Sands D E, Ledgerwood A M, Lucas C E
Department of Surgery, Wayne State University, Detroit, Michigan 48201.
Am Surg. 1988 Jul;54(7):434-7.
Mediastinal emphysema results from multiple etiologies and is associated with a variety of underlying disease entities. Twenty five patients with pneumomediastinum treated on a surgical service over a 6 year period were reviewed. The cause of the mediastinal emphysema was related to trauma in seven patients, attempted central venous access in four patients, cardiopulmonary resuscitation in four patients and some type of Valsalva maneuver in ten patients. Besides the mediastinal emphysema, air may dissect into the peritoneal cavity, the pericardium, and the subcutaneous tissues within the neck and chest wall. Treatment of the mediastinal emphysema, per se, is expectant; success or failure is determined by treatment of the associated underlying problems. Deaths occurred in three patients after cardiopulmonary resuscitation and in one patient after crushing chest injury. One patient with an associated hydrothorax was found to have a perforated distal esophagus which was treated by emergency fundoplication. When associated diseases are absent and there is no evidence of pleural effusion or hydrothorax, no special diagnostic tests are indicated. Sequential chest x-rays are used to follow the pneumomediastinum through resolution, which usually occurs within 72 hours.
纵隔气肿由多种病因引起，与多种潜在疾病相关。回顾了6年间在外科接受治疗的25例纵隔积气患者。纵隔气肿的病因与7例创伤、4例中心静脉穿刺尝试、4例心肺复苏以及10例某种类型的瓦尔萨尔瓦动作有关。除纵隔气肿外，空气可扩散至腹腔、心包以及颈部和胸壁的皮下组织。纵隔气肿本身的治疗是观察性的；其成败取决于相关潜在问题的治疗。3例患者在心肺复苏后死亡，1例患者在胸部挤压伤后死亡。1例合并胸腔积液的患者发现远端食管穿孔，经急诊胃底折叠术治疗。当不存在相关疾病且无胸腔积液或胸腔积水证据时，无需进行特殊诊断检查。通过连续胸部X线检查观察纵隔积气的消散情况，通常在72小时内消散。
