非外伤性儿童纵隔气肿64例临床分析

Clinical analysis of 64 cases of non-traumatic pneumomediastinum in children

目的：探讨非外伤性儿童纵隔气肿的病因、临床特征、治疗及预后。方法回顾性分析2003年1月至2013年12月收治的64例非外伤性纵隔气肿患儿的临床资料。根据病因是否明确，分为病因不明的自发性纵隔气肿组和病因明确的纵隔气肿组；根据年龄，分为＜6岁组和6～18岁组。分别对两组临床资料进行比较分析。结果64例非外伤性儿童纵隔气肿中，自发性纵隔气肿19例，年龄（14.90±2.00）岁，男性占84.2%；病因明确纵隔气肿45例，年龄（4.26±4.45）岁，男性占55.6%，常见病因包括下呼吸道感染、哮喘和支气管异物等。自发性纵隔气肿患儿胸痛症状更突出，而病因明确的纵隔气肿患儿呼吸困难、咳嗽、皮下气肿更多见。自发性纵隔气肿患儿予卧床休息、吸氧、止咳化痰、预防感染等保守治疗；病因明确的纵隔气肿患儿予积极治疗原发病并及时行纵隔排气、皮下穿刺排气及胸腔闭式引流排气。所有患儿预后均良好。＜6岁患儿35例，均为病因明确的纵隔气肿，病因以肺炎等下呼吸道感染最多见；6～18岁患儿29例，其中19例为自发性纵隔气肿。结论不同年龄段儿童纵隔气肿的病因不同，需积极寻找病因，尤其是＜6岁患儿；有明确病因的非外伤性纵隔气肿治疗关键是积极治疗原发病。

Objective To investigate the underlying causes, clinical characteristics, treatment and prognosis of non-traumatic pneumomediastinum （PM） in children. Methods A retrospective analysis of the clinical data of 64 children diagnosed with non-traumatic PM in Yuying Children’s Hospital Affiliated to Medical University from Jan 2003 to Dec 2013 was performed. Nineteen children with SPM and the other 45 with clear causes of non-traumatic PM were divided into two groups for comparison. According to age, 64 cases were divided into 0-6y group and 6-18y group for further comparison. Results A total of 64 patients with non-traumatic PM were collected. Nineteen of them aged 14.90±2.00 y had SPM with unknown etiology, and 84.2%were male. The other group of 45 patients aged 4.26±4.45y, and 55.6%of this group were male. The common causes were pneumonia or other lower respiratory tract infection, asthma and foreign body inspiration. The patients with SPM were always with chest pain. While the patients with clear causes of non-traumatic PM were more complained of dyspnea, coughing, subcutaneous emphysema. The treatment of patients with SPM was bed rest, oxygen uptaking, antitussive, anti-infection and other conservative therapy. All the patients with clear causes of non-traumatic PM had favorable prognosis with the treatment of actively curing primary disease and timely mediastinal air drainage, subcutaneous air drainage and thoracic close drainage. In 35 cases younger than 6 years old, the most common causes were pneumonia or other lower respiratory tract infection, none had SPM. In 29 cases older than 6 years, 19 of them had SPM. Conclusions Etiologies of pneumomediastinum varied with age in children,which should be vigilantly examined, especially for those younger than 6 years old. The key of the treatment to non-traumatic PM with clear etiologies was to treat its primary disease.