| 香港大学葛量洪医院相关学者的研究表明，奥曲肽（octreotide）疗法有助于控制先心病术后难愈性的乳糜胸。此种疗法对于乳糜胸超过2周或者每天引流量超过10ml/Kg的患者具有较为明显的效果。奥曲肽的用法为：静脉维持，起始量10μg/kg/d，分三次使用；如果效果不明显，可间隔72或96小时候逐步以5到10μg/kg/d加量，最大剂量为40μg/kg/d。疗程一般为一周，如果胸引持续3天小于10ml/kg/d，可按照每天10μg/kg的剂量逐步停药。治疗同时需要密切关注血糖变化、胃肠道相关不良反应等。 奥曲肽的作用机理包括：①直接激活血管壁上的生长抑素受体，②通过降低肠道活力，可选择性地减少门静脉及其侧枝循环的血流量和压力，间接减少肝脏等内脏器官的淋巴管流量。 Original article Chylothorax in Children After Congenital Heart Surgery Shu-yan Chan MBBSa, Wendy Lau MBBSa, Wilfred H.S. Wong MMedSca, Lik-cheung Cheng MBBSb, Adolphus K.T. Chau MBBSa and Yiu-fai Cheung MDa, Corresponding Author Contact Information, E-mail The Corresponding Author aDivision of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China bDivision of Cardiothoracic Surgery, Grantham Hospital, The University of Hong Kong, Hong Kong, China Accepted 31 May 2006. Available online 22 October 2006. Referred to by: Invited commentary The Annals of Thoracic Surgery, Volume 82, Issue 5, November 2006, Pages 1656-1657, Glenn J. Pelletier Background A definitive management strategy for postoperative chylothorax remains elusive. We reviewed our experience in the management of chylothorax in children after congenital heart surgery. Methods The case records of 51 patients, with a median age of 11 months (range, 4 days to 19.6 years), diagnosed to have postoperative chylothorax between 1981 and 2004 were reviewed. The responses of patients to nutritional modifications, octreotide therapy, and surgical interventions were noted. Results The prevalence of postoperative chylothorax, which developed at a median of 9 days after operation (range, 0 to 24 days), was 0.85% (51 of 5,995). Four patients died, and among the 47 survivors the median duration and total volume of chylous drainage was 15 days (range, 1 to 89 days) and 156 mL/kg (range, 3 to 6,476), respectively. The duration of chyle output was significantly longer after the Fontan-type procedures (p = 0.0006). Twenty-one patients were diagnosed between 1981 and 1999 and managed by nutritional modifications, 2 of whom required further surgical interventions. Of the 30 patients diagnosed between 2000 and 2004, 12 responded to nutritional modifications alone while 18 were started on octreotide therapy at a median of 19.5 days (range, 7 to 35 days) after the onset of chylothorax. Fifteen of the 18 (83%) patients responded to octreotide therapy at 15.3 ± 5.5 days after starting octreotide, while 3 required further surgical interventions. None developed side effects from octreotide therapy. Conclusions Octreotide has been incorporated into the management algorithm of postoperative chylothorax and appears to be a useful adjunctive therapy. |
