缪江永 高解春 肖现民 苏昌祺 闵若良 200032 上海医科大学附属儿科医院外科 中华手外科杂志 1999 0 15 4


    关键词：麻痹；产伤性；膈神经；呼吸系统 期刊 zhswkzz 0 论著 fur -->


    

【摘要】 目的 观察产瘫患儿行膈神经移位术后对呼吸功能的影响。 方法 比较84例产瘫患儿臂丛神经手术后呼吸功能的变化。 47例为膈神经移位组,37例为非膈神经移位组。 术后临床观察呼吸变化，摄胸片。 用肺功能仪对膈神经组中16例作术前、术后肺功能测定。 结果 膈神经移位组术后胸片示患侧膈肌均有抬高，透视下见膈肌随呼吸呈矛盾运动。 术后患儿呼吸窘迫、肺炎、肺不张等发生率明显高于非膈神经移位组。 年龄小于6个月的手术组，其并发症明显高于6个月以上组。 呼吸窘迫均出现在年龄小于3个月的手术组。 术后肺功能仪测定中每分钟通气量VE、吸入潮气量V_TINS 有下降。 结论 产瘫患儿年龄在6个月以上作膈神经移位较为合适，以避免产生呼吸系统的严重并发症。

The changes of respiratory function after phrenic nerve transfer for treatment of obstetric brachial plexus palsy

MIAO Jiangyong, GAO Jiechun, XIAO Xianmin, et al. Department of Pediatric Surgery, Children's Hospital of Shanghai Medical University, Shanghai 200032

【Abstract】 Objective To study the changes of respiratory function after phrenic nerve transfer for treatment of obstetric brachial plexus palsy (OBPP). Methods The changes of respiratory function were examined in 84 patients of OBPP who had neurotization procedures. The average age of the patients was 10.6 months. Clinical observation of the respiratory movement and X - ray examination of the chest were performed and compared in 47 cases who received phrenic nerve transfer and 40 cases who didn't receive phrenic nerve transfer. In 16 cases of phrenic nerve transfer, pre - and post - operative respiratory function was assesses by Respiratory Function Instrument. Results All cases of phrenic nerve transfer manifested diaphragmatic elevation and paradoxical movement with breathing. The incidence of respiratory distress, pneumonia and atelectasis was significantly higher than that of the cases without phrenic nerve transfer. Such complications occurred more often in children under 6 months. Respiratory distress happened in those under 3 months. Decrease of postoperative value of VE and V_TINS was found after phrenic nerve transfer. Conclusions Phrenic nerve transfer is suitable for treatment of OBPP in children over 6 months old in order to avoid severe respiratory complications.

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