早期新生儿病理性气胸的围生因素分析

目的分析早期新生儿病理性气胸的围生因素。方法收集2005年1月-2011年2月本院病理性气胸患儿38例(病例组),按13的比例,选择病例组住院号连续3份相同孕周产科分娩新生儿为对照组,对其临床资料进行回顾分析,分析发生病理性气胸的围生因素。结果早期新生儿病理性气胸占同期活产儿比例即发病率为0.25‰(38/150 575例)。肺部基础疾病包括肺炎(7.9%)和湿肺(92.1%)2种。经保守治疗和胸腔穿刺或引流后痊愈。病例组63.2%的患儿孕周<39周。病例组剖宫产娩出率(73.7%)、男童比例(81.6%)、羊水混浊率(34.2%)均显著高于对照组(Pa<0.05)。Logistic回归分析显示:男童、羊水混浊、剖宫产是增加7 d内新生儿发生气胸的危险因素,OR值(95%CI)分别为5.585(2.169～14.382)、3.431(1.336～8.811)、3.294(1.356～8.001)。结论湿肺是引起新生儿病理性气胸的原因之一,剖宫产是早期新生儿发生病理性气胸的重要危险因素。产科医师应严格控制选择性剖宫产率,尽可能在39周后进行选择性剖宫产,儿科医师对合并肺部并发症的新生儿出生48 h内严密观察病情,及时随访胸片,及早诊治病理性气胸。

Analysis of Perinatal Factors of Early Onset Neonatal Pathologic Pneumothorax

Objective To analyze the perinatal factors of early onset neonatal pathologic pneumothorax.Methods Retrospective case control study,38 infants diagnosed as early onset neonatal pathologic pneumothorax from Jan.2005 to Feb.2011 were selected as case group.Each case were matched with 3 neonates with same gestational age according to medical record number(control group).Clinical data were retrospectively analyzed.Results The incidence of early onset neonatal pathologic pneumothorax was 0.25‰(38/150 575 cases).Under-lying diseases of pathologic pneumothorax were pneumonia(7.9%) and wet lung(92.1%).All cases were recovered after conservative medical management or pleurocentesis and thoracic drainage.Gestational age of case group was lower than 39 weeks in 63.2% of cases.The propo-tion of caesarean section(73.7%),male(81.6%) and amniotic fluid stained by meconium(34.2%) of case group were significantly higher than those of control group(Pa<0.05).The risk factors of early onset neonatal pathologic pneumothorax included male,caesarean section and amniotic fluid stained by meconium,values of OR(95% CI) were 5.585(2.169-14.382),3.431(1.336-8.811),3.294(1.356-8.001),respectively.Conclusions Wet lung is one of the causes of neonatal pathologic pneumothorax.Caesarean section is an important risk factor for early onset neonatal pathologic pneumothorax.Obstetrician shall take measures to reduce the rate of elective caesarean section(ECS) and try to carry out ECS after 39 gestional weeks.In order to diagnose and treat neonatal pathologic pneumothorax as early as possible,pediatrician shall observe carefully the condition of neonates who are suffered from lung disease during first 48 hours after birth and follow up the X-ray in time.