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目的探讨膈肌折叠术适应证及其使患儿脱离呼吸机的益处。方法回顾性分析北京儿童医院2008年10月至2014年6月完成婴儿(<1岁)心内直视手术2 692例中同期经B超及胸部X线检查诊断膈肌麻痹31例患者的临床资料,其中男22例、女9例,年龄1~12(4.5±4.2)个月,体重2.9~8.5(5.6±2.2)kg。双侧膈肌麻痹6例,左侧膈肌麻痹10例,右侧膈肌麻痹15例。患儿均呼吸机辅助呼吸,脱离呼吸机困难,31例在全身麻醉气管插管下行膈肌折叠手术。结果 31例患儿均行膈肌折叠术,膈肌折叠术前机械通气时间123~832(420±223)h,折叠后机械通气时间15~212(75±58)h,差异有统计学意义(P<0.05)。术后所有患儿均顺利脱离呼吸机辅助,治愈出院。结论婴儿先天性心脏病术后发生膈肌麻痹时,常常难以顺利脱离呼吸机。膈肌折叠是非常安全、简便的治疗手段,有利于脱离呼吸机或改善呼吸状态。
Objective To investigate the indications of diaphragmatic folds and the benefits of removing them from the ventilator. Methods The clinical data of 2 692 cases of diaphragmatic paralysis diagnosed in 2 692 infants (<1 year old) undergoing simultaneous open heart surgery from October 2008 to June 2014 in Beijing Children’s Hospital were analyzed retrospectively. There were 22 males and 9 females, ranging in age from 1 to 12 (4.5 ± 4.2) months and weighing 2.9 to 8.5 (5.6 ± 2.2) kg. Bilateral diaphragm paralysis in 6 cases, left diaphragm diaphragm paralysis in 10 cases, right diaphragm paralysis in 15 cases. Children were ventilator assisted breathing, breathing machine from the difficulties, 31 cases of general anesthesia tracheal intubation diaphragmatic fold surgery. Results All of the 31 cases underwent diaphragmatic folding. The duration of mechanical ventilation was 123 ~ 832 (420 ± 223) h and the duration of mechanical ventilation was 15 ~ 212 (75 ± 58) h after diaphragmatic folding. The difference was statistically significant (P <0.05). All children were successfully ventilator-assisted after surgery, cured and discharged. Conclusion Infantile congenital heart disease after diaphragm paralysis, it is often difficult to smoothly from the ventilator. Diaphragm folding is a very safe and easy treatment, which is good for escaping the ventilator or improving the breathing state.