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目的分析新生儿乳糜胸的临床特点。方法对2005年1月至2013年6月本院新生儿科收治的新生儿乳糜胸病例进行回顾性研究,分析患儿病史、临床表现、相关检查、治疗方法、疗程、治疗效果及不良反应。结果研究期间共收治7例新生儿乳糜胸患儿,生后40 min至13天起病,其中1例于产前超声即提示有胸腔积液。患儿均有气促、发绀、呼吸困难进行性加重、患侧胸廓饱满及肺部听诊呼吸音减低,5例有肺部湿啰音。经胸部X线、胸部CT或胸部超声证实胸腔积液,左侧4例,右侧2例,双侧1例。胸水白细胞(150~72 000)×106/L,乳糜实验均阳性,血总蛋白、白蛋白均明显降低。7例均予胸腔闭式引流,部分患儿予奥曲肽、红霉素、沙培林治疗,疗程7~48天。5例患儿完全吸收出院;1例好转出院,3个月后随访完全吸收;1例因败血症、肺炎死亡。结论新生儿乳糜胸应早期予以胸腔闭式引流,并联合使用红霉素针胸腔注射和奥曲肽针静脉滴注。难治性乳糜胸经家属同意后可用沙培林治疗。
Objective To analyze the clinical features of neonatal chylothorax. Methods A retrospective study was conducted on neonatal chylothorax in our hospital from January 2005 to June 2013. The patients’ history, clinical manifestations, related examinations, treatments, courses of treatment, treatment effects and adverse reactions were analyzed. Results A total of 7 neonates with chylothorax were admitted during the study period, and 40 to 13 days after birth. One patient was diagnosed with pleural effusion by prenatal ultrasound. Children with shortness of breath, cyanosis, progressive dyspnea, ipsilateral full of thoracic and lung auscultation decreased respiratory sounds, lung wet rales in 5 cases. Pleural X-ray, chest CT or chest ultrasound confirmed pleural effusion, left in 4 cases, right in 2 cases, bilateral in 1 case. Pleural effusion white blood cells (150 ~ 72 000) × 106 / L, chyle test were positive, blood total protein, albumin were significantly lower. 7 cases were closed thoracic drainage, some children to octreotide, erythromycin, sappaphyl, treatment of 7 to 48 days. 5 cases were completely absorbed and discharged; 1 case was discharged and was completely absorbed after 3 months; 1 case died of sepsis and pneumonia. Conclusions Neonatal chylothorax should be closed thoracic drainage in early stage and combined with erythromycin needle thoracic injection and octreotide intravenous infusion. Refractory chylothorax may be treated with saperpine after family consent.