儿童非外伤性纵隔气肿的诊治及预后

Diagnosis and prognosis of non-traumatic pneumomediastinum in children

目的:探讨儿童非外伤性纵隔气肿的病因、临床表现、治疗及预后。方法:总结回顾2011年1月~2015年12月湖南省人民医院儿童医学中心收治的非外伤性纵隔气肿住院儿童的临床资料,对病因及预后进行分析。结果:本研究纳入非外伤性纵隔气肿住院儿童33例,中位年龄30.0(IQR 14.0-69.0)m,中位住院天数13.0(9.5-19.5)d。病因诊断以重症肺炎最为常见,共22例(病原以呼吸道病毒感染常见,包括腺病毒8例,流感病毒4例),其他诊断包括气道异物、支气管哮喘急性发作、自发性气胸等。临床表现以咳嗽、气促、发绀常见,常伴皮下气肿及气胸。大部分非外伤性纵隔气肿患儿需入住儿童重症监护病房(26/33,78.8%),常需应用气管前筋膜切开引流减压(22/33,66.7%),大部分患儿预后良好。在不同年龄组(<5y和5-14y)非外伤性纵隔气肿患儿的病因、临床表现、治疗及预后无统计学差异。结论:儿童非外伤性纵隔气肿发生病因以重症肺炎多见,尤其是呼吸道病毒感染。非外伤性纵隔气肿的治疗主要是原发病治疗及气管前筋膜切开减压治疗。

Objective To investigate the causes, clinical characteristics, treatment and prognosis of non-traumatic pneumomediastinum(PM) in children. Methods A retrospective analysis of the clinical data of children diagnosed with non-traumatic PM in Hunan provincial People’s Hospital from Jan 2011 to Dec 2015 was performed. Results A total of 33 patients with nontraumatic pneumomediastinum(PM) were collected. The median age of patients was 30. 0(IQR 14. 0-69. 0) months, and the median length of stay in hospital was 13. 0(IQR 9. 5-19. 5)d. The common causes of PM were severe pneumonia, foreign body inspriration, asthma and spontaneous pneumomediastinum. Viruses were the common etiologies of severe pneumonia, including adenovirus(8 cases) and influenza virus(4 cases). Clinical manifestations included cough, shortness of breath, cyanosis, subcutaneous emphysema and pneumothorax. Seventy-eight point eight percent(26/33) of patients with non traumatic pneumomediastinum were admitted to pediatric intensive care unit, and most of cases performed mediastinal air drainage and had favorable prognosis. No significant differences was observed in causes of disease, clinical features, treatment and prognosis between different age groups. Conclusion The common causes of non-traumatic pneumomediastinum in children were severe pneumonia, especially viruses infection. The treatment should be focused on dealing with primary diseases as well as symptomatic treatment by mediastinal air drainage.