4例新生儿乳糜胸的药物治疗分析及药学服务  

Analysis of drug treatment and pharmaceutical care for 4 cases of neonatal chylothorax

作　　者：李三妮 尹雪冬[1] 胡文娟 孙华君[1] 李志玲[1] LI Sanni;YIN Xuedong;HU Wenjuan;SUN Huajun;LI Zhiling(Department of Pharmacy,Shanghai Children’s Hospital,Children’s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200062,China;Department of Pharmacy,Children’s Hospital of Hebei Province,Shijiazhuang 050031,China)

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院药学部,上海200062 [2]河北省儿童医院药学部,石家庄050031

出　　处：《药学服务与研究》2021年第5期378-383,共6页Pharmaceutical Care and Research

基　　金：上海交通大学医学院“临床药学创新研究院”专项建设项目(CXYJY2019MS003)。

摘　　要：目的:分析新生儿乳糜胸的治疗和药学服务过程,探讨临床药师在治疗中的作用。方法:回顾性分析上海市儿童医院2019年2月-2020年4月收治的4例新生儿乳糜胸患儿的病例特点和药物治疗差异,总结不同病例的药学服务共同点和侧重点。结果:4例均为先天性新生儿乳糜胸,其中男1例,女3例,平均出生体重(3.41±0.85)kg。3例保守治疗有效,1例保守治疗无效后用乳糖酸红霉素进行胸膜固定术后治愈。保守治疗所用药物中,静脉营养脂肪为多种油脂肪乳和中长链脂肪乳,抗菌药物为第三代头孢菌素或青霉素+β-内酰胺酶抑制剂。3例好转出院,1例治愈出院。1例患儿出现药物相关性胆汁瘀积型肝炎。结论:新生儿乳糜胸合并细菌感染几率高,合理使用抗菌药物可避免发展为严重细菌感染。乳糜胸患儿经过胸腔闭式引流、抗菌治疗、奥曲肽抑制分泌、静脉营养和以中链三酰甘油为主的肠内营养等综合治疗,预后良好。长期应用全静脉营养和奥曲肽应注意监测胆汁瘀积型肝炎等不良反应。Objective:To analyze the treatment of neonatal chylothorax and the process of pharmaceutical care,and also explore the role of clinical pharmacists in treatment of the disease.Methods:A retrospective analysis was made on the case characteristics and differences in drug treatment of the neonates admitted to the Shanghai Children’s Hospital from February 2019 to April 2020,and the common problems encountered and different focuses of pharmaceutical care were summarized for different cases.Results:Of the 4 patients with congenital chylothorax,one was male and three were female,with an average birth weight of(3.41±0.85)kg.Three cases were efficient with conservative treatment.Following failure with conservative treatment,one case was cured after pleural fixation with erytkromycin lactobionate.Of the drugs used in conservative treatment,a variety of oil fat emulsion and medium and long chain fat emulsion were used in parenteral nutrition.The antibacterials used were the third-generation cephalosporins or penicillin+β-lactamase inhibitors.Consequently,3 cases were discharged after symptom improvement and one case was discharged following cure.There was one case of drug-associated cholestatic hepatitis.Conclusion:There was high probability for the newborn to get neonatal chylothorax complicated with bacterial infection,and rational use of antimicrobials could avoid development of serious bacterial infection.Good prognosis could be achieved in the children with chylothorax following comprehesive treatment with closed thoracic drainage,antibacterial therapy,secretion inhibition by octreotide,as well as parenteral and enteral nutrition based on medium chain triglycerides.Physicians should be highly alert on such adverse reactions as cholestatic hepatitis in prolonged use of total parenteral nutrition and octreotide.

关 键 词：新生儿 乳糜胸 药物治疗 药学服务 药物副反应报告系统 

分 类 号：R722.1[医药卫生—儿科] R969.3[医药卫生—临床医学]