7例新生儿乳糜胸的临床分析  

Clinical Aanlysis of 7 Neonates with Chylothorax and Review the Related Literatures

作　　者：杨建生 吴本清 贺务实 燕旭东 

机构地区：[1]暨南大学第二临床医学院深圳市人民医院新生儿科,广东省深圳市518020

出　　处：《中华全科医学》2011年第8期1175-1176,1229,共3页Chinese Journal of General Practice

基　　金：广东省深圳市医学重点学科专项基金(20091998A03)

摘　　要：目的分析新生儿乳糜胸的原因、临床过程及治疗效果并复习相关文献。方法对2009～2010年收住深圳市人民医院新生儿重症监护室的7例乳糜胸患儿进行回顾性分析。详细分析病史及相关检查结果明确病因,并对其采取的治疗方法包括:一般治疗方法、化学胸膜固定术(胸腔内注入红霉素)以及奥曲肽持续滴入的治疗时间、疗程、效果及副作用进行分析。结果 7例患儿中3例为创伤性乳糜胸,4例为先天性乳糜胸。其中3例创伤性乳糜胸和1例先天性乳糜胸患儿在一般治疗加用化学胸膜固定术治疗后痊愈;2例大量及反复的先天性乳糜胸患儿在其基础上加用生长抑素类似物奥曲肽后痊愈,且没有发现任何副作用;1例患儿因合并有严重的合并症,家长放弃治疗。结论新生儿乳糜胸为新生儿胸腔积液的常见病因之一;随着中心静脉营养的开展,应注意新生儿创伤性乳糜胸的发生;对于新生儿乳糜胸的治疗,首先应选择保守的治疗措施,使用一般治疗加用化学胸膜固定术(胸腔内注入红霉素)有效,对于难治性及反复的乳糜胸患儿在其基础上加用生长抑素及其类似物奥曲肽治疗效果明显。Objective To investigate the underlying etiology, clinical course and treatment of neonatal chylothorax and to review the related literatures. Methods A retrospective analysis of 7 neonates admitted to our neonatal intensive care unit with chylo- thorax between January 2009 and December 2010 was performed. The history,related test results and the time of starting treat- ment, optimum duration, efficacy and side-effects of therapeutic strategies including： conservative treatments, chemical pleurodesis （ intrapleural Erythromycin）, continuous intravenous infusion of octreotide were analyzed. Results There were three patients who had traumatic chylothorax and four patients who had congenital chylothorax in all cases. 3 cases of traumatic chylothorax were cured after treated with conservative treatments and chemical pleurodesis. 2 cases recovered from congenital chylothorax accompa- nied large and recurrent hydrothorax by conservative treatments, chemical pleurodesis and octreotide and no side-effects were observed. 1 case with sever complication abandoned treatment. Conclusion Chylothorax was the most common form of pleural effusion in the neonate;with the development of nutrition by central vein catheter, traumatic ehylothorax should be noticed. For the therapeutic strategies about neonatal chylothrorax, conservative medical treatments should be taken initially. It was effective for small or moderate amount pleural effusion that taking conservative measures and chemical pleurodesis （ intrapleural Erythromyein） and for large and recurrent hydrothorax that adding to octreotide based on above strategies. Which was corresponded with literatures.

关 键 词：新生儿乳糜胸 化学胸膜固定术(胸腔内注入红霉素) 奥曲肽 

分 类 号：R561.7[医药卫生—呼吸系统] R722.1[医药卫生—内科学]