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目的分析儿童纵隔气肿的病因、临床特征、治疗及预后。方法回顾性总结46例纵隔气肿患儿的临床资料,对病因、临床表现、影像学特征、治疗及预后进行分析。结果 46例儿童纵隔气肿中,1岁以下病因以重症肺炎最常见,1~3岁病因主要为肺炎、支气管异物,3岁以上病因主要为肺炎、哮喘。临床表现多为剧烈咳嗽、呼吸困难、发绀,32例伴有皮下气肿。所有患儿均予卧床休息、吸氧,同时积极治疗原发病,14例因出现呼吸衰竭行机械通气治疗,8例行胸腔闭式引流排气,6例行纤维支气管镜术,4例行硬支气管镜术。43例经积极治疗恢复良好,3例死亡。结论纵隔气肿常急性起病,病情进展快。不同年龄段儿童纵隔气肿的病因构成不同,肺部感染是最常见的原因。治疗的关键是积极治疗原发病。
Objective To analyze the etiology, clinical features, treatment and prognosis of children with mediastinal emphysema. Methods The clinical data of 46 patients with mediastinal emphysema were retrospectively reviewed. The etiology, clinical manifestations, imaging features, treatment and prognosis were analyzed. Results Among 46 cases of children with mediastinal emphysema, the etiology of severe pneumonia was the most common in children under 1 year of age. The main causes of pneumonia and bronchus were 1 to 3 years old. The main causes of pneumonia were 3 years old and pneumonia. Mostly clinical manifestations of severe cough, difficulty breathing, cyanosis, 32 cases associated with subcutaneous emphysema. All children were bed rest, oxygen, and active treatment of primary disease, 14 cases of respiratory failure due to mechanical ventilation treatment, 8 cases of thoracic drainage drainage, 6 cases of bronchoscopy, 4 cases Hard bronchoscopy. Forty-three patients recovered well and 3 died. Conclusion Mediastinal emphysema often acute onset, rapid progression. The causes of mediastinal emphysema in children of different ages have different constitutions. Pulmonary infection is the most common cause. The key to treatment is active treatment of the primary disease.