹病率的增加與住院天數的延長,本研究的目的在評估橫膈膜麻痺在先天性心臟病手術後的影響。 方法與結果:從1990年到1995年共有770位患先天性心臟病的兒童在高雄榮民總醫院接心臟手術,其中19位(佔2.46%)在術後的煦顧中被發現罹患橫膈膜麻痺。這19位先天性心臟病兒童中,有9位(佔1.8%)接受開心手術,另外10位(佔3.6 %)接受非開心手術,橫膈膜麻痺最常發生於Senning's operation、開放性動脈導管結紮併肺動脈窄縮手術(PDA ligation plus PAB)、系統-肺動脈接合手術(systemic-pulmonary artery anastomosis)以及大動脈轉位手術。此外發現年齡小於一歲的患兒亦容易於心臟手術後罹患橫膈膜麻痺。大部份的病人接受支持性治療後改善,僅一位需接受手術治療。另外有14位(佔74 %)病人發生橫膈膜麻痺導致的併發症而需延長住院天數。 結論:先天性心臟病手術後所造成的橫膈膜麻痺不僅造成術後罹病率的增加,更延長病人的住院天數,因此手術時的預防是很重要的。如果一旦發生橫膈膜麻痺,必須及早發現並予以治療,萬一支持性治療失敗,應考慮橫膈膜手術來加以矯正。 |
英文摘要 | Backgroud. Diaphragmatic paralysis is not an unusual finding during post operative care of congenital heart disease surgery. It also causes frequent morbidity and prolongs the hospital stay. This study is a retrospective review of 770 patients undergoing cardiac procedures at this hospital. Methods & Results. Diaphragmatic paralysis was diagnosed by ultrasound or fluoroscopy in 19 of 770 patients (2.46%) with congenital heart diseases who underwent corrective or palliative surgery at Veterans General Hospital-Kaohsiung (VGH-KS) during a 5-year period (1990-1995). The incidence was 1.8% for open heart surgery and 3.6% for closed heart surgery. Diaphragmatic paralysis was most commonly noted following Senning's operation, persistent ductus arteriosus (PDA) ligation plus pulmonary artery banding (PAB), systemic-pulmonary artery anastomosis, and arterial switch. In this study, patients younger than one year old were more susceptible to phernic nerve injuries when receiving cardiac surgery, but a definite conclusion needs greater patient numbers for further study. Most patients were managed conservatively with ventilatory support by nasotracheal or orotracheal intubation and positive end-expiratory pressure. Major complications occurred in 14 of the 19 patients with diaphragmatic paralysis (74%). Conclusions. Because of this frequent morbidity and the prolonged hospital stay of this complication, prevention is necessary. If injury does occur, early diagnosis is important. Should supportive care fail, diaphragmatic plication may provide a safe and valuable method to correct this complication. |
本系統中英文摘要資訊取自各篇刊載內容。