伊朗伊斯法罕新生儿重症监护中心新生儿气胸的发病因素、发生率和死亡率调查

Predisposing factors, incidence and mortality of pneumothorax in a neonatal intensive care unit in Isfahan, Iran

摘要:

目的：该研究旨在调查伊朗伊斯法罕新生儿重症监护中心(NICU) 住院新生儿气胸的发病因素、发生率和死亡率。方法：738 例入住NICU的新生儿中，43例发生了气胸。回顾性分析气胸患儿的临床资料，包括胎龄、出生体重、Apgar评分、出生方式、母亲年龄、产次、围产期窒息、出生时复苏、气胸发生部位、机械通气情况、肺表面活性物质治疗、肺部疾病等。结果：气胸患儿平均胎龄为31周，出生体重为1 596 g。12例（28%）患儿胎龄小于28周。28例（65%）出生体重低于1 500 g。共43 例(5.8%)新生儿发生了气胸。97%的气胸为单侧（n=63)，双侧气胸仅占3%（n=2）。呼吸窘迫综合征(40/43, 93%)和机械通气(37/43, 86%)是导致气胸发生的常见原因。共28例(65%)患儿死亡。死亡患儿与幸存患儿出生体重、胎龄及胸管留置时间差异有统计学意义。需要肺表面活性物质治疗的气胸患儿死亡率显著增加，与无需表面活性物质治疗的气胸患儿比较差异有统计学意义。结论：该研究中气胸的发生率与死亡率高于其他报道，其原因可能是该研究中新生儿出生体重和胎龄都较低。呼吸窘迫综合征和机械通气是导致新生儿气胸发生的常见原因。患儿胎龄越小，体重越低，肺部疾病越严重，死亡率则越高。

Abstract:

OBJECTIVE: To assess the predisposing factors, frequency and mortality of pneumothorax (PTX) among the newborns hospitalized in a neonatal intensive care unit (NICU) in Isfahan, Iran. METHODS: The data of 43 cases of PTX among the 738 neonates hospitalized in the NICU were analyzed retrospectively according to gestational age, birth weight, Apgar score, type of delivery, age of mother, parity, perinatal asphyxia, resuscitation at birth, side of PTX, mechanical ventilation, surfactant therapy, and underlying lung disorders. RESULTS: Mean gestational age was 31 weeks and birth weight was 1 596 g in the PTX cases. The gestational age of 12 (28%) neonates was less than 28 weeks. Twenty-eight (65%) neonates were below 1 500 g. In total, PTX occurred in 43 (5.8%) neonates. Sixty-three episodes of PTX (97%) were unilateral and 2 (3%) were bilateral. Respiratory distress syndrome (RDS) (40/43, 93%) and mechanical ventilation (37/43, 86%) were common predisposing factors of PTX. Overall, 28 (65%) neonates with PTX died. Birth weight, gestational age and chest tube duration were significantly different between dead and surviving infants. The mortality rate was significantly higher in neonates who required surfactant therapy than that in those who did not require it. CONCLUSIONS: The incidence and mortality of PTX in this study were higher than some other reports and this might be attributed to lower birth weight and gestational age. RDS and mechanical ventilation were the most common predisposing factors for the development of neonatal PTX, and mortality increased with lower birth weight, lower gestational age and more severe underlying primary lung disease.［Chin J Contemp Pediatr, 2010, 12 (6):417-420］