新生儿乳糜胸1例回顾性探讨

Retrospectively analysis of a case of neonatal chylothorax

目的报道1例新生儿乳糜胸病例并对此病例的病因,治疗及早期识别等方面行回顾性探讨。方法对1例确诊为新生儿乳糜胸患儿的临床资料及治疗情况进行总结,并结合文献资料及指南进行回顾性分析。结果患儿,女,以全身青紫、气促、呼吸困难为主要临床表现,查体以右侧胸腔叩诊浊音,肝脏增大为主要临床体征,行胸腔穿刺引流出乳状液体结合实验室检查确诊为新生儿乳糜胸,通过胸腔闭式引流及初期完全肠外营养,后期使用富含中链三酰甘油的(medium-chain triglyceride-rich,MCT)配方奶的过渡喂养,抗生素的使用,白蛋白的补充后患儿的病情得到明显好转。结论新生儿乳糜胸发病率低,早期识别较困难,急性期症状危重,救治难度大,且病死率高,需引起新生儿科医生的重视,及时发现并开展有效治疗。

Objective To report a case of neonatal chylothorax and make a retrospective study on its etiology,treatment and early recognition.Methods The clinical data and treatment of a case of neonatal chylothorax were summarized,and the literature and guidelines were analyzed retrospectively.Results The children,female,were characterized by cyanosis,shortness of breath and dyspnea.The main clinical signs of physical examination were dullness of percussion in the right thorax and enlargement of the liver.The neonatal chylothorax was diagnosed by pleural puncture and drainage combined with laboratory examination.The children's condition improved significantly after the use of closed thoracic drainage and initial complete parenteral nutrition,baby formula that rich in medium chain triglyceride(MCT),the use of antibiotics and the supplement of albumin.Conclusions The incidence rate is low,difficult to early recognition,critical in acute symptoms,difficult to treatment,the mortality of neonatal chylothorax is high.It needs to be paid attention to by neonatal pediatricians,to find and carry out effective treatment in time.