Diaphragm Plication for the Treatment of Diaphragmatic Paralysis in Infants after Surgical Correction for Congenital Heart Diseases_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

OUYang-hui , WUXiao-chen , DINGSheng , YUEQin , XINDong , GAOFeng ,  ZHANGJin-bao

Department of Cardiovascular Surgery, Chengdu Military General Hospital, Chengdu 610083, P. R. China;

Corresponding author：

ZHANGJin-bao, Email: nowwilson@yeah.net

Keywords：

Infant; Cardiopulmonary bypass; Diaphragmatic paralysis; Diaphragm placation; Ventilator-associated pneumonia

DOI：

10.7507/1007-4848.20140064

Video：

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Objective To evaluate clinical outcomes of diaphragm plication for the treatment of diaphragmatic paralysis (DP) in infants after surgical correction for congenital heart diseases. Methods Clinical data of 13 infants who had DP after surgical correction for congenital heart diseases from December 2009 to December 2012 were retrospectively analyzed. There were 5 male and 8 female patients with their age of 35 days-11 months (6.6±3.2 months) and body weight of 3.5-9.6 (6.2±1.8) kg. Diaphragm plication was performed 19.08±4.29 days after open heart surgery. All the patients were not able to wean from mechanical ventilation,or were repeatedly reintubated because of severe respiratory failure after extubation. All the 13 patients received diaphragm plication for singleor double-sided DP. Results Two patients had ventilator associated pneumonia (15.4%) including 1 patient with positive sputum cultures for Acinetobacter baumannii but negative blood culture. Another patient who had double-sided DP after surgical correction for tetralogy of Fallot with pulmonary atresia underwent double-sided diaphragm plication and later died of multiple organ dysfunction syndrome,whose sputum and blood cultures were both positive for Pseudomonas aeruginosa on the 11th day after double-sided diaphragm plication. Chest X-ray of all the patients showed plicated diaphragm in normal position after diaphragm plication. The average time from diaphragm plication to extubation was 5.38±3.09 days. After diaphragm plication,arterial partial pressures of oxygen (PaO₂) significantly increased (90.22±8.47 mm Hg vs. 80.69±6.72 mm Hg,P<0.05) and arterial partial pressures of carbon dioxide (PaCO₂) significantly decreased (39.87±6.31 mm Hg vs. 56.38±7.19 mm Hg,P<0.05). Twelve patients were followed up for 24 months after discharge. During follow-up,1 patient who received double-sided diaphragm plication had 2 episodes of pneumonia within 6 months after discharge. Respiratory function of all the other patients was normal. All the patients were in NYHA class Ⅰ-Ⅱ. Conclusion Diaphragm plication is a safe,easy and effective treatment to increase survival rate and decrease the incidence of hospital-acquired infection for infants who have DP and are unable to wean from mechanical ventilation after surgical correction for congenital heart diseases.

Citation： OUYang-hui, WUXiao-chen, DINGSheng, YUEQin, XINDong, GAOFeng, ZHANGJin-bao. Diaphragm Plication for the Treatment of Diaphragmatic Paralysis in Infants after Surgical Correction for Congenital Heart Diseases. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 220-223. doi: 10.7507/1007-4848.20140064 Copy

