纵隔气肿并发糖尿病酮症酸中毒：呼吁采取保守的诊断方法。
Mediastinal emphysema complicating diabetic ketoacidosis: plea for conservative diagnostic approach.
作者信息
Pauw R G, van der Werf T S, van Dullemen H M, Dullaart R P F
机构信息
Department of Internal Medicine, Division of Pulmonary Medicine & Tuberculosis, University Medical Centre Groningen, University of Groningen, the Netherlands.
出版信息
Neth J Med. 2007 Nov;65(10):368-71.
BACKGROUND
Spontaneous pneumomediastinum has been infrequently reported as a complication of diabetic ketoacidosis. Evidence-based guidelines are currently not available to help in choosing the best diagnostic approach.
METHODS
We conducted a systematic review of the literature and looked for diagnostic clues that might indicate the need for a work-up to rule out oesophageal perforation.
RESULTS
In all 56 published cases of spontaneous pneumomediastinum associated with diabetic ketoacidosis, the condition was self-limiting. We report one additional case of a 31-year-old female who presented with a spontaneous pneumomediastinum and also epidural pneumatosis, complicating diabetic ketoacidosis.
CONCLUSION
Important pathology, such as oesophageal rupture, was not detected in any of the reported cases, and we suggest a restrictive diagnostic work-up.
背景
自发性纵隔气肿作为糖尿病酮症酸中毒的一种并发症，报道较少。目前尚无循证指南可用于指导选择最佳诊断方法。
方法
我们对文献进行了系统回顾，寻找可能提示需要进一步检查以排除食管穿孔的诊断线索。
结果
在所有56例已发表的与糖尿病酮症酸中毒相关的自发性纵隔气肿病例中，病情均为自限性。我们报告另外1例31岁女性，该患者出现自发性纵隔气肿及硬膜外积气，并发糖尿病酮症酸中毒。
结论
在所有报道的病例中均未检测到诸如食管破裂等重要病变，我们建议采取限制性的诊断检查。
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