背景：虽然不常见，现有的证据表明,成年期合并自发性纵隔气肿(SPM)的肺出血(PR)通常是良性的和自限性的.本研究旨在回顾我们的经验，并确定SPM患儿发生PR的危险因素。
方法：在2007年9月至2017年9月期间，回顾性分析了年龄≤18岁的SPM患者，并分析了有和无PR的SPM患者的临床特征和结局。
结果：总计，最终确定29例患者中30例连续发生SPM，并将其分为SPM（n=24）和SPM加PR（n=6）组。在接受的介入检查中没有显着差异，发现两组之间预防性使用抗生素或限制口服摄入。两组均以住院为主；但SPM加PR组的住院时间往往较长（中位数为5.5vs.3天,p=0.08)。在血清C反应蛋白（CRP）水平异常（>5mg/L）的患者中观察到PR的频率更高，确定的诱发因素，以及SPM等级更严重的那些（分别为p=0.005、0.001和<0.001）。在多元回归分析中，SPM加PR组比SPM组表现出更多的诱发因素(系数:0.514,标准误差:0.136,p<0.001)。所有患者均成功治疗，无发病率和死亡率。
结论：尽管肺出血患者保持较高的CRP水平，更明确的诱发因素和长期住院护理，在同时进行SPM和PR的儿科中，保守管理而不进行广泛的检查将是一种适当且有利的策略。
BACKGROUND: Although uncommon, available evidence suggests that
pneumorrhachis (PR) with spontaneous pneumomediastinum (SPM) in adulthood is usually benign and self-limiting. This
study aimed to review our experience and identify the risk factors of PR in pediatric patients with SPM.
METHODS: Between September 2007 and September 2017, SPM in patients aged ≤18 years was retrospectively reviewed and clinical features and outcomes between SPM patients with and without PR were analyzed.
RESULTS: In total, thirty consecutive occurrences of SPM in 29 patients were finally identified and classified into SPM (n = 24) and SPM plus PR (n = 6) groups. No significant differences in received interventional exams, prophylactic antibiotic administration or restriction of oral intake between the two groups were found. Both groups were treated with hospitalization predominantly; but the SPM plus PR group tended to have longer length of hospital stay (median 5.5 vs. 3 days, p = 0.08). PR was observed more frequently in patients with abnormal serum C-reactive protein (CRP) levels (>5 mg/L), identified predisposing factors, and those with more severe grade of SPM (p = 0.005, 0.001 and < 0.001, respectively). On multivariable regression analysis, the SPM plus PR group exhibited more predisposing factors than did the SPM group (coefficient: 0.514, standard error: 0.136, p < 0.001). All patients were successfully treated without morbidity and mortality.
CONCLUSIONS: Although patients with
pneumorrhachis retained a higher CRP level, more identified predisposing factors and prolonged inpatient care, conservative management without an extensive work-up would be an appropriate and favorable strategy in pediatrics with concurrent SPM and PR.
