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.	?呂小東,李守軍.嬰兒心臟手術后膈肌麻痹的手術治療.中華小兒外科雜志,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.	張燕搏,王旭,李守軍,等.兒童先天性心臟病術后膈肌麻痹的臨床研究.中華實用診斷與治療雜志,2011,25 (12):1152-1153.
4.	賈艷,李慶印,趙艷.嬰幼兒心臟手術后合并膈肌麻痹的監護.中華護理雜志,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.	楊立平,陳良萬,張貴燦,等.嬰幼兒患者長時間體外循環風險分析.中國胸心血管外科臨床雜志,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,程國棟,梁林寶.心臟術后呼吸機相關性肺炎的預防措施.中國醫藥指南,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,李守軍,呂小東,等.嬰幼兒心臟手術后膈肌麻痹的超聲診斷.中國超聲醫學雜志,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.兒科護理學.第4 版.北京:人民衛生出版社,2006.188.
14.	胡亞蘭,郭琳,張綿.心臟手術后呼吸機相關肺炎的臨床分析.內科急危重癥雜,2011,1 (3):173-174.
15.	汪春明,余建華,田建國.呼吸機相關性肺炎的病原菌及耐藥性研究.中華醫院感染學雜志,2003,13 (7):696-698.
16.	唐義虎,吳延虎,劉翔,等.體外循環術中炎癥介質表達與呼吸機相關性肺炎的臨床研究.南京醫科大學學報:自然科學版,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,白書媛,等.開胸手術后下呼吸道感染病原菌及其耐藥分析.中國胸心血管外科臨床雜志,2011,18 (2):126-129.
21.	張燕搏,王飛燕,王強,等.兒童心臟外科重癥監護病房醫院感染臨床研究.中華實用診斷與治療雜志,2011,25 (5):429-432.
22.	朱耀斌,劉迎龍.兒童先天性心臟病繼發肺動脈高壓.中華實用診斷與治療雜志,2009,23 (3):209-211.
23.	彭冉.心臟直視手術后膈肌麻痹的預防及對策.基層醫學論壇,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. ?呂小東,李守軍.嬰兒心臟手術后膈肌麻痹的手術治療.中華小兒外科雜志,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. 張燕搏,王旭,李守軍,等.兒童先天性心臟病術后膈肌麻痹的臨床研究.中華實用診斷與治療雜志,2011,25 (12):1152-1153.
4. 賈艷,李慶印,趙艷.嬰幼兒心臟手術后合并膈肌麻痹的監護.中華護理雜志,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. 楊立平,陳良萬,張貴燦,等.嬰幼兒患者長時間體外循環風險分析.中國胸心血管外科臨床雜志,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,程國棟,梁林寶.心臟術后呼吸機相關性肺炎的預防措施.中國醫藥指南,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,李守軍,呂小東,等.嬰幼兒心臟手術后膈肌麻痹的超聲診斷.中國超聲醫學雜志,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.兒科護理學.第4 版.北京:人民衛生出版社,2006.188.
14. 胡亞蘭,郭琳,張綿.心臟手術后呼吸機相關肺炎的臨床分析.內科急危重癥雜,2011,1 (3):173-174.
15. 汪春明,余建華,田建國.呼吸機相關性肺炎的病原菌及耐藥性研究.中華醫院感染學雜志,2003,13 (7):696-698.
16. 唐義虎,吳延虎,劉翔,等.體外循環術中炎癥介質表達與呼吸機相關性肺炎的臨床研究.南京醫科大學學報:自然科學版,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,白書媛,等.開胸手術后下呼吸道感染病原菌及其耐藥分析.中國胸心血管外科臨床雜志,2011,18 (2):126-129.
21. 張燕搏,王飛燕,王強,等.兒童心臟外科重癥監護病房醫院感染臨床研究.中華實用診斷與治療雜志,2011,25 (5):429-432.
22. 朱耀斌,劉迎龍.兒童先天性心臟病繼發肺動脈高壓.中華實用診斷與治療雜志,2009,23 (3):209-211.
23. 彭冉.心臟直視手術后膈肌麻痹的預防及對策.基層醫學論壇,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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