脑室腹腔分流术胸腔内移位引起的张力性胸水。

C A Dickman, D Gilbertson, H W Pittman, H L Rekate, W J Daily
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引用次数: 38

摘要

一个男婴接受了髓脑膜膨出修复术,随后放置脑室-腹膜分流术治疗脑积水。分流手术后5天,婴儿急性出现囟门深度凹陷、面色苍白、呼吸急促、心动过缓和烦躁。胸片显示胸腔内远端分流管移位和张力性胸水。治疗包括开胸管和暂时外置远端分流管。病人完全康复了。新生儿分流术并发囟门凹陷的急性休克应引起对紧张性胸水的怀疑。对于危重婴儿,建议立即穿刺或开胸。在病情较轻的儿童中,暴露颈部分流管并通过远端分流管抽出胸腔积液可作为紧急措施。强调了对这一问题的早期认识和紧急处理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tension hydrothorax from intrapleural migration of a ventriculoperitoneal shunt.

A male newborn underwent a myelomeningocele repair, with subsequent placement of a ventriculoperitoneal shunt for treatment of hydrocephalus. Five days after shunt surgery, the infant acutely developed a deeply sunken fontanel, pallor, tachypnea, bradycardia, and irritability. Chest radiographs revealed intrathoracic migration of the distal shunt tubing and a tension hydrothorax. Treatment consisted of tube thoracostomy and temporary externalization of the distal shunt tubing. The patient fully recovered. The acute onset of shock in association with a sunken fontanel in a neonate with a shunt should raise the suspicion of tension hydrothorax. For critically ill infants immediate needle aspiration or thoracostomy is suggested. In less severely ill children, exposure of the shunt tubing in the neck and withdrawal of the pleural effusion by the distal shunt tubing may be performed as an emergency measure. The early recognition and urgent management of this problem are emphasized.

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