自发性纵隔气肿62例临床分析

Clinical Analysis of 62 Cases with Spontaneous Pneumomediastinum

目的探讨自发性纵隔气肿的发生机理、临床表现、治疗方法及预后等情况。方法对该院自2014年3月—2016年9月收治的62例自发性纵隔气肿患者的临床资料进行分析总结,观察62例患者的临床疗效。结果 62例自发性纵膈气肿患者均经X或CT线检查确诊,常见诱发因素有咳嗽、哮喘、腹压增高、呕吐、剧烈运动等,其中54例患者经吸氧、止咳、平喘、消炎或仅予观察等方法获痊愈,4例患者经纵膈切开引流治愈,2例患者行胸腔闭式引流治愈,1例行开胸手术治愈,1例患者经胸骨旁纵膈穿刺引流症状好转后转其他医院治疗,全组患者无死亡病例。平均住院时间为10.35 d。结论根据患者的临床表现、X线检查及CT检查结果,自发性纵隔气肿的诊断一般并无困难,多数患者病情稳定,可经观察及对症处理等保守治疗方法治愈,预后良好,合并自发性气胸的需行胸腔闭式引流,张力性纵膈气肿患者病情危重,需及时行纵膈切开引流减压,合并纵膈脓肿的患者需行纵膈穿刺引流或手术治疗,由食管破裂引起的纵膈气肿病情凶险,需尽早明确诊断,及时手术治疗。

Objective To discuss the occurrence mechanism, clinical manifestation, treatment method and prognosis of spontaneous pneumomediastinum. Methods 62 cases of patients with spontaneous pneumomediastinum admitted and treated in our hospital from March 2014 to September 2016 were selected and the clinical curative effect of the patients was observed. Results 62 cases of patients were confirmed by the X or CT ray examination, and the common inducing factors included the cough, asthma, increased abdominal pressure, vomiting and strenuous exercise, and 54 cases of patients were cured after the oxygen inhalation, relieving cough and asthma or only observation, 4 cases were cured after the incision and drainage, 2 cases were cured after the thoracic close drainage, 1 case was cured by the thoracotomy, and 1 case was converted to other hospital for treatment after improvement, and there was no death case in the whole group, and the average length of stay was 10.35 d. Conclusion The diagnosis of spontaneous pneumomediastinum is generally not difficult according to the clinical manifestations, X ray examination and CT examination results, and the disease condition of most patients is steady, and the patients can be cured by the observation and symptomatic treatment, and the prognosis is good, and the patients with therapeutic pneumothorax need the thoracic close drainage, and the disease of patients with pressure pneumothorax is severe, and they need the incision and drainage in time, and the patients with mediastinal abscesses need the percutaneous catheter drainage or operation treatment, and the disease condition of mediastinal emphesema caused by the esophageal rupture is dangerous, and we need to diagnose it as soon as possible and conduct the operation treatment in time.