新生儿气胸30例临床分析

目的 探讨新生儿气胸的病因、临床特点及防治方法,提高对该病的早期诊断及正确处理,降低病死率.方法 对收集2008年6月至2014年12月本院新生儿重症监护室(NICU)收治的30例新生儿气胸的临床资料进行回顾性分析.结果 30例新生儿气胸中,自发性气胸4例,医源性气胸6例,病理性气胸20例.所有病例气胸均吸收,其中行高频振荡通气12例,3例予高频振荡通气过程中病情加重行胸腔闭式引流后缓解;3例气胸具张力性、肺压缩50％以一次性外周用静脉留置针行一次性胸腔穿刺抽气治疗后予鼻导管吸氧缓解;9例确诊后单纯予鼻导管吸氧缓解;3例予调整常频机械通气参数后气胸吸收;3例自行吸收;本组病例无放弃治疗及死亡病例.结论 新生儿气胸与窒息复苏不当、胎粪吸入、肺炎、新生儿呼吸窘迫综合征、机械通气等相关.防治措施主要是加强围生期保健,减少窒息发生,正确复苏,正确应用机械通气.应用一次性外周用静脉留置针或传统胸腔穿刺针予胸腔穿刺抽气、闭式引流及或高频振荡通气(HFOV)是治疗新生儿气胸的有效方法.

Clinical analysis of 30 cases of newborn pneumothorax

Objective To explore the pathogeny,clinical characteristics and prevention and control of neonatal pneumothorax,improve the early diagnosis and correct treatment of the disease,and reduce the case fatality rate.Method The clinical data of 30 cases of neonatal pneumothorax was retrospectively analyzed.Results In 30 cases of neonatal pneumothorax,there were 4 cases of spontaneous pneumothorax,6 cases of iatrogenic pneumothorax,20 cases of pathological pneumothorax.All cases had pneumothorax absorption.12 cases were treated with high frequency oscillatory ventilation,exacerbation remitted after closed thoracic drainage in 3 cases during high frequency oscillatory ventilation treatment.Pneumothorax,pulmonary tension compression 50％ in 3 cases remitted after disposable thoracic puncture extraction with disposable peripheral venous indwelling needle and nasal catheter oxygen inhalation.9 diagnosed cases remitted after nasal catheter oxygen inhalation.Pneumothorax absorption occurred in 3 cases after adjusting conventional mechanical ventilation parameters.Self absorption occurred in 3 cases.There were no giving up treatment or death cases in this group.Conclusions Neonatal pneumothorax is related to improper asphyxia resuscitation,meconium aspiration,pneumonia,neonatal respiratory distress syndrome,and mechanical ventilation.The main prevention measures are strengthening perinatal care,reducing asphyxia,correct resuscitation,and correct application of meehanical ventilation.Pleural puncture extraction with disposable peripheral venous indwelling needle or traditional thoracic puncture needle,closed drainage,and high frequency oscillatory ventilation (HFOV) are effective methods for the treatment of neonatal pneumothorax.