纵隔气肿102例临床特征分析

Analysis of clinical manifestations of 102 patients with mediastinal emphysema

目的总结分析引起纵隔气肿的常见病因、临床表现及预后,提高对纵隔气肿疾病本质的认识。方法回顾分析本院以纵隔气肿为首发表现患者的临床资料,并复习文献,总结引起纵隔气肿的疾病谱,分析气肿产生的原因及临床特点。结果共102例患者首发表现为纵隔气肿,以外伤性纵隔气肿最多。最常见的症状为皮下气肿95例(93%)、胸骨后不适87例(85%)。常见的先兆诱因为严重钝挫伤41例(40%),饮酒或暴饮暴食后恶心、呕吐14例(13%)。最终治愈87例、死亡15例。结论除特发性纵隔气肿外,临床上所见的纵隔气肿多数情况下是某种系统疾病的局部表现,而不单纯是一种孤立的疾病,均有一定的病因。引起纵隔气肿的疾病谱广,需综合考虑患者病史、临床表现、分析特定环境下气肿的产生的原因,有针对性对原发病进行积极的治疗才是重点。

Objective To summarize and analyze the causes, clinical manifestations and prognosis of pneumomediastinum, and raise awareness on the nature of mediastinal emphysema. Methods The clinical data of patients with mediastinal emphysema as the first manifestation were retrospectively analyzed, and relevant literature was reviewed. The disease spectrum of pneumome- diastinum was summarized. Emphysema causes and clinical features were analyzed. Results A total of 102 patients had pneumomediastinum as the first manifestation, and mainly suffered from trau- matic pneumomediastinum. The most common symptoms included subcutaneous emphysema in 95 cases （93%）, chest pain in 87 cases （85%）, harbinger of incentives for severe blunt trauma in 41 cases （40%）, and drinking or overeating, nausea, vomiting in 14 cases （13%）. In the end, 87 pa- tients were cured with 15 dead. Conclusion Except the idiopathic mediastinal emphysema, in most cases, the clinical findings are pneumomediastinum as a local manifestation of a certain system dis- eases, in stead of simply being an isolated disease. There is a certain etiology. The spectrum of caus- ing pneumomediastinum is wide, and we need to consider the causes for patient history, clinical manifestations, the specific environment of emphysema generated. Targeted aggressive treatment is the focus of the primary disease.