Title: The Macklin Effect
题目：Macklin （麦克林）效应
Author 作者: Haney Mallemat

Pneumomediastinum may be caused by many things:
纵隔气肿可能由很多因素造成：
Esophageal perforation (e.g., complication from EGD)
食管穿孔（如，EGD的并发症 ）
Tracheal / Bronchial injury (e.g., trauma, complication of bronchoscopy, etc.)
气管/支气管损伤（如外伤，支气管镜检查并发症等）
Abdominal viscus perforation with translocation of air across the diaphragmatic hiatus
腹部空腔脏器穿孔，气体通过膈肌裂孔进入纵隔
Air may reach mediastinum along the fascial planes of the neck.
气体可能沿颈部筋膜达到纵隔
Alveolar rupture, also known as the "Macklin Effect"
肺泡破裂，又称为“Macklin（麦克林）效应”

The "Macklin Effect" is typically a self-limiting condition leading to spontaneous pneumomediastinum and massive subcutaneous emphysema after the following:
“麦克林效应”通常是一种自限性过程，可导致自发性纵隔气肿和大面积皮下气肿,可在下列情况下发生：
Alveolar rupture from increased alveolar pressure (e.g., asthma, blunt trauma, positive pressure ventilation, etc.)
肺泡内压增高导致肺泡破裂（如哮喘，钝器创伤，正压通气，等）
Air released from alveoli dissects along broncho-vascular sheaths and enters mediastinum
从肺泡释放的气体沿支气管血管鞘进入纵隔
Air may subsequently track elsewhere (e.g., cervical subcutaneous tissues, face, epidural space, peritoneum, etc.)
随后气体可能移行到其他地方（例如，颈部皮下组织，面部，硬膜外腔，腹膜等）
Pneumomediastinum secondary to the Macklin effect frequently leads to an extensive workup to search for other causes of mediastinal air. Although, no consensus exists regarding the appropriate workup, the patient's history should guide the workup to avoid unnecessary imaging, needless dietary restriction, unjustified antibiotic administration, and prolonged hospitalization.
由麦克林效应产生的纵隔气肿往往会导致积极全面的评估，以找到其他导致纵隔气肿的原因。虽然没有统一的共识应做哪些合理的检查，然而病人的病史将有助于指导评估，以避免不必要的影像学检查，不必要的限制饮食，不合理的应用抗生素，及延长住院时间。
Treatment of spontaneous pneumomediastinum includes:
自发性纵隔气肿的治疗包括：
Supplemental oxygen and observation for airway obstruction secondary to air expansion within the neck
给氧和观察由颈部气体膨胀导致的气道梗阻
Avoiding positive airway pressure, if possible
如果可能的话，避免气道正压通气
Avoiding routine chest tubes (unless significant pneumothorax is present)
避免常规放置胸导管（除非有严重的气胸）
Administering prophylactic antibiotics are typically unnecessary
通常不需要预防性抗生素
Ordering imaging as needed
做必要的影像检查