新生儿呼吸窘迫综合征合并气胸27例临床分析

Clinical analysis of 27 cases of neonatal respiratory distress syndrome complicated with pneumothorax

目的探讨新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)合并气胸的临床特点及其防治要点。方法选取2010年10月至2015年10月入住天津医科大学总医院新生儿重症监护病房、并在病程中出现气胸的NRDS患儿共27例,对NRDS合并气胸病例的临床资料进行分析。结果 27例患儿均为早产儿,剖宫产娩出者24例,合并新生儿窒息者13例,合并胎粪吸入综合征者11例,接受正压通气复苏者9例,机械通气治疗中发生气胸者3例。共有25例患儿于出生72 h内发生气胸,其中生后第2天发病者最多,共12例。多数病例表现为呼吸窘迫突然较前加重或再次出现;19例患儿还出现心率增快;仅3例患儿有气胸体征。24例患儿采取保守治疗后气胸逐渐吸收,3例患儿行胸腔闭式引流治疗;仅1例患儿家长放弃治疗自动出院,余例预后较好。结论 NRDS是引发早产儿气胸的主要疾患,深入了解NRDS并发气胸的发病机制,减少或避免其相关危险因素,是预防气胸的关键。在临床工作中需进一步提高对该病的认识,做到早期诊断,及时合理治疗,有效控制患儿病情进展,提高早产儿救治水平。

Objective To study the clinical features and key points of prevention and treatment of neonatal respiratory distress syndrome（ NRDS） complicated with pneumothorax. Methods A retrospective analysis was conducted on clinical data of 27 neonates with NRDS complicated with pneumothorax,who were admitted to the neonatal intensive care unit from October 2010 to October 2015. Results All 27 cases were preterm infants,of whom 24 cases were delivered by cesarean section,13 cases were complicated with asphyxia,11 cases were complicated with meconium aspiration syndrome,9 cases were treated with positive pressure ventilation,in 3 of the cases the pneumothorax occurred during mechanical ventilation. Pneumothorax happened to 25 cases within 72 hours after birth,and the number of the patients who got pneumothorax within 24- 48 hours after birth was 12. Most cases showed that respiratory distress was suddenly worsened or recurred again; 19 cases got increased heart rate. Only 3 cases developed signs of pneumothorax. For 24 cases conservative management was applied to have gas absorbed gradually,3 cases underwent thoracic close drainage; 1 case gave up treatment,other cases had good prognosis. Conclusion NRDS is the leading cause of pneumothorax in preterm infants. Well understanding pathogenesis of NRDS complicated with pneumothorax,minimizing or eliminating potential risk factors are keys of effective prevention of pneumothorax. In order to diagnose and treat pneumothorax as early as possible and appropriately,it is necessary to improve awareness of this disease so that disease exacerbation could be controlled and preterm infants management could be improved.