Bedside ultrasound for the diagnosis of postoperative diaphragmatic paralysis after congenital cardiac surgery in infant / 中华超声影像学杂志

ABSTRACT

Objective To investigate the diagnostic performance of bedside ultrasound for postoperative diaphragmatic paralysis after congenital cardiac surgery in infant . Methods A total of 47 postoperative infants presented dyspnea after congenital cardiac surgery were collected . The diaphragmatic motion was detected by bedside ultrasound as an indirect indicator to reflect the condition of the phrenic nerve . The diagnostic performance of the combination of paradoxical and hypokinetic motion in parallel tests were assessed according to the final diagnostic results . The proportion of confirmed diaphragmatic paralysis in patients with different diaphragmatic motion was calculated respectively and compared . Ten cases were randomly selected for the estimation of the repeatability by calculating the weighted Kappa value based on the results in two different doctors . Results Utilizing the combination of paradoxical and hypokinetic motion in parallel tests as the diagnostic criteria ,the sensitivity was 100％ and the specificity was 40％ . After observation period , all the 14 patients presented with diaphragmatic paradoxical motion were confirmed as diaphragmatic paralysis ;while in the 23 patients presented with hypokinetic motion ,8 cases were confirmed as diaphragmatic paralysis ,there was significant difference between them ( P = 0 .000) . The reproducibility for bedside ultrasound was good ( Kappa value was 0 .891) . Conclusions Utilizing the bedside ultrasound for the diagnosis of diaphragmatic paralysis in infant is sensitive and reliable . For reducing the time for definite diagnosis and avoiding over-treatment ,paradoxical diaphragmatic motion can be considered as a direct diagnostic criteria ,however follow-up estimation for hypokinetic diaphragmatic motion is necessary before the confirmation of final diagnosis .