胸腔镜胸腺肿瘤切除术膈神经损伤导致低氧血症：2例病例报告和文献综述

马璐璐; 黄宇光

doi:10.24920/003648

Your Location：

Home >

Browse articles >

胸腔镜胸腺肿瘤切除术膈神经损伤导致低氧血症：2例病例报告和文献综述

中国医学科学杂志（英文版） 2020年35卷第2期页码：191-194

病例报告 | Updated：2024-04-10

- 胸腔镜胸腺肿瘤切除术膈神经损伤导致低氧血症：2例病例报告和文献综述
- Affiliations：
  
  Department of anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Author bio：
  
  *, E-mail: garypumch@163.com; Tel: 86-10-69152020.
- Funds：
- DOI：10.24920/003648
  中图分类号：
- 收稿日期：2019-08-06，
  
  录用日期：2019-12-30，
  
  网络出版日期：2020-06-16，
  
  纸质出版日期：2020-06-16
- Accepted：
Scan QR Code
马璐璐, 黄宇光. 胸腔镜胸腺肿瘤切除术膈神经损伤导致低氧血症：2例病例报告和文献综述[J]. 中国医学科学杂志（英文版）, 2020,35(2):191-194.

Ma Lulu, Huang Yuguang. Phrenic Nerve Injury Is a Differential Diagnosis of Hypoxemia after Video-Assisted Thoracoscopic Thymectomy: 2 Cases Report and Literature Review[J]. Chinese medical sciences journal, 2020, 35(2): 191-194.
马璐璐, 黄宇光. 胸腔镜胸腺肿瘤切除术膈神经损伤导致低氧血症：2例病例报告和文献综述[J]. 中国医学科学杂志（英文版）, 2020,35(2):191-194. DOI： 10.24920/003648.

Ma Lulu, Huang Yuguang. Phrenic Nerve Injury Is a Differential Diagnosis of Hypoxemia after Video-Assisted Thoracoscopic Thymectomy: 2 Cases Report and Literature Review[J]. Chinese medical sciences journal, 2020, 35(2): 191-194. DOI： 10.24920/003648.

摘要

全麻术后低氧血症并不少见。对于胸科手术患者而言

低氧血症的鉴别诊断比较困难。手术、麻醉和患者相关的因素均会导致术后低氧血症。本文描述了两例视频辅助胸腔镜胸腺瘤切除术的患者

拔管后即刻出现低氧血症

两位患者均怀疑发生了膈神经损伤。一例未经干预

膈神经功能恢复。另一例最终证实为双侧膈神经损伤

经过物理治疗和呼吸功能锻炼2个月后仍未脱离呼吸机支持。

Abstract

Hypoxemia after general anesthesia is not uncommon. For patients after thoracotomy

the differential diagnosis is usually difficult. Surgical

anesthetic

and patient-associated factors may contribute to postoperative hypoxemia. We described two patients who underwent video-assisted thoracoscopic thymectomy and developed hypoxemia immediately after extubation. Phrenic nerve injury was suspected in both patients. One case recovered spontaneously without intervention. The second case who had been demonstrated as bilateral phrenic nerve injury after the operation was continuously on ventilator after physical therapy and respiratory training for 2 months.

关键词

Keywords

references

Markand ON , Moorthy SS , Mahomed Y , et al . Postoperative phrenic nerve palsy in patients with open-heart surgery . Ann Thorac Surg 1985 ; 39 ( 1 ): 68 - 73 . doi: 10.1016/s0003-4975(10)62524-6 https://dx.doi.org/s0003-4975(10)62524-6 . DOI: 10.1016/s0003-4975(10)62524-6 http://doi.org/10.1016/s0003-4975(10)62524-6 https://www.ncbi.nlm.nih.gov/pubmed/3966838 https://www.ncbi.nlm.nih.gov/pubmed/3966838

Merino-Ramirez MA , Juan G , Ramón M , et al . Electrophysiologic evaluation of phrenic nerve and diaphragm function after coronary bypass surgery: prospective study of diabetes and other risk factors . J Thorac Cardiovasc Surg 2006 ; 132 ( 3 ): 530 - 6 . doi: 10.1016/j.jtcvs.2006.05.011 https://dx.doi.org/j.jtcvs.2006.05.011 . DOI: 10.1016/j.jtcvs.2006.05.011 http://doi.org/10.1016/j.jtcvs.2006.05.011 https://www.ncbi.nlm.nih.gov/pubmed/16935106 https://www.ncbi.nlm.nih.gov/pubmed/16935106

Bulkley GB , Bass KN , Stephenson GR , et al . Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis . Ann Surg 1997 ; 226 ( 3 ): 324 - 34 . doi: 10.1097/00000658-199709000-00012 https://dx.doi.org/00000658-199709000-00012 . DOI: 10.1097/00000658-199709000-00012 http://doi.org/10.1097/00000658-199709000-00012 https://www.ncbi.nlm.nih.gov/pubmed/9339939 https://www.ncbi.nlm.nih.gov/pubmed/9339939

Salati M , Cardillo G , Carbone L , et al . Iatrogenic phrenic nerve injury during thymectomy: the extent of the problem . J Throrac Cardiovasc Surg 2010 ; 139 ( 4 ): e77 - 8 . doi: 10.1016/j.jtcvs.2008.06.051 https://dx.doi.org/j.jtcvs.2008.06.051 .

