中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

呼吸机通气下超声诊断先天性心脏病术后膈肌麻痹的自身交叉对照研究

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目的 探索先天性心脏病术后患者在呼吸机通气情况下超声诊断膈肌麻痹的可行性。 方法 2013 年 1 月 1 日至 2016 年 4 月 30 日我院 542 例先天性心脏病外科手术后,难以脱离呼吸机或者怀疑存在膈肌麻痹的患者,分别在呼吸机持续气道正压通气(CPAP)模式下和完全自主呼吸状态下,以超声检查膈肌功能诊断是否存在膈肌麻痹。其中男 327 例、女 215 例,年龄(14±32)个月。对比在呼吸机 CPAP 模式下与在完全自主呼吸状态下超声诊断的结果。 结果 完全自主呼吸状态下,82 例患者诊断为膈肌麻痹,其中右侧 39 例,左侧 25 例,双侧 18 例,其他均为正常;CPAP 模式下,82 例患者诊断膈肌麻痹,其中右侧 38 例,左侧 25 例,双侧 19 例,其他均为正常。超声在 CPAP 模式下诊断先天性心脏病术后膈肌麻痹的结果,与在完全自主呼吸状态下对比,敏感性为 100.0%,特异性为 99.9%。 结论 在呼吸机通气状态下用超声检查诊断先天性心脏病术后患者是否存在膈肌麻痹结果准确可行。

Objective To explore the feasibility of ultrasound diagnosis of diaphragmatic paralysis in patients with ventilation after congenital heart disease surgery. Methods There were 542 patients with congenital heart disease after surgery, difficult to be weaned off the ventilator or suspected diaphragmatic paralysis of the patients, respectively, in the ventilator continous positive pressure breathing(CPAP) mode and completely independent breathing state, to ultrasound examination of diaphragm function to determine the presence of diaphragmatic paralysis in our hospital between January 1, 2013 and April 30, 2016. There were 327 males and 215 females at age of 14±32 months.The results of ultrasound diagnosis between ventilator CPAP mode and completely spontaneous breathing mode were compared. Results Five hundred and forty-two patients underwent ultrasound diaphragmatic examination. The results of bedside ultrasound were completely diagnosed: in completely spontaneous breathing, 82 patients who were diagnosed diaphragmatic paralysis, including 39 on the right, 25 on the left, 18 on both sides; in CPAP mode, 82 patients who were diagnosed diaphragmatic paralysis, 38 on the right, left 25, bilateral 19. Ultrasound in CPAP mode to diagnose diaphragmatic paralysis after congenital heart disease surgery, compared with the completely spontaneous breathing state, the sensitivity was 100.0% and the specificity was 99.9%. Conclusion It is accurate and feasible to diagnose the presence of diaphragmatic paralysis in patients with ventilation after congenital heart disease surgery.

关键词: 先天性心脏病; 超声; 心脏手术; 膈肌麻痹; 机械通气

Key words: Congenital heart disease; ultrasound; heart surgery; diaphragmatic paralysis; mechanical ventilation

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