胸膜腔内注入红霉素治疗新生儿乳糜胸的疗效分析

Effect of intrapleural instillation of erythromycin for treatment of neonates with congenital chylothorax

目的回顾性分析胸膜腔内注入红霉素对新生儿乳糜胸的治疗效果。方法对2007年1月—2011年12月出院诊断为新生儿乳糜胸(排除因外科手术导致的乳糜胸)患儿的临床资料进行回顾性分析。所有患儿均采取保守治疗措施,包括必要的胸腔引流、呼吸支持、肠外营养和补充丢失的体液和蛋白质,治疗2周以上无效[胸水引流量>10～15 mL/(kg.d)]者均给予红霉素经胸腔引流管内注入治疗。于2012年6月对所有患儿进行电话随访,部分患儿进行肺功能测定。结果 16例患儿确诊为新生儿乳糜胸,其中7例患儿接受红霉素胸膜腔内注入治疗(2例注入1次,3例注入2次,另2例分别注入3次和4次),胸水明显减少至消失,无1例行手术,有效率达100%。与治疗前比较,红霉素胸膜腔内注入后的胸腔引流天数显著减少(P<0.01)。随访结果显示:行与未行红霉素胸膜腔内注入治疗患儿的肺功能测定指标比较,差异均无统计学意义(P>0.05)。结论采用胸腔内注入红霉素治疗新生儿乳糜胸,方法简单、易行且安全有效,避免了手术干预,是一种值得临床推广使用的保守治疗方法。

Objective To investigate the outcome of intrapleural instillation of erythromycin for treatment of neonates with congenital chylothorax. Methods The clinical data of neonates with diagnosis of congenital chylothorax between January 2007 and December 2011 were retrospectively analysed, and those caused by operations were excluded. Conservative treatment has been carried out for all neonates, including drainage of pleural fluid, respiratory support, total parenteral nutrition and supplementation of lost electrolytes and protein. Intrapleural instillation of erythromycin was done in those with no response to treatment, whose amount of pleural effusion was 〉 10 - 15 mL/（ kg.d） for two weeks. Follow up with telephone survey was conducted in June 2012, and pulmonary function tests were performed in part of the neonates. Results Sixteen neonates were diagnosed as congenital chylothorax, and intrapleural instillation of erythromyein was conducted in 7 （once in 2 neonates, twice in 3, 3 times in 1, and 4 times in 1）. The pleural fluid significantly decreased till disappeared, and none of these cases required surgical intervention, with the effective rate of 100%. The duration required for chest drainage after intrapleural instillation of erythromyein was significantly shorter than that before intrapleural instillation of erythromycin （ P 〈 0.01）. The follow-up findings indicated that there was no significant difference in the parameters of pulmonary function tests between neonates with intrapleural instillation of erythromyciu and those without （P 〉 O. 05）. Conclusion Intrapleural instillation of erythromycin is a safe and effective treatment for neonates with congenital chylothorax, which is a conservative method worthy of clinical application.