中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2013年
11期
849-851
,共3页
张雪雅%张维溪%盛安群%张海邻%李昌崇
張雪雅%張維溪%盛安群%張海鄰%李昌崇
장설아%장유계%성안군%장해린%리창숭
儿童%纵隔气肿%诊断%治疗%预后
兒童%縱隔氣腫%診斷%治療%預後
인동%종격기종%진단%치료%예후
Child%Mediastinal emphysema%Diagnosis%Therapy%Prognosis
目的 探讨儿童自发性纵隔气肿的诊断、治疗及预后.方法 对温州医科大学附属育英儿童医院2007年12月至2013年2月收治的18例自发性纵隔气肿患儿的临床资料进行回顾性总结,同时电话随访了解疾病再发及后遗症等情况.本组资料排除由于机械通气等医源性操作,外伤,异物吸入以及由于肺部基础疾病等原因导致的纵隔气肿病例.另外继发于气胸的纵隔气肿及新生儿纵隔气肿也被排除在外.结果 18例自发性纵隔气肿患儿中男15例,女3例,年龄14.7(9～17)岁；一般在无明显诱因或体育运动,剧烈咳嗽后发病,临床表现为胸痛、胸闷、颈部疼痛、背部疼痛、吞咽疼痛或有异物感、呼吸困难、咽喉部肿痛等.18例患儿胸部CT均显示纵隔积气,8例显示合并不同程度的颈部、胸部等部位积气.18例患儿经过静卧休息,吸氧,祛痰止咳和预防感染等治疗后,15例胸部CT或X线复查显示纵隔积气消失或明显吸收,3例出院后门诊随访恢复情况良好.电话联系随访18例患儿,成功联络14例,失访4例,随访平均时间为(24±17)个月.患儿均无严重后遗症,但有1例出现纵隔气肿再发.结论 儿童自发性纵隔气肿是一种良性病变,当患儿出现胸痛、胸闷等临床症状,在排除其他常见疾病后需警惕纵隔气肿,通常结合胸部CT表现可确诊,采用保守治疗,随访预后良好.
目的 探討兒童自髮性縱隔氣腫的診斷、治療及預後.方法 對溫州醫科大學附屬育英兒童醫院2007年12月至2013年2月收治的18例自髮性縱隔氣腫患兒的臨床資料進行迴顧性總結,同時電話隨訪瞭解疾病再髮及後遺癥等情況.本組資料排除由于機械通氣等醫源性操作,外傷,異物吸入以及由于肺部基礎疾病等原因導緻的縱隔氣腫病例.另外繼髮于氣胸的縱隔氣腫及新生兒縱隔氣腫也被排除在外.結果 18例自髮性縱隔氣腫患兒中男15例,女3例,年齡14.7(9～17)歲；一般在無明顯誘因或體育運動,劇烈咳嗽後髮病,臨床錶現為胸痛、胸悶、頸部疼痛、揹部疼痛、吞嚥疼痛或有異物感、呼吸睏難、嚥喉部腫痛等.18例患兒胸部CT均顯示縱隔積氣,8例顯示閤併不同程度的頸部、胸部等部位積氣.18例患兒經過靜臥休息,吸氧,祛痰止咳和預防感染等治療後,15例胸部CT或X線複查顯示縱隔積氣消失或明顯吸收,3例齣院後門診隨訪恢複情況良好.電話聯繫隨訪18例患兒,成功聯絡14例,失訪4例,隨訪平均時間為(24±17)箇月.患兒均無嚴重後遺癥,但有1例齣現縱隔氣腫再髮.結論 兒童自髮性縱隔氣腫是一種良性病變,噹患兒齣現胸痛、胸悶等臨床癥狀,在排除其他常見疾病後需警惕縱隔氣腫,通常結閤胸部CT錶現可確診,採用保守治療,隨訪預後良好.
목적 탐토인동자발성종격기종적진단、치료급예후.방법 대온주의과대학부속육영인동의원2007년12월지2013년2월수치적18례자발성종격기종환인적림상자료진행회고성총결,동시전화수방료해질병재발급후유증등정황.본조자료배제유우궤계통기등의원성조작,외상,이물흡입이급유우폐부기출질병등원인도치적종격기종병례.령외계발우기흉적종격기종급신생인종격기종야피배제재외.결과 18례자발성종격기종환인중남15례,녀3례,년령14.7(9～17)세；일반재무명현유인혹체육운동,극렬해수후발병,림상표현위흉통、흉민、경부동통、배부동통、탄인동통혹유이물감、호흡곤난、인후부종통등.18례환인흉부CT균현시종격적기,8례현시합병불동정도적경부、흉부등부위적기.18례환인경과정와휴식,흡양,거담지해화예방감염등치료후,15례흉부CT혹X선복사현시종격적기소실혹명현흡수,3례출원후문진수방회복정황량호.전화련계수방18례환인,성공련락14례,실방4례,수방평균시간위(24±17)개월.환인균무엄중후유증,단유1례출현종격기종재발.결론 인동자발성종격기종시일충량성병변,당환인출현흉통、흉민등림상증상,재배제기타상견질병후수경척종격기종,통상결합흉부CT표현가학진,채용보수치료,수방예후량호.
Objective To analyze the diagnosis,treatment and prognosis of spontaneous pneumomediastinum (SPM) in children.Method A retrospective analysis of the clinical data of 18 children diagnosed with SPM in Yuying Children's Hospital Affiliated to Wenzhou Medical University from December 2007 to February 2013 was performed.Information of the sequelae and recurrence of SPM was obtained by telephone follow-up.SPM was diagnosed according to Versteegh's standard.SPM cases due to mechanical ventilation,trauma,inhaled foreign body or as a result of the underlying disease were not included.Also cases of secondary pneumothorax pneumomediastinum and neonatal mediastinal emphysema were excluded.Result Fifteen of 18 cases were boys and 3 were girls,the range of age was from 9 to 17 years.Predisposing factors included sport activities,severe cough or without a known cause.Clinical manifestations included chest pain,chest tightness,dyspnea,neck pain,back pain,foreign body sensation or pain on swallowing,throat pain of swelling.Chest CT of 18 cases showed pneumomediastinum,8 cases displayed varied degrees of air in neck,chest; 18 cases of SPM responded well to bed rest,oxygen,antitussive and anti-infection treatment.Fifteen cases received chest CT or X-ray inspection after therapy,showing that the pneumomediastinum disappeared or significantly absorbed,3 cases improved in clinical symptom.Among 18 patients,telephone follow-up of 14 were successful and 4 cases were lost.An average follow-up time was (24 ± 17) months.None of the cases had any serious consequences,and recurrence happened in one case.Conclusion Children's spontaneous pneumomediastinum is a benign disease.When a child has chest pain or chest tightness,SPM should be considered after excluding the common diseases.SPM can be diagnosed in association with clinical feature and chest CT examination.Patients respond well to conservative therapy and most of them had no severe sequelae.
