新生儿先天性乳糜胸分层治疗方案探讨  

Exploration of stratified treatment plans for neonatal congenital chylothorax

作　　者：刘蕾 王亚娟 杨学芳 丁翊君 Liu Lei;Wang Yajuan;Yang Xuefang;Ding Yijun(Department of Neonatology,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;Department of Neonatal Internal Medicine,Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,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,北京100045 [2]首都儿科研究所附属儿童医院新生儿内科,北京100020

出　　处：《中华围产医学杂志》2025年第3期241-246,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的总结新生儿先天性乳糜胸临床治疗特点,探讨先天性乳糜胸分层治疗方案流程。方法选取2010年1月1日至2021年12月31日首都医科大学附属北京儿童医院新生儿中心收治的36例先天性乳糜胸患儿的临床资料进行回顾性分析。根据治疗方法及初始引流量,分为单纯保守治疗组[初始引流量<20 ml/(kg·d),n=20]、奥曲肽组[初始引流量≥20~<30 ml/(kg·d),n=4]、红霉素组[初始引流量≥30~<50 ml/(kg·d),n=6]和奥曲肽+红霉素组[初始引流量≥50 ml/(kg·d),n=6]。根据不同治疗方法患儿的临床特点及治疗效果,以及进一步治疗方案的选择,总结不同治疗方法的选择时机,并结合文献梳理更规范的分层治疗方案。结果36例先天性乳糜胸中,18例(50.0%)为宫内诊断,均未进行宫内干预治疗。单纯保守治疗组20例仅采用呼吸支持、胸腔引流、营养疗法等,除1例放弃治疗自动出院外,余19例均痊愈或好转。奥曲肽组4例患儿奥曲肽持续静脉滴注剂量范围1~10μg/(kg·h),3例好转,1例痊愈均未发生低血糖、甲状腺功能异常和新生儿坏死性小肠结肠炎等不良反应。红霉素组6例患儿红霉素胸腔注射剂量为25~30 mg/kg,注射3~5次时中位胸腔引流量约减至用药前50%,4例好转,2例痊愈。奥曲肽+红霉素组6例患儿采用静脉滴注奥曲肽同时加用胸腔注射红霉素治疗,4例好转,2例痊愈。结合既往治疗并综合文献报道,最终形成治疗侵袭性由小到大的分层治疗流程。结论先天性乳糜胸根据初始引流量及对治疗的反应,建议采取分层治疗方案,由保守治疗到药物治疗(静脉滴注奥曲肽),效果欠佳的患儿可加用手术治疗(胸腔注射红霉素或其他外科手术干预)。ObjectiveTo explore the stratified treatment plan process for neonatal congenital chylothorax by summarizing its clinical treatment characteristics.MethodsA retrospective analysis was conducted on the clinical data of 36 neonates with congenital chylothorax treated at the Department of Neonatology of Beijing Children's Hospital,Capital Medical University,from January 1,2010,to December 31,2021.Based on different treatment methods and initial drainage volumes,the cases were divided into the conservative treatment group[initial drainage volume<20 ml/(kg·d),n=20],octreotide group[initial drainage volume≥20-<30 ml/(kg·d),n=4],erythromycin group[initial drainage volume≥30-<50 ml/(kg·d),n=6],and octreotide plus erythromycin group[initial drainage volume≥50 ml/(kg·d),n=6].The clinical characteristics and treatment effects of the children in different treatment groups,as well as the choice of further treatment plans,were summarized to determine the timing of different treatment methods.A more standardized stratified treatment plan was formulated by combining the literature.ResultsAmong the 36 cases of congenital chylothorax,18 cases(50.0%)were diagnosed in utero,with no intrauterine intervention.In the conservative treatment group,20 cases were treated with respiratory support,thoracic drainage,and nutritional therapy.Except for one case who was discharged after abandoning treatment,the remaining 19 cases were cured.In the octreotide group,four children received continuous intravenous infusion of octreotide at doses ranging from 1 to 10μg/(kg·h),with three cases improving and one case being cured.No adverse effects such as hypoglycemia,thyroid dysfunction,or neonatal necrotizing enterocolitis occurred.In the group of six children who received intrapleural erythromycin injections,the dosage of erythromycin was 25-30 mg/kg,and the median thoracic drainage volume was reduced to approximately 50%of the pre-treatment volume after 3-5 injections,with four cases improving and two cases being cured.In the group of si

关 键 词：乳糜胸 先天性 新生儿 治疗 

分 类 号：R722.1[医药卫生—儿科]