Diaphragmatic paralysis

Introduction to diaphragmatic paralysis Diaphragmatic paralysis is caused by impaired phrenic nerve on one or both sides, and paralysis of the diaphragm caused by nerve impulse conduction, leading to abnormal rise of the diaphragm and dyskinesia. Most of the unilateral diaphragmatic paralysis is asymptomatic. The left diaphragmatic paralysis may have gastrointestinal symptoms such as hernia, abdominal distension, and abdominal pain due to elevated gastric fundus. In patients with bilateral complete diaphragmatic paralysis, the patient presented with severe dyspnea, abnormal abdominal breathing (abdominal depression during inhalation), difficulty breathing, and assisted respiratory muscles. There are usually manifestations of respiratory failure such as cyanosis. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: respiratory failure, lung cancer

Cause of diaphragmatic paralysis

The causes are diverse, malignant tumor invasion or compression and traumatic radial nerve palsy are common, and the causes can be classified as follows:

Malignant tumor invasion (25%):

The most common clinically, it is more common in the mediastinal lymph node metastasis of lung cancer or direct invasion of central lung cancer and mediastinal tumor, and occasionally seen in pericardium, malignant tumor of heart and pleura.

Trauma (20%):

Traumatic sacral paralysis involves mediastinal surgery, including mediastinal tumor, lung cancer, pericardial resection, coronary artery bypass grafting, open heart surgery, etc., all of which may damage or even cut the phrenic nerve, various types of chest injury, baby neck during childbirth Excessive traction, etc., may also damage the phrenic nerve.

Cervical disease (12%):

Due to trauma, tumor, cervical vertebra hyperplasia or intervertebral disc disease and cervical tuberculosis, the phrenic nerve is compressed or damaged at the level of the cervical 3-5.

Nervous system disease (13%):

Brain stem disease involves the respiratory center that supports the phrenic nerve, infectious polyradiculitis, etc., and can even cause paralysis of the phrenic nerve.

Infectious diseases (10%):

Polio, herpes zoster, diphtheria and other diseases can cause paralysis of the phrenic nerve.

Inflammatory disease involving the mediastinum (10%):

Massive lymph node tuberculosis, mediastinal inflammation, etc. can damage the phrenic nerve, but it is very rare in clinical practice. Occasionally, chest surgery accidentally injured the nerve.

Other (6%):

Motor neuron disease, tuberculosis, pericarditis, mediastinal inflammation, pneumonia, lead poisoning, etc., such as giant aortic aneurysm caused by left phrenic nerve palsy, some patients can not find a clear cause of phrenic nerve palsy.

Pathogenesis

Pathological change

The diaphragmatic paralysis causes the diaphragm to be in a relaxed state. Due to the negative pressure of the pleural cavity, the diaphragm is passively prolonged and bulged. The long-term diaphragmatic paralysis can produce a diaphragm of the diaphragm atrophy, and finally forms a posterior diaphragmatic bulge, which is a diaphragm-like diaphragm. The abdominal organs are obviously inflated into the thoracic cavity.

2. Pathophysiology

Diaphragm paralysis can be unilateral, bilateral, complete or incomplete, unilateral complete diaphragmatic paralysis increases diaphragmatic muscles and contradictory movements (inflamed side of the affected side of the diaphragm muscles and the healthy side declines), but due to the contralateral diaphragmatic muscle Compensation, the lung capacity is only reduced by about 30%. Because the human lung ventilation function has a large reserve capacity, it has no effect on the ventilation in calm state or mild to moderate exercise. The left diaphragmatic paralysis may have hernia due to the elevation of the fundus. Digestive tract symptoms such as abdominal distension and abdominal pain. When bilateral bilateral diaphragmatic paralysis occurs, the diaphragm is completely relaxed. Because the relationship between the intercostal muscles and the auxiliary inspiratory muscles and the diaphragm is in series, the intercostal muscles and the auxiliary inspiratory muscles cannot It has a better compensatory effect on diaphragmatic paralysis. Due to the ascending muscles during inhalation, the contractile force of the intercostal muscles and the auxiliary inspiratory muscles cannot be well converted into the negative pressure of the pleural cavity, while the negative pressure in the thoracic cavity is greater. The extent depends on the passive pulling force when the diaphragm is rising (this is the theoretical basis for the treatment of bilateral diaphragmatic paralysis by diaphragmatic folding), so when the bilateral complete diaphragmatic paralysis is reduced, the vital capacity is usually reduced by more than 80%, resting state. The ventilation is also significantly affected, resulting in significant dyspnea and respiratory failure, due to limited lung expansion, prone to atelectasis and repeated lung infections.

