【摘要】 目的提高对注射用A群链球菌治疗新生儿先天性乳糜胸的认识。方法对2013年—2015年2例新生儿先天性乳糜胸采用注射用A群链球菌治疗痊愈的患儿进行分析,并对注射用A群链球菌治疗乳糜胸在万方数据库和Pub Med数据库进行检索,检索时间从建库至2015年6月,共38篇文献入选,其中采用胸膜腔内注入注射用A群链球菌的胸膜固定术治疗新生儿和胎儿乳糜胸报道共18篇,共87例先天性乳糜胸。对此87例及该文2例共89例患儿临床资料及注射用A群链球菌胸膜腔固定术的治疗反应进行总结。结果 1本文2例患儿均为足月儿,入院胸腔穿刺后确诊新生儿先天性乳糜胸,分别于出生后第24天和第1天入院,均经过胸腔闭式引流和控制饮食等治疗,效果不佳,分别于入院第20天和第5天予以胸腔内注入注射用A群链球菌治疗,胸腔积液迅速得到控制,痊愈出院。289例患儿中有80例为产前采用注射用A群链球菌胸膜固定术宫内给药治疗先天性乳糜胸,其中基因突变相关或染色体核型异常的共有18例,14例均宫内死亡,2例核型异常的患儿在乳糜胸成功治疗后出生不满1岁死亡;23例对注射用A群链球菌胸膜固定术部分有效(胸腔积液未完全吸收),余41例均疗效显著,无明显不良反应。另7例新生儿乳糜胸为出生后保守治疗或奥曲肽治疗无效后改用注射用A群链球菌治疗,效果显著。该文2例先天性乳糜胸均采用胸腔引流、饮食控制及联合注射用A群链球菌治愈。结论对先天性乳糜胸新生儿在闭式胸腔引流的基础上早期联合胸膜腔内注射注射用A群链球菌的胸膜固定术,可快速减少乳糜液渗出而早日拔除胸导管,减少感染等相关并发症风险,缩短禁食和住院时间。更多还原

【Abstract】 Objective To improve the understanding of treatment with streptococcus a group for injection(SAGI) for neonatal congenital chylothorax.Methods The therapeutic effect of intrapleural injection of SAGI in two newborn infants with congenital chylothorax was analyzed and the literatures was reviewed from Wanfang and Pub Med database until June 2015.Finally 38 articles were screened including 18 articles of neonatal and fetal chylothorax treated with intrapleural injection of SAGI,and a total of 87 cases of congenital chylothorax.The clinical data and the newborn’s therapeutic response to SAGI of 87 cases and the 2 cases in this study were summarized.Results Two cases of full term were diagnosed of newborn congenital chylothorax according to pleural puncture and respectively admitted to the hospital on the 24 thand 1stday after birth.The therapeutic response was not good through the chest drainage or diet treatment,then pleurodesis by intrapleural injection of SAGI was applied on the 20 thday and 5thday after admission,respectively and chylous fluid was reduced sharply,finally the patients were recovered and discharged from the hospital.Totally,80 cases out of the 89 cases were antenatally treated with pleurodesis with SAGI for congenital chylothorax,and 18 cases had gene mutation related diseases or abnormal chromosome karyotype.Intrauterine death occurred in 14 cases and 2 cases of abnormal chromosome karyotype died less than one year old after successful treatment about chylothorax.Twenty-three cases were partially effectively treated,while 41 cases had obvious curative effect.In the other 7 cases of neonatal chylothorax,the treatment efficacy of SAGI after conservative treatment or octreotide administration after birth was remarkable.In this paper,congenital chylothorax in the two cases achieved rapid and effective control due to chest drainage,diet control and combination with SAGI.Conclusion That SAGI should be considered as a therapeutic option for neonatal chylothorax,and its earlier usage may bring with expectation of the quick reduction of the chylous fluid,early removal of the chest tube,less risk of complication related to infection and less time of fasting and hospitalization.更多还原