新生儿乳糜胸临床特点及预后分析  

Clinical characteristics and prognostic analysis of neonatal chylothorax

作　　者：陈岩 李雪琪 杨子馨 向希盈 齐宇洁 黑明燕 Chen Yan;Li Xueqi;Yang Zixin;Xiang Xiying;Qi Yujie;Hei Mingyan(Neonatal Center,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院新生儿中心/国家儿童医学中心新生儿中心,北京100045

出　　处：《中华新生儿科杂志（中英文）》2024年第4期209-212,共4页Chinese Journal of Neonatology

基　　金：国家重点研发计划重点专项子课题(2022YFC2704805)。

摘　　要：目的探讨新生儿乳糜胸的临床特点及预后。方法回顾性分析北京儿童医院新生儿中心2016年6月至2023年6月明确诊断为乳糜胸新生儿的临床资料,根据乳糜胸发病原因分为先天性组和获得性组,比较两组临床特点、治疗方法及预后情况。结果共纳入23例患儿,先天性组17例(73.9%),获得性组6例(26.1%)。两组患儿性别、胎龄、出生体重比较差异无统计学意义(P>0.05)。与获得性组相比,先天性组淋巴细胞百分比(97.0%比85.0%)、使用红霉素(7/17比1/6)及奥曲肽(9/17比1/6)、特殊配方奶喂养(13/17比2/6)比例更高,右侧胸水发生率(1/17比3/6)、有创机械通气比例(6/17比6/6)、母乳喂养率(0/17比3/6)更低,差异均有统计学意义(P<0.05)。两组胸水白细胞计数、胸水及血浆蛋白含量、双侧及左侧胸水发生率、胸腔闭式引流比例、单日最大引流量、引流时长、总引流量、白蛋白使用率、住院时长、存活率方面比较差异无统计学意义(P>0.05)。18例经保守治疗胸腔积液吸收无复发;5例患儿住院期间死亡,其中4例因家长放弃治疗后死亡,1例胸导管结扎术后并发新生儿坏死性小肠结肠炎死亡。结论先天性乳糜胸与获得性乳糜胸严重程度、病程及总体预后相似,先天性乳糜胸使用红霉素及奥曲肽治疗率较获得性乳糜胸高。新生儿乳糜胸总体预后良好。Objective To investigate the clinical characteristics and prognosis of neonatal chylothorax.Methods The clinical data of newborns diagnosed with chylothorax from June 2016 to June 2023 in Neonatal Center of Beijing Children's Hospital were retrospectively analyzed,and divided into congenital group and acquired group according to the pathogenesis of chylothorax.The clinical characteristics,treatment methods and prognosis of the two groups were compared.Results A total of 23 cases were included,including 17 cases(73.9%)in the congenital group and 6 cases(26.1%)in the acquired group.There was no significant difference in gender,gestational age and birth weight between the two groups(P>0.05).Compared with the acquired group,the proportion of lymphocytes(97.0%vs.85.0%),the use of erythromycin(7/17 vs.1/6)and octreotide(9/17 vs.1/6)and special formula milk feeding(13/17 vs.2/6)were higher in the congenital group;the proportion of right hydrothorax(1/17 vs.3/6),invasive mechanical ventilation(6/17 vs.6/6)and breastfeeding(0/17 vs.3/6)were lower in the congenital group(P<0.05).There were no significant differences in terms of the white blood cell count in pleural fluid and plasma protein content,incidence of bilateral and left pleural fluid,proportion of closed thoracic drainage,maximum daily drainage volume,drainage duration,total drainage volume,albumin utilization rate,length of stay and survival rate between the two groups(P>0.05).18 cases of pleural effusion absorption without recurrence after conservative treatment;5 cases died,of which 4 cases died after their parents abandoned treatment,and 1 case died of neonatal necrotizing enterocolitis after thoracic duct ligation surgery.Conclusions Congenital chylothorax and acquired chylothorax were similar in severity,course of disease and overall prognosis.The utilization rate of erythromycin and octreotide in congenital chylothorax was higher than that in acquired chylothorax.The neonatal chylothorax is usually with an overall good prognosis.

关 键 词：新生儿 乳糜胸 先天性 获得性 临床特点 

分 类 号：R722.1[医药卫生—儿科]