Diaphragm paralysis prevention

1. Mainly for the prevention of different primary diseases, such as the decline of resistance is an important factor in the incidence of herpes zoster. Therefore, in spring, work should be combined with rest and rest, drink plenty of water to eat fresh vegetables and fruits, exercise more and improve resistance. This is the key to prevention.

2. Early patients can embed electrodes under the skin to stimulate the phrenic nerve, restore the contractor function of the diaphragm, and achieve the purpose of improving ventilation.

Diaphragmatic paralysis complications Complications, respiratory failure, lung cancer

1. Long-term diaphragmatic paralysis can produce diaphragmatic atrophy to form a thin film.

2. Bilateral diaphragmatic paralysis causes severe dyspnea and may be complicated by respiratory failure. The patient has difficulty breathing and eventually died of hypoxia.

3. If caused by lung cancer, it can be combined with other symptoms caused by the transfer of lung cancer to other organs.

Symptoms of diaphragmatic paralysis Common symptoms Hairy sputum repeated pneumonia, sputum, weakness, lung distension, abdominal pain, respiratory failure, bloating, difficulty swallowing, difficulty breathing

1. The unilateral diaphragmatic paralysis can reduce the lung capacity by 37% and the ventilation volume by 20%. However, due to the compensatory effect, the patient is often asymptomatic. In the chest X-ray examination, the diaphragmatic muscle rises and the contradictory movement is found by chance. Some patients complained severely. There is difficulty in breathing during exercise. The left diaphragmatic paralysis may have gastrointestinal symptoms such as hernia, abdominal distension, abdominal pain and other symptoms due to elevated fundus. When bilateral bilateral diaphragmatic paralysis occurs, the patient presents with severe dyspnea and abnormal breathing in the abdomen (inhalation) Abdominal depression), respiratory effort and assisted respiratory muscle use, usually with respiratory failure such as cyanosis, most of the patients receiving mechanical ventilation cause ventilator dependence, due to limited lung expansion and dysfunction, easy to have repeated pneumonia And atelectasis.

2. The clinical manifestations of bilateral complete diaphragmatic paralysis have certain characteristics, which can be based on clinical severe dyspnea and abdominal abnormal breathing, combined with basic diseases that may cause diaphragmatic paralysis, can make clinical diagnosis, unilateral diaphragm Paralyzed persons, especially those with incomplete paralysis, are usually asymptomatic in clinical practice and need to be diagnosed by auxiliary examination. The diagnosis of diaphragmatic paralysis includes X-ray chest fluoroscopy and sacral nerve electromagnetic wave stimulating action potential and trans-iliac muscle pressure. Determination.

Examination of diaphragmatic paralysis

1. Infectious diseases or inflammatory diseases, white blood cells are normal or elevated.

2. X-ray chest perspective

The unilateral diaphragmatic paralysis is elevated, the activity is weakened or disappeared, and the contralateral diaphragm muscle is decreased and the diaphragmatic muscle of the affected side is increased during inhalation. This phenomenon is more obvious when sucking the nose vigorously. When the heart is qi, the mediastinum moves to the healthy side and exhales to the affected side.

3. Radial nerve stimulation

Can be 3cm ~ 4cm on the neck sternocleidal joint, the posterior margin of the sternocleidomastoid muscle stimulates the phrenic nerve through non-invasive electric or magnetic waves, or can stimulate the phrenic nerve with magnetic waves near the spinous process of the cervical spine 7 7 intercostal body surface recording induced action potential and sacral nerve conduction time; and the trans-sacral muscle pressure induced by esophageal-stomach cystic duct method can confirm diaphragmatic paralysis, and can also be judged to be complete or incomplete paralysis.

Diagnosis and differentiation of diaphragmatic paralysis

1. Newborns should be differentiated from congenital diaphragmatic bulging: diaphragmatic paralysis often has a history of sacral nerve damage, diaphragmatic muscles, paralyzed movements and mediastinal shifts are not as obvious as diaphragmatic bulging, which can be distinguished. The bulging of the sputum is due to varying degrees of paralysis of the muscle fibers, hypoplasia or atrophy of the tendon, resulting in abnormal elevation of all or part of the diaphragm. Some patients may have respiratory or digestive symptoms.

2. In adults should be identified with the lung bottom liquid phase.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.