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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13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。
Objective To analyze the perinatal factors of early neonatal pathologic pneumothorax. Methods Thirty-eight children with pathologic pneumothorax (case group) from January 2005 to February 2011 were enrolled in this study. Three consecutive neonates with obstetric births were selected as the control group according to the ratio of 13. , The clinical data were retrospectively analyzed, the occurrence of pathological pneumothorax perinatal factors. Results The proportion of early neonatal pathologic pneumothorax in the same period of live birth was 0.25 ‰ (38/150 575 cases). Pulmonary infrastructure diseases include pneumonia (7.9%) and wet lung (92.1%). After conservative treatment and thoracentesis or drainage after recovery. 63.2% of the patients in the case group had gestational weeks <39 weeks. Cesarean delivery rate (73.7%), boy ratio (81.6%) and amniotic fluid turbidity rate (34.2%) were significantly higher in the case group than those in the control group (Pa0.05). Logistic regression analysis showed that the incidence of pneumothorax in neonate was increased by 7 days for boys with cloudy amniotic fluid and cesarean section. The OR values (95% CI) were 5.585 (2.169-14.382) and 3.431 (1.336-8.811) respectively, 3.294 (1.356 ~ 8.001). Conclusions Wet lung is one of the causes of neonatal pathologic pneumothorax. Cesarean section is an important risk factor for early neonatal pathological pneumothorax. Obstetricians should strictly control the rate of selective cesarean section, as far as possible after 39 weeks of selective cesarean section, pediatricians with complications of lung complications within 48 h of strict observation of the disease, timely follow-up of chest radiographs, early Diagnosis and treatment of pathological pneumothorax.