Ostrowska M , de Carvalho M . Prognosis of phrenic nerve injury following thoracic interventions: four new cases and a review . Clin Neurol Neurosurg 2012 ; 114 ( 3 ): 199 - 204 . doi: 10.1016/j.clineuro.2011.12.016 https://dx.doi.org/j.clineuro.2011.12.016 . DOI: 10.1016/j.clineuro.2011.12.016 http://doi.org/10.1016/j.clineuro.2011.12.016 https://www.ncbi.nlm.nih.gov/pubmed/22221740 https://www.ncbi.nlm.nih.gov/pubmed/22221740

Joho-Arreola AL , Bauersfeld U , Stauffer UG , et al . Incidence and treatment of diaphragmatic paralysis after cardiac surgery in children . Eur J Cardiothorac Surg 2005 ; 27 ( 1 ): 53 - 7 . doi: 10.1016/j.ejcts.2004.10.002 https://dx.doi.org/j.ejcts.2004.10.002 . DOI: 10.1016/j.ejcts.2004.10.002 http://doi.org/10.1016/j.ejcts.2004.10.002 https://www.ncbi.nlm.nih.gov/pubmed/15621471 https://www.ncbi.nlm.nih.gov/pubmed/15621471

Kocher GJ , Mauss K , Carboni GL , et al . Effect of phrenic nerve palsy on early postoperative lung function after pneumonectomy: a prospective study . Ann Thorac Surg 2013 ; 96 ( 6 ): 2015 - 20 . doi: 10.1016/j.athoracsur.2013.07.006 https://dx.doi.org/j.athoracsur.2013.07.006 . DOI: 10.1016/j.athoracsur.2013.07.006 http://doi.org/10.1016/j.athoracsur.2013.07.006 http://dx.doi.org/10.1016/j.athoracsur.2013.07.006 http://dx.doi.org/10.1016/j.athoracsur.2013.07.006

Zhang YB , Wang X , Li SJ , et al . Postoperative diaphragmatic paralysis after cardiac surgery in children: incidence, diagnosis and surgical management . Chin Med J 2013 ; 126 ( 21 ): 4083 - 7 . https://www.ncbi.nlm.nih.gov/pubmed/24229678 https://www.ncbi.nlm.nih.gov/pubmed/24229678

Lemmer J , Stiller B , Heise G , et al . Postoperative phrenic nerve palsy: early clinical implications and management . Intensive Care Med 2006 ; 32 : 1227 - 33 . doi: 10.1007/s00134-006-0208-4 https://dx.doi.org/s00134-006-0208-4 . DOI: 10.1007/s00134-006-0208-4 http://doi.org/10.1007/s00134-006-0208-4 https://www.ncbi.nlm.nih.gov/pubmed/16741696 https://www.ncbi.nlm.nih.gov/pubmed/16741696

Gottesman E , McCool FD. Ultrasound evaluation of the paralyzed diaphragm . Am J Respir Crit Care Med 1997 ; 155 ( 5 ): 1570 - 4 . doi: 10.1164/ajrccm.155.5.9154859 https://dx.doi.org/ajrccm.155.5.9154859 . DOI: 10.1164/ajrccm.155.5.9154859 http://doi.org/10.1164/ajrccm.155.5.9154859 https://www.ncbi.nlm.nih.gov/pubmed/9154859 https://www.ncbi.nlm.nih.gov/pubmed/9154859

Dimopoulou I , Daganou M , Dafni U , et al . Phrenic nerve dysfunction after cardiac operations: electrophysiologic evaluation of risk factors . Chest 1998 ; 113 ( 1 ): 8 - 14 . doi: 10.1378/chest.113.1.8 https://dx.doi.org/chest.113.1.8 . DOI: 10.1378/chest.113.1.8 http://doi.org/10.1378/chest.113.1.8 https://www.ncbi.nlm.nih.gov/pubmed/9440560 https://www.ncbi.nlm.nih.gov/pubmed/9440560

Hamadah HK , Kabbani MS , Elbarbary M , et al . Ultrasound for diaphragmatic dysfunction in postoperative cardiac children . Cardiol Young 2017 ; 27 ( 3 ): 452 - 8 . doi: 10.1017/S1047951116000718 https://dx.doi.org/S1047951116000718 . DOI: 10.1017/S1047951116000718 http://doi.org/10.1017/S1047951116000718 https://www.ncbi.nlm.nih.gov/pubmed/27161831 https://www.ncbi.nlm.nih.gov/pubmed/27161831

Kot P , Granell M , Rodriguez P , et al . Diaphragmatic ultrasound: early diagnosis when phrenic injury in thoracic surgery is suspected . J Cardiothorac Vasc Anesth 2018 ; 32 ( 6 ): e7 - 8 . doi: 10.1053/j.jvca.2018.06.024 https://dx.doi.org/j.jvca.2018.06.024 . DOI: 10.1053/j.jvca.2018.06.024 http://doi.org/10.1053/j.jvca.2018.06.024 https://www.ncbi.nlm.nih.gov/pubmed/30072267 https://www.ncbi.nlm.nih.gov/pubmed/30072267

浏览量

374

Downloads

CSCD

文章被引用时，请邮件提醒。

Submit

关联资源

暂无数据