创伤性纵隔气肿与自发性纵隔气肿的临床特征及预后  

Clinical characteristics and prognosis of traumatic mediastinal emphysema and spontaneous mediastinal emphysema

作　　者：余长永 刘武新 王强 YU Chang-yong;LIU Wu-xin;WANG Qiang(Department of Thoracic Surgery,Jiangsu Shengze Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu 215228,China;Department of General Surgery,Jiangsu Shengze Hospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu 215228,China)

机构地区：[1]南京医科大学附属江苏盛泽医院胸外科,江苏苏州215228 [2]南京医科大学附属江苏盛泽医院普外科,江苏苏州215228

出　　处：《临床肺科杂志》2020年第8期1197-1201,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的总结创伤性纵隔气肿(traumatic mediastinal emphysema,TPM)与自发性纵隔气肿(spontaneous mediastinal emphysema,SPM)的常见病因、临床表现、治疗及预后,了解两组疾病特征的差异。方法回顾性分析2013年1月至2019年8月我院收治的41例纵隔气肿(mediastinal emphysema,PM)患者的临床资料,按有无明确外伤病因分为TPM 27例与SPM 14例。结果 41例PM患者平均年龄(39.22±18.80)岁,男36例,女5例,男女比例7.2∶1。TPM组27例,年龄(43.19±17.54)岁;SPM组14例,年龄(28.15±15.20)岁。SPM临床表现主要有胸痛(11/14)、胸闷(6/14)、咳嗽(4/14)、咽喉肿痛或异物感(4/14)及皮下气肿(4/14),TPM则为胸痛(22/27)、咳嗽(16/27)、胸闷(14/27)、呼吸困难(9/27)及皮下气肿(21/27);SPM治疗以吸氧、抗感染、禁食等治疗为主,仅1例行胸腔闭式引流治疗,而TPM组的有创治疗包括胸腔闭式引流13例、纵隔切开减压1例、机械通气2例及气管切开1例;SPM出院随访除1例失访未知外,其余恢复良好,TPM出院随访20例恢复良好,4例失访未知,3例死亡,包括2例院内死亡和1例院外死亡。结论 TPM和SPM症状都以胸痛为主,皮下气肿是最常见体征,呼吸困难与皮下气肿是区分TPM与SPM的最主要症状和体征。SPM是病程简单,而TPM病程相对复杂,需经历较长的气肿吸收期,治疗上需要更多的有创治疗方式,尤其以胸腔闭式引流治疗为多见,其预后的主要影响因素仍是创伤合并症,尤其是颅脑损伤。Objective To summarize the common etiology, clinical manifestations, treatment and prognosis of traumatic mediinal emphysema( TPM) and spontaneous mediastinal emphysema( SPM),and to understand the differences of clinical features between the two kinds of diseases. Methods A retrospective analysis of the clinical data of 41 patients with PM in Jiangsu Shengze hospital affiliated to Nanjing medical university from Jan 2013 to Aug2019 was performed. According to the etiology of trauma was clear or not.,they were divided into the SPM group and the TPM group. Results The mean age of 41 patients with mediastinal emphysema was 39. 22 ± 18. 80 years,including 36 males and 5 females,with a male-female ratio of 7. 2: 1. There were 27 patients in the TPM group( age:43. 19 ± 17. 54 yrs) and 14 cases in the SPM group( age: 28. 15 ± 15. 20 yrs). The main clinical manifestations of SPM were chest pain( 11/14),chest tightness( 6/14),cough( 4/14),sore throat or abnormal sensation of throat( 4/14) and subcutaneous emphysema( 4/14),while TPM was chest pain( 22/27),cough( 16/27),chest tightness( 14/27),dyspnea( 9/27) and subcutaneous emphysema( 21/27). SPM was mainly treated with oxygen inhalation,anti-infection,fasting,and only 1 patient was treated with closed thoracic drainage,while the invasive treatment in the TPM group included 13 cases of closed thoracic drainage,1 case of mediastinal decompression,2 cases of mechanical ventilation and 1 case of tracheotomy. SPM discharge follow-up showed good recovery except for 1 patient who was lost to follow-up,while TPM showed good recovery in 20 patients,4 patients were lost to follow-up,and 3 patients died,including 2 patients died in hospital and 1 patient died after discharge. Conclusion The symptoms of TPM and SPM are mainly chest pain,subcutaneous emphysema is the most common sign,and dyspnea and subcutaneous emphysema are the most important signs and symptoms to distinguish TPM from SPM. The course of SPM is simple,while the course of TPM is relatively complicated,which require

关 键 词：创伤性纵隔气肿 自发性纵隔气肿 纵隔气肿 预后 临床特征 

分 类 号：R655.5[医药卫生—外科学]