目的:我们旨在量化常规胸外科手术患者围手术期膈肌功能和膈神经传导的变化。
方法:在接受食管切除术或肺叶切除术的患者中进行了一项前瞻性观察性研究。检查是在手术前一天进行的,术后3天和10-14天。膈肌功能的终点包括膈肌偏移和增厚分数的超声测量。膈神经传导的终点包括基线到峰值振幅,峰间振幅,和传输延迟。对胸部的手术侧和非手术侧进行测量。
结果:40名患者被纳入研究。对于所有偏移措施,在胸腔的手术侧观察到膈肌偏移显着减少(右半膈肌的后部,p<0.001;hemididiaphragictoppoint,p<0.001;胸内面积变化,p<0.001)。所有膈神经测量值均出现显著变化(基线至峰值振幅,p<0.001;峰-峰振幅,p<0.001;传输延迟,手术侧p=0.041)。然而,在所有膈神经测量的非手术侧也观察到显著变化(基线到峰值振幅,p<0.001;峰-峰振幅,p<0.001;传输延迟,p=0.022)。术后后膈肌偏移减少50%以上与术后肺部并发症显著相关(系数:2.69(95%CI[1.38,4.01],p<0.001)。
结论:胸部手术导致胸腔手术侧膈肌偏移的单侧显著减少,伴有膈神经传导的显著变化。然而,膈神经传导在非手术侧也受到了较小程度的显著影响,这在膈肌运动中没有反映出来。我们的研究结果表明,膈神经麻痹在术后膈肌功能障碍中起作用,这可能是术后肺部并发症发病的一个促成因素。
背景:NCT04507594。
OBJECTIVE: We aimed to quantify perioperative changes in diaphragmatic function and phrenic nerve conduction in patients undergoing routine thoracic surgery.
METHODS: A prospective observational study was performed in patients undergoing esophageal resection or pulmonary lobectomy. Examinations were carried out the day prior to surgery, 3 days and 10-14 days after surgery. Endpoints for diaphragmatic function included ultrasonographic measurements of diaphragmatic excursion and thickening fraction. Endpoints for phrenic nerve conduction included baseline-to-peak amplitude, peak-to-peak amplitude, and transmission delay. Measurements were assessed on both the surgical side and the non-surgical side of the thorax.
RESULTS: Forty patients were included in the study. Significant reductions in diaphragmatic excursion were seen on the surgical side of the thorax for all excursion measures (posterior part of the right hemidiaphragm, p < 0.001; hemidiaphragmatic top point, p < 0.001; change in intrathoracic area, p < 0.001). Significant changes were seen for all phrenic nerve measures (baseline-to-peak amplitude, p < 0.001; peak-to-peak amplitude, p < 0.001; transmission delay, p = 0.041) on the surgical side. However, significant changes were also seen on the non-surgical side for all phrenic nerve measures (baseline-to-peak amplitude, p < 0.001; peak-to-peak amplitude, p < 0.001; transmission delay, p = 0.022). A postoperative reduction in posterior diaphragmatic excursion of more than 50% was significantly associated with postoperative pulmonary complications (coefficient: 2.69 (95% CI [1.38, 4.01], p < 0.001).
CONCLUSIONS: Thoracic surgery caused a significant unilateral reduction in diaphragmatic excursion on the surgical side of the thorax, which was accompanied by significant changes in phrenic nerve conduction. However, phrenic nerve conduction was also significantly affected on the non-surgical side to a lesser extent, which was not mirrored in diaphragmatic excursion. Our findings suggest that phrenic nerve paresis plays a role in postoperative diaphragmatic dysfunction, which may be a contributing factor in the pathogenesis of postoperative pulmonary complications.
BACKGROUND: NCT04507594.