早产儿乳糜腹5例分析及文献复习  

Isolated chylous ascites in preterm infants:a case report and literature review

作　　者：全美盈[1] 万伟琳[1] 张玉[1] 张乐嘉[1] 王晨[1] 李正红[1] Quan Meiying;Wan Weilin;Zhang Yu;Zhang Lejia;Wang Chen;Li Zhenghong(Department of Pediatrics,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院儿科,北京100730

出　　处：《中华全科医师杂志》2022年第10期972-975,共4页Chinese Journal of General Practitioners

基　　金：中央高水平医院临床科研专项。

摘　　要：回顾分析2011—2021年北京协和医院新生儿重症监护病房收治的5例早产儿乳糜腹患儿资料。5例平均胎龄为29+1周,出生体重(1122±323)g,其中男婴3例、女婴2例。产前超声检查均未发现腹腔积液,患儿在开始肠内营养后4~10 d出现腹胀、腹腔积液,行腹腔积液常规及乳糜试验诊断为乳糜性腹水。禁食1~3周,采用高蛋白(4 g·kg^(-1)·d^(-1))、低脂肪(2.0~2.5 g·kg^(-1)·d^(-1))肠外营养支持方案;再次开奶4例以含50%中链脂肪酸的配方奶喂养、1例以母乳开奶,中链脂肪酸配方奶持续时间1~3个月。随诊3~5年,无乳糜腹复发。检索到PubMed及万方数据库文献报道的7例早产儿乳糜腹病例资料,其中6例产前超声检查发现胎儿腹腔积液,发现时胎龄21~23周;3例进行核素淋巴显像检查,2例发现腹腔淋巴瘘或淋巴管扩张;5例需禁食同时持续静脉输注奥曲肽治疗;3例保守治疗无效者行腹腔镜/开腹手术治疗后好转。7例保守治疗阶段4例合并败血症,需要静脉抗生素治疗。The clinical data of 5 cases of chylous ascites in preterm infants admitted in NICU of Peking Union Hospital from 2001 to 2021 were retrospectively analyzed. There were 3 boys and 2 girls with the gestational age of 29 +1 weeks, and birth weight of (1 122±323) g. No peritoneal effusion was found on prenatal ultrasound examination. All the five cases diagnosed with chylous ascites after the initiation of enteral nutrition on d4 to d10. All cases were resolved by conservative treatment, including fasting with total parenteral nutrition for 3 wks. The parenteral nutrition strategy was specified by high protein concentration (4 g·kg^(-1)·d^(-1)) and low lipid emulsion (2.0-2.5 g·kg^(-1)·d^(-1)). Formula containing 50% medium chain triglyceride or human milk was fed sequentially, and no feeding intolerance or abdominal distension were observed. All patients were discharged stable and followed up for 3-5 years,and no recurrence occurred. The PubMed and Wanfang database were searched for cases of chylous ascites in preterm infants, and 7 cases were reported in literature. Six cases were diagnosed by antenatal ultrasound between 21 and 23 weeks of gestational age. Three cases underwent radionuclide lymphoscintigraphy, and 2 of them demonstrated peritoneal lymphatic fistula or lymphatic dilatation. Five cases were treated with fasting plus intravenous infusion of octreotide. Three infants who failed to respond to conservative treatment underwent surgical treatment. Four cases were complicated with sepsis and needed intravenous antibiotic treatment.

关 键 词：乳糜性腹水 产前诊断 婴儿 早产 营养疗法 奥曲肽 手术疗法 

分 类 号：R722.6[医药卫生—儿科]