新生儿气胸的床边X线诊断分析

X-ray diagnosis and clinical analysis of pneumothorax in neonates at bedside

目的分析新生儿气胸的床边X线表现与临床特点,提高对新生儿气胸的诊断与鉴别诊断水平,为临床治疗提供指导。方法收集该院2011-02~2016-10经床边X线检查的新生儿气胸患儿23例,分析其X线特征。结果 23例新生儿气胸病例中,自发性气胸1例(4.3%),病理性气胸13例(56.6%),医源性气胸9例(39.1%)。23例新生儿气胸中,双侧4例,共27侧气胸,根据X线表现分为5种类型:前胸壁型2侧(7.5%),内侧缘型1侧(3.7%),膈上型5侧(18.5%),成人型11侧(40.7%),混合型8侧(29.6%)。结论新生儿气胸床边X线表现具有多样性,也有一定的特征性,即表现为"局部透亮征"、"纵隔心缘清晰征"、"深窦征"等,准确判断气胸的存在与分型对临床治疗有重要的指导作用,当气胸量大时需行外科处理。

Objective To analyze the X-ray manifestations and clinical characteristics of neonatal pneumothorax at bedside,and to improve the level of diagnosis and differential diagnosis of neonatal pneumothorax and to guide the clinical treatment. Methods 23 neonates with neonatal pneumothorax who were examined by the bedside X-ray in our hospital from February 2011 to October 2016 were collected,and their X-ray manifestations were analyzed. Results In the 23 cases with neonatal pneumothorax,spontaneous pneumothorax occurred in 1 case（ 4. 3%）,pathologic pneumothorax in 13 cases（ 56. 6%） and iatrogenic pneumothorax in 9 cases（ 39. 1%）. In the 23 cases with neonatal pneumothorax,4 cases were bilateral and a total of 27 bilateral pneumothorax occurred. According to the X-ray manifestations,it was divided into five types： anterior chest wall type in 2 cases（ 7. 5%）,medial margin type in 1 case（ 3. 7%）,superior diaphragm type in 5 cases（ 18. 5%）,adult type in 11 cases（ 40. 7%） and mixed type in 8 cases（ 29. 6%）. Conclusion X-ray examination has diversified manifestations in neonatal pneumothorax.It also has the certain characteristics as follow： ＂local bright character＂,＂side of mediastinal heart clear sign＂and＂deep sinus sign＂.