1.	吕小东,李守军.婴儿心脏手术后膈肌麻痹的手术治疗.中华小儿外科杂志,2007,28 (6):294-296.
2.	Hortal J,Giannella M,Pérez MJ,et al.Incidence and risk factors for ventilator-associated pneumonia after major heart surgery.Intensive Care Med,2009,35 (9):1518-1525.
3.	张燕搏,王旭,李守军,等.儿童先天性心脏病术后膈肌麻痹的临床研究.中华实用诊断与治疗杂志,2011,25 (12):1152-1153.
4.	贾艳,李庆印,赵艳.婴幼儿心脏手术后合并膈肌麻痹的监护.中华护理杂志,2011,46 (11):1070-1071.
5.	Yemisci OU,Cosar SN,Karatas M,et al.A prospective study of temporal course of phrenic nerve palsy in children after cardiac surgery.J Clin Neurophysiol,2011,28 (2):222-226.
6.	杨立平,陈良万,张贵灿,等.婴幼儿患者长时间体外循环风险分析.中国胸心血管外科临床杂志,2013,20 (3):367-368.
7.	Russell RI,Mulvey D,Laroche C,et al.Bedside assessment of phrenic nerve function in infants and children.J Thorac Cardiovasc Surg,1991,101 (1):143-147.
8.	Safdar N,Dezfulian C,Collard HR,et al.Clinical and economic Consequences of ventilator-associated pneumonia:a systematic review.Crit Care Med,2005,33 (10):2184-2193.
9.	朱春磊,程国栋,梁林宝.心脏术后呼吸机相关性肺炎的预防措施.中国医药指南,2012,10 (18):526-527.
10.	Groth SS,Andrade RS.Diaphragm plication for eventration or paralysis:a review of the literature.Ann Thorac Surg,2010,89 (6):S2146-S2150.
11.	李永青,李守军,吕小东,等.婴幼儿心脏手术后膈肌麻痹的超声诊断.中国超声医学杂志,2010,26 (7):631-633.
12.	Akay TH,Ozkan S,Gultekin B,et al.Diaphragmatic paralysis after cardiac surgery in children:incidence,prognosis and surgical management.Pediatr Surg Int,2006,22 (4):341-346.
13.	崔焱.儿科护理学.第4 版.北京:人民卫生出版社,2006.188.
14.	胡亚兰,郭琳,张绵.心脏手术后呼吸机相关肺炎的临床分析.内科急危重症杂,2011,1 (3):173-174.
15.	汪春明,余建华,田建国.呼吸机相关性肺炎的病原菌及耐药性研究.中华医院感染学杂志,2003,13 (7):696-698.
16.	唐义虎,吴延虎,刘翔,等.体外循环术中炎症介质表达与呼吸机相关性肺炎的临床研究.南京医科大学学报:自然科学版,2013,33 (3):356-359.
17.	Bouadma L,Wolff M,Lucet JC.Ventilator-associated pneumonia and its prevention.Curr Opin Infect Dis,2012,25 (4):395-404.
18.	Tamayo E,Álvarez FJ,Martínez-Rafael B,et al.Ventilator-associated pneumonia is an important risk factor for mortality after major cardiac surgery.J Crit Care,2012,27 (1):18-25.
19.	Melsen WG,Rovers MM,Koeman M,et al.Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies.Crit Care Med,2011,39 (12):2736-2742.
20.	王春梅,支修益,白书媛,等.开胸手术后下呼吸道感染病原菌及其耐药分析.中国胸心血管外科临床杂志,2011,18 (2):126-129.
21.	张燕搏,王飞燕,王强,等.儿童心脏外科重症监护病房医院感染临床研究.中华实用诊断与治疗杂志,2011,25 (5):429-432.
22.	朱耀斌,刘迎龙.儿童先天性心脏病继发肺动脉高压.中华实用诊断与治疗杂志,2009,23 (3):209-211.
23.	彭冉.心脏直视手术后膈肌麻痹的预防及对策.基层医学论坛,2007,11 (3 A):201-202.
24.	Groth SS,Andrade RS.Diaphragm plication for eventration or paralysis:a review of the literature.Ann Thorac Surg,2010,89 (6):2146-2150.

