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目的探讨新生儿机械通气并发气胸的发病危险因素、诊断和治疗,以早期诊断,提高生存率。方法对本院新生儿重症监护病房2002—2010年机械通气并发气胸的患儿临床资料进行回顾性分析。结果 2002—2010年本院机械通气新生儿共313例,气胸31例,发生率9.9%。其中右侧气胸19例,左侧气胸7例,双侧气胸5例,气胸发生率与气道峰压及呼气末正压呈正相关(χ2值分别为7.53、7.23,P<0.05),与胎龄、体重无显著相关性。采用保守治疗、胸腔穿刺排气、中心静脉导管留置进行胸腔闭式引流及高频振荡通气等治疗,治愈27例,放弃1例,转院2例,死亡1例。结论新生儿机械通气治疗中,采用较高的频率、较低的吸气峰压和低呼气末正压对气胸的防治有效。使用高频震荡通气治疗气胸效果较好。
Objective To investigate the risk factors, diagnosis and treatment of neonatal mechanical ventilation complicated with pneumothorax to early diagnosis and improve the survival rate. Methods The clinical data of children with mechanical ventilation and pneumothorax during neonatal intensive care unit from 2002 to 2010 in our hospital were retrospectively analyzed. Results A total of 313 neonates with mechanical ventilation in our hospital from 2002 to 2010 were enrolled. There were 31 cases of pneumothorax, the incidence rate was 9.9%. There were 19 cases of right pneumothorax, 7 cases of left pneumothorax and 5 cases of bilateral pneumothorax. The incidence of pneumothorax was positively correlated with peak airway pressure and positive end-expiratory pressure (χ2 = 7.53, 7.23, P <0.05) Gestational age, weight no significant correlation. Conservative treatment, thoracentesis, central venous catheters indwelling thoracic closure drainage and high-frequency oscillatory ventilation were used to treat 27 cases, 1 case was abandoned, 2 cases were transferred and 1 case died. Conclusions In the neonatal mechanical ventilation, higher frequency, lower peak inspiratory pressure and lower positive end-expiratory pressure are effective in preventing and treating pneumothorax. The use of high-frequency vibration ventilation pneumothorax better.