目的分析并评估膈肌折叠术治疗婴幼儿先天性心脏病矫治术后膈肌麻痹的临床效果。方法回顾性分析2009年12月至2012年12月13例先天性心脏病婴幼儿行矫治手术后发生膈肌麻痹的临床资料,其中男5例、女8例;年龄35 d至11个月[(6.6±3.2)个月];体重3.5~9.6(6.2±1.8)kg。膈肌折叠术在心脏直视手术后(19.08±4.29)d施行。所有患者均无法顺利脱离呼吸机,或脱机后因严重呼吸困难反复行气管内插管,13例患儿均行单侧或双侧膈肌折叠术。结果发生呼吸机相关性肺炎2例,发生率15.4%,其中1例痰培养为复合鲍曼不动杆菌阳性、血细菌培养阴性;另1例为法洛四联症合并肺动脉闭锁患儿,双侧膈肌麻痹,行双侧膈肌折叠术后第11 d痰培养和血培养均为铜绿假单胞菌阳性,并因多脏器功能衰竭死亡。所有患儿膈肌折叠术后胸部X线片提示膈肌下降至正常位置。膈肌折叠术后患儿脱离呼吸机时间为(5.38±3.09)d。膈肌折叠术后患儿动脉血氧分压(PaO2)较术前明显增高[(90.22±8.47)mm Hg vs.(80.69±6.72)mm Hg;P<0.05],动脉血二氧化碳分压(PaCO2)较术前明显降低[(39.87±6.31)mm Hg vs.(56.38±7.19)mm Hg;P<0.05]。随访12例,随访时间24个月,1例患儿行双侧膈肌折叠术,出院后6个月内反复2次出现肺部感染,其余患儿呼吸功能正常。所有随访患儿心功能Ⅰ~Ⅱ级(NYHA)。结论先天性心脏病婴幼儿行心脏直视手术后发生膈肌麻痹时,难以顺利脱离呼吸机,行膈肌折叠术是较安全、简便、有效的治疗手段,能提高患者的生存率,降低院内感染几率。 Objective To analyze and evaluate the clinical effect of diaphragmatic muscle fold in the treatment of postoperative diaphragmatic paralysis in children with congenital heart disease. Methods A retrospective analysis of clinical data of 13 cases of diaphragmatic paralysis occurred in 13 infants with congenital heart disease undergoing orthopedic surgery between December 2009 and December 2012 was retrospectively analyzed, including 5 males and 8 females, aged from 35 days to 11 months [(( 6.6 ± 3.2) months; body weight 3.5 ~ 9.6 (6.2 ± 1.8) kg. Diaphragmatic folds were performed after direct open-heart surgery (19.08 ± 4.29) d. All patients were unable to leave the ventilator smoothly or they were repeatedly intratracheally intubated due to severe dyspnea after being off-line. All the 13 children underwent unilateral or bilateral diaphragmatic folding. Results 2 cases of ventilator-associated pneumonia occurred, the incidence rate was 15.4%. One case of sputum culture was Acinetobacter baumannii-positive and the blood culture was negative. The other case was tetralogy of Fallot with pulmonary atresia, Lateral diaphragmatic paralysis, Pseudomonas aeruginosa positive sputum culture and blood culture on the 11th day after bilateral diaphragmatic folds were performed, and died of multiple organ failure. All children with diaphragmatic fold chest X-ray film prompted the diaphragm down to normal position. Diaphragm folding surgery after the time from the ventilator (5.38 ± 3.09) d. Arterial partial pressure of oxygen (PaO2) was significantly higher in patients with diaphragmatic collapse than that before operation [(90.22 ± 8.47) mm Hg vs. (80.69 ± 6.72) mm Hg; P <0.05] (39.87 ± 6.31) mm Hg vs. (56.38 ± 7.19) mm Hg, P <0.05]. Follow-up was performed in 12 cases. The follow-up time was 24 months. One child underwent bilateral diaphragmatic folds, and pulmonary infection was repeated twice within 6 months after discharge. Other children had normal respiratory function. All follow-up children with cardiac function Ⅰ ~ Ⅱ grade (NYHA). Conclusions Infantile diaphragmatic paralysis after cardiac surgery in infants and young children with congenital heart disease is difficult to get rid of the ventilator smoothly. It is a safe, simple and effective treatment for diaphragmatic folds, which can improve the survival rate of patients and reduce the chance of nosocomial infection .