Brachial Plexus Injury Following Coronary Artery Bypass Surgery: a Case Report

臂神經叢傷害為心臟術後一個常見的併發症，其臨床表徵多變而輕重程度不一，但大多數這些症狀可自行改善而不需治療，不過仍有極少數病例發生持續性的症狀，甚至造成上肢功能不全。吾人即經歷一位67歲男性，在冠狀動脈繞道術後，發生永久性的左上肢麻痺及感覺喪失，神經傳導及肌電圖檢查影示病灶區位於第五頸椎至第一胸椎之神經根。回顧文獻並仔細播視手術過程，引起上述傷害的肇因最可能是因過寬和過久的胸骨撐開而導致臂神經叢的壓破或過度伸展。其次，剝離內乳動脈時，不對稱的胸骨半葉牽引也可能導致神經害。因此，語人推論欲減低臂神經叢傷害，應進行精確的正中胸骨切開，低位而儘可能最小的胸骨撐開，同時避免長時間和不對稱的胸骨半葉牽引。

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並列摘要

Postoperative brachial plexus injury, often manifesting as a variety of upper extremity neuropathies, is a recognized and not uncommon complication following cardiac surgery that requires a median sternotomy. In general, the vast majority of its neurological symptoms are transient and need no treatment. Nevertheless, in very rare cases, the peripheral neuropathies will persist and cause disability. We treated a 67-year-old male patient complicated by permanent paresthesia and paralysis of the left upper extremity after an eventful coronary artery bypass surgery. The nerve conduction measurements and electrormyography all revealed a C5 to T 1 lesion. After carefully reviewing the surgical course and referring to the published literature, we tentatively concluded that compression or overstretching produced by wide and prolonged sternal separation of the brachial plexus was the most likely etiology. Asymmetrical traction of the sternal halves during internal mammary artery harvesting might also have contributed to this nerve injury. We surmised, therefore, that brachial plexus injury could be minimized by an exact median sternotomy, a lower position and the smallest possible opening for the sternal retractor, and the avoidance of constant and asymmetrical traction on the sternal halves.

並列關鍵字

median sternotomy；brachial plexus injury；coronary artery bypass grafting

國際替代計量

Brachial Plexus Injury Following Coronary Artery Bypass Surgery: a Case Report

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