1. 吕小东,李守军.婴儿心脏手术后膈肌麻痹的手术治疗.中华小儿外科杂志,2007,28 (6):294-296.
2. Hortal J,Giannella M,Pérez MJ,et al.Incidence and risk factors for ventilator-associated pneumonia after major heart surgery.Intensive Care Med,2009,35 (9):1518-1525.
3. 张燕搏,王旭,李守军,等.儿童先天性心脏病术后膈肌麻痹的临床研究.中华实用诊断与治疗杂志,2011,25 (12):1152-1153.
4. 贾艳,李庆印,赵艳.婴幼儿心脏手术后合并膈肌麻痹的监护.中华护理杂志,2011,46 (11):1070-1071.
5. Yemisci OU,Cosar SN,Karatas M,et al.A prospective study of temporal course of phrenic nerve palsy in children after cardiac surgery.J Clin Neurophysiol,2011,28 (2):222-226.
6. 杨立平,陈良万,张贵灿,等.婴幼儿患者长时间体外循环风险分析.中国胸心血管外科临床杂志,2013,20 (3):367-368.
7. Russell RI,Mulvey D,Laroche C,et al.Bedside assessment of phrenic nerve function in infants and children.J Thorac Cardiovasc Surg,1991,101 (1):143-147.
8. Safdar N,Dezfulian C,Collard HR,et al.Clinical and economic Consequences of ventilator-associated pneumonia:a systematic review.Crit Care Med,2005,33 (10):2184-2193.
9. 朱春磊,程国栋,梁林宝.心脏术后呼吸机相关性肺炎的预防措施.中国医药指南,2012,10 (18):526-527.
10. Groth SS,Andrade RS.Diaphragm plication for eventration or paralysis:a review of the literature.Ann Thorac Surg,2010,89 (6):S2146-S2150.
11. 李永青,李守军,吕小东,等.婴幼儿心脏手术后膈肌麻痹的超声诊断.中国超声医学杂志,2010,26 (7):631-633.
12. Akay TH,Ozkan S,Gultekin B,et al.Diaphragmatic paralysis after cardiac surgery in children:incidence,prognosis and surgical management.Pediatr Surg Int,2006,22 (4):341-346.
13. 崔焱.儿科护理学.第4 版.北京:人民卫生出版社,2006.188.
14. 胡亚兰,郭琳,张绵.心脏手术后呼吸机相关肺炎的临床分析.内科急危重症杂,2011,1 (3):173-174.
15. 汪春明,余建华,田建国.呼吸机相关性肺炎的病原菌及耐药性研究.中华医院感染学杂志,2003,13 (7):696-698.
16. 唐义虎,吴延虎,刘翔,等.体外循环术中炎症介质表达与呼吸机相关性肺炎的临床研究.南京医科大学学报:自然科学版,2013,33 (3):356-359.
17. Bouadma L,Wolff M,Lucet JC.Ventilator-associated pneumonia and its prevention.Curr Opin Infect Dis,2012,25 (4):395-404.
18. Tamayo E,Álvarez FJ,Martínez-Rafael B,et al.Ventilator-associated pneumonia is an important risk factor for mortality after major cardiac surgery.J Crit Care,2012,27 (1):18-25.
19. Melsen WG,Rovers MM,Koeman M,et al.Estimating the attributable mortality of ventilator-associated pneumonia from randomized prevention studies.Crit Care Med,2011,39 (12):2736-2742.
20. 王春梅,支修益,白书媛,等.开胸手术后下呼吸道感染病原菌及其耐药分析.中国胸心血管外科临床杂志,2011,18 (2):126-129.
21. 张燕搏,王飞燕,王强,等.儿童心脏外科重症监护病房医院感染临床研究.中华实用诊断与治疗杂志,2011,25 (5):429-432.
22. 朱耀斌,刘迎龙.儿童先天性心脏病继发肺动脉高压.中华实用诊断与治疗杂志,2009,23 (3):209-211.
23. 彭冉.心脏直视手术后膈肌麻痹的预防及对策.基层医学论坛,2007,11 (3 A):201-202.
24. Groth SS,Andrade RS.Diaphragm plication for eventration or paralysis:a review of the literature.Ann Thorac Surg,2010,89 (6):2146-2150.

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Diaphragm Plication for the Treatment of Diaphragmatic Paralysis in Infants after Surgical Correction for Congenital Heart Diseases

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