新生儿乳糜性浆膜腔积液临床分析

A clinical analysis of neonatal chylous effusions

摘要:

目的 探讨新生儿乳糜性浆膜腔积液的临床特征、病因、治疗和转归。方法 回顾性收集并分析21例新生儿乳糜性浆膜腔积液患儿的临床资料。结果 21例患儿中，单纯乳糜性胸腔积液13例，乳糜性腹腔积液2例，乳糜性心包积液2例，乳糜性多浆膜腔积液4例。先天性乳糜性浆膜腔积液患儿（n=5）纳入先天组，多发生在胎儿期，生后即出现症状；后天性乳糜性浆膜腔积液患儿（n=16）纳入后天组，多在中心静脉置管后1周内出现症状（n=14），2例与败血症相伴出现。先天组患儿浆膜腔积液的比重、白细胞计数、单核细胞百分比、白蛋白水平均高于后天组（P < 0.05）；而葡萄糖、三酰甘油水平均低于后天组（P < 0.05）。置管相关乳糜性浆膜腔积液的发生多与置管位置不当、移位损伤、渗透压过高等因素有关。乳糜性浆膜腔积液患儿的治疗以保守治疗为主（n=20），有效率达85%。先天组特殊奶粉喂养比例高于后天组，拔除置管比例低于后天组，浆膜腔积液吸收时间长于后天组（P < 0.05）。结论 引发新生儿乳糜性浆膜腔积液的原因和疾病发生的部位不同，症状出现的时间和表现不一。后天性患儿因血管损伤导致静脉高渗液渗出的可能性大。保守治疗效果显著，先天性患儿治疗难度高于后天性患儿。

Abstract:

Objective To study the clinical features, etiology, treatment, and prognosis of neonatal chylous effusions. Methods A retrospective analysis was performed for the clinical data of 21 neonates with chylous effusions. Results Among these 21 neonates, 13 had chylothorax, 2 had chyloperitoneum, 2 had chylopericardium, and 4 had chylous polyserositis. Five neonates with congenital chylous effusions were enrolled as the congenital group, which mostly occurred in the fetal period, and symptoms were observed shortly after birth. Sixteen neonates with acquired chylous effusions were enrolled as the acquired group, and the symptoms mainly appeared within 1 week after central venous catheterization (in 14 neonates) or appeared together with sepsis (in 2 neonates). Compared with the acquired group, the congenital group had significantly higher specific gravity, white blood cell count, monocyte percentage, and albumin level in effusions (P < 0.05) and significantly lower levels of glucose and triglyceride (P < 0.05). Central venous catheterization-induced chylous effusions were mainly associated with inappropriate position, displacement damage, and hypertonicity. Conservative treatment was the main treatment method for the neonates with chylous effusions (in 20 children), with a response rate of 85%. Compared with the acquired group, the congenital group had a significant higher proportion of neonates receiving special formula feeding, a significantly lower proportion of neonates with extubation, and a significantly longer time to the absorption of effusions (P < 0.05). Conclusions The time to the occurrence of symptoms and clinical manifestations vary with disease etiology and location in neonates with chylous effusions. Neonates with acquired chylous effusions may experience hypertonic solution effusion due to vascular injury. Conservative treatment has a marked clinical effect on neonatal chylous effusions. It appears to be more difficult to treat neonates with congenital chylous effusions than those with acquired chylous effusion.