摘要
目的 探讨膈神经移位术对不同年龄小儿呼吸系统的远期影响及其规律。方法 从1998年3月至2001年4月收治34例臂丛神经损伤患儿，按手术时年龄分为0～12个月组（17例），13～36个月组（11例）和37～60个月组（6例）。手术方式均采用膈神经移位术，术后随访3～7年，平均4．03年。随访时以34名同龄健康儿童作为对照进行配对（身高、体重、性别相同）研究。行常规体检、肺功能（潮气、通气功能及脉冲振荡检查）测定、血气分析及胸透观察膈肌活动度。结果 与对照组相比，膈神经移位术时年龄0～12、13～36个月组患儿肺容量及肺顺应性较低（最大肺活量为0．9L±0．2L、1．2L±0．4L vs．1．3L±1.3L、1．4L±0．5L，一秒量为0．8L±0．1L、0．9L±0．1L vs．1．0L±0．1L、1．0L±0．1L，均P〈0．05），而37～60个月组肺功能与对照组差异无统计学意义（最大肺活量为1．6L±0．4L vs．1．8L±0．5L，一秒量为1．5L±0．1L vs．1．6L±0．3L，均P〉0．05）。3组患儿血气分析结果与对照组比较均无明显差异。胸透显示膈神经移位术后，患侧膈顶较对侧抬高0．5～3．5个肋间，平均1．93个肋间，膈顶高度差各组间差异有统计学意义（均P〈0．05）。术时年龄0～12、13～36个月组患儿术后反复性呼吸道感染的发生率分别为47．1％（8／17例）和27．3％（3／11例），胸廓畸形的发生率分别为41．2％（7／17例）、9．1％（1／11例），术时年龄0～12个月的患儿尚有17．6％（3／17例）出现不同程度的消化系统症状，而术时年龄37～60个月组的患儿均无上述临床表现。结论 年龄小于3岁的患儿行膈神经移位术可能对呼吸系统、胸廓发育及消化系统产生不良影响，手术年龄越小影响越显著，而3岁以上患儿膈神经切断无上述影响。
Objective To study the long-term impact of transfer of phrenic nerve on respiratory system of children. Methods Thirty-four children with brachial plexus injury, 25 boys and 9 girls, underwent transfer of phrenic nerve and were divided into 3 groups according to the age when they underwent operation： group of the age of 0-12 months （n = 17） , group of 13-36 months （n = 11 ）, and group of 37-60 months （ n = 6）. Thirty-four sex, height, and body weight-matched healthy children were used as controls. Follow-up, including physical examination, pulmonary function examination （tidal volume, ventilation, etc）, blood gas analysis, and chest radiography, was conducted for 4.03 years （3-7 years）. Results The values of maximum vital capacity of the group of 0-12 months and group of 13-36 months were 1.0 L ±0.2 L and 1.2 L ± 0.4 L, both significantly lower than those of the corresponding control groups （ 1.3 L ± 0.3 L and 1.4 L ±0.5 L, both P 〈 0.05 ）. The values of one-second vital capacity of the group of 0-12 months and group of 13-36 months were 0.8 L ±0.1 L and 0.9 L ±0. 1 L, both significantly lower than those of the corresponding control groups （1.0 L±0. 1 L and 1.0 L±0. 1 L, both P〈0.05）. However, the values of the maximum vital capacity and one-second vital capacity of the group of 37-60 months were 1.6 L ± 0.3 L and 1.8 L ± 0.5 L respectively, both not significantly different from those of the controls （ both P 〉 0.05 ）. The results of blood gas analysis of the 3 operation groups were not significantly different fi＇om those of the corresponding controls. Chest radiograph showed that the diaphragm top was raised by 1.93 intercostal spaces （0.5-3.5 intercostal spaces） in comparison with the contralateral sides with significant differences between the group of 0-12 months and the group of 13-36 months and between the group of 0-12 months and the group of 37-60 months （both P 〈0.05 ）. The recurrent respiratory infection rate and of the groups of 0- 12 months
出处
《中华医学杂志》
CAS
CSCD
北大核心
2006年第17期1179-1182,共4页
National Medical Journal of China
基金
国家"973"重点基础研究发展计划基金资助项目(2003CB515305)
关键词
神经移植
膈神经
呼吸系统
Nerve transfer
Phrenic nerve
Respiratory system
