新生儿气胸病因及防治分析

Etiology and prevention of neonatal pneumothorax

摘要:

目的：探讨新生儿气胸发生的相关因素和防治方法。方法：对2010年10月至2011年11月在NICU住院的2286例患儿的临床资料进行分析， 对发生气胸的相关因素和防治方法进行病例对照研究。结果：2286患儿中发生气胸的有36例，气胸的发生率为1.57%；足月儿气胸发生率明显高于早产儿（23/1033 vs 13/1253，P=0.023）。Logistic回归分析显示剖宫产、新生儿呼吸窘迫综合征(NRDS)、湿肺、肺炎、机械通气是新生儿气胸的发生的独立危险因素（OR值分别为7.951、6.090、7.898、6.272、4.389，均P<0.05）。机械通气时气道峰压（PIP）越高，气胸发病率越高（P<0.001）；对于NRDS患儿，应用肺表面活性物质后气胸的发生率明显降低（2.9% vs 10.1%，P=0.006）。结论：新生儿气胸多发生于足月儿；剖宫产、NRDS、湿肺、肺炎、机械通气与气胸的发生密切相关；严把剖宫产指征、机械通气时采用低PIP通气和肺表面活性物质的应用可以预防气胸的发生。

Abstract:

OBJECTIVE: To investigate the risk factors and preventative measures for neonatal pneumothorax. METHODS: Retrospective analysis was performed on the clinical data of 2286 neonates who were hospitalized in the neonatal intensive care unit between October 2010 and November 2011, and a case-control study was conducted to analyze the risk factors and preventative measures for neonatal pneumothorax. RESULTS: The incidence of pneumothorax among the neonates was 1.57% (36/2286), and it was significantly higher in full-term infants than in preterm infants (23/1033 vs 13/1253, P=0.023). Logistic regression analysis indicated that cesarean section, neonatal respiratory distress syndrome (NRDS), wet lung, pneumonia and mechanical ventilation were the independent risk factors for neonatal pneumothorax (odds ratios=7.951, 6.090, 7.898, 6.272 and 4.389; P<0.05 for all). The higher the peak inspiratory pressure (PIP) during mechanical ventilation, the higher the incidence of neonatal pneumothorax (P<0.001). Pulmonary surfactant reduced the incidence of pneumothorax among neonates with NRDS (2.9% vs 10.1%; P=0.006). CONCLUSIONS: Neonatal pneumothorax occurs mostly in full-term infants. Cesarean section, NRDS, wet lung, pneumonia and mechanical ventilation are closely associated with neonatal pneumothorax. Strict management of indications for cesarean section, keeping PIP at a low level during mechanical ventilation, and use of pulmonary surfactant are helpful in preventing neonatal pneumothorax.