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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。 4 7例为膈神经移位组 ,3 7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 VTINS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
Objective To observe the effects of phrenic nerve transposition on respiratory function in children with hemiplegia. Methods 84 patients with paraplegia after brachial plexus surgery respiratory function changes. 47 cases of phrenic nerve shift group, 37 cases of non-phrenic nerve shift group. Postoperative clinical observation of respiratory changes, chest radiograph. Sixteen cases of phrenic nerve group were measured preoperatively and postoperatively with pulmonary function test. Results In the phrenic nerve transposition group, the chest radiographs showed elevation of the diaphragm on the affected side. In the fluoroscopy, diaphragmatic muscle showed contradictory movement with respiration. Postoperative respiratory distress, pneumonia, atelectasis were significantly higher than non-phrenic nerve transposition group. The age of less than 6 months in the operation group, the complication was significantly higher than 6 months. Respiratory distress occurred in the surgery group less than 3 months old. Postoperative pulmonary function test ventilation VE per minute, inhaled tidal VTINS decreased. Conclusion Children with paralysis at the age of 6 months or more for phrenic nerve transposition more appropriate to avoid the serious respiratory complications