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.
Esme H, Dogru O, Eren S, Korkmaz M, Solak O. The factors affecting persistent pneumothorax and mortality in neonatal pneumothorax[J]. Turk Pediatr, 2008, 50(3): 242-246.
Apiliogullari B, Sunam GS, Ceran S, Koc H. Evaluation of neonatal pneumothorax[J]. J Int Med Res, 2011, 39(6): 2436-2440.
[4]
Kim SK, Kim WH. Tension pneumothorax in a newborn after Cesareansection delivery[J]. Korean J Anesthesiol, 2010, 59(6): 420-424.
[5]
Benterud T, Sandvik L, Lindemann R. Cesarean section is associated with more frequent pneumothorax and respiratory problems in the neonate[J]. Acta Obstet Gynecol Scand, 2009, 88(3): 359-361.
Girard I, Sommer C, Dahan S, Mitanchez D, Morville P. Risk factors for developing pneumothorax in full-term neonates with respiratory distress[J]. Arch Pediatr, 2012, 19(4): 368-373.
[8]
Zenciroglu A, Aydemir C, Bas AY, Demirel N. Evaluation of predisposing and prognostic factors in neonatal pneumothorax cases[J]. Tuberk Toraks, 2006, 54(2): 152-156.
[9]
Seger N, Soll R. Animal derived surfactant extract for treatment of respiratory distresssyndrome[EB/OL]. (2009-04-15)[2012-10-11].http//www.ncbi.nlm.nih.gov/pubmed/19370695. pdf.
[10]
Biniwale M, Kleinman M. Safety of surfactant administration before transport of premature infants[J]. Air Med J, 2010, 29(4): 170-177.
[11]
Soll R, Ozek E. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome [EB/OL]. (2009-01-21)[2012-10-11]. http//www.ncbi.nlm.nih.gov/pubmed/19160177. pdf.
[12]
Watkinson M, Tiron I. Events before the diagnosis of a pneumothorax in ventilated neonates[J]. Arch Dis Child Fetal Neonatal Ed, 2001, 85(3): 201-203.
[13]
Klinger G, Ish-Hurwitz S, Osovsky M, Sirota L, Linder N. Risk factors for pneumothorax in very low birth weight infants[J]. Pediatr Crit Care Med, 2008, 9(4): 398-402.
Verbrugge SJ, Bohm SH, Gommers D, Zimmerman LJ, Lachmann B. Surfactant impairment after mechanical-ventilation with large alveolar surface area changes and effects of positive end-expiratory pressure[J]. Br J Anaesth, 1998, 80(3): 360-364.
