新生儿气胸临床及高危因素分析

发布时间：2018-10-29 14:15

【摘要】：目的:回顾性分析新生儿气胸(Neonatal pneumothorax,NP)的临床资料,探讨NP的临床相关危险因素及临床诊疗要点。为NP的预防、早期识别及治疗,降低其发生率、提高抢救成功率提供理论依据。方法:本研究采用回顾性临床调查分析的方法,通过对2012年12月至2015年12月期间盐城市妇幼保健院新生儿科及苏州大学附属儿童医院新生儿重症监护室(Neonatal Intensive Care Unit,NICU)住院患儿中NP病例118例的临床资料进行汇集分析,同期选取未发生NP的118例作为对照组,危险因素分析的资料中包括母亲产次、胎龄、生产方式、有无产兆、有无胎儿宫内窘迫、性别、出生体重、Apgar评分、羊水情况、脐带情况、胎盘情况、机械通气、单胎/多胎、有无酸中毒、白细胞计数、有无合并肺炎、RDS、MAS、湿肺、畸形、先天性心脏病、妊娠期高血压、妊娠期糖尿病等共计23个因素,上述因素在SPSS21.软件中进行单因素分析和多因素Logistic回归分析。同时对118例NP组中使用常频机械通气和高频机械通气进行了对比。结果:1、NP发生率及临床预后:本组资料显示2012年12月至2015年12月期间盐城市妇幼保健院新生儿科及苏州大学附属儿童医院NICU住院患儿共计9371例。其中确诊NP118例,NP患病率为1.26%,死亡共计10例,病死率为8.47%。2、单因素分析显示:NP的发病与生产方式、机械通气、酸中毒、白细胞计数、感染性肺炎、妊娠期高血压等6个指标密切相关,P值分别为0.004、0.001、0.002、0.003、0.000、0.004。3、二值多元Logistic回归分析结果表明:发现5个与NP相关的独立因素,分别是:生产方式(OR-2.683,95%CI 1.399-5.148,P=0.004)、机械通气(OR-2.791,95%CI1.266-6.150,P=0.001)、白细胞计数(OR-1.085,95%CI 1.030-1.143,P=0.003)、感染性肺炎(OR-9.642,95%CI 4.786-19.426,P=0.000)、妊娠期高血压(OR-4.882,95%CI 1.508-15.811,P=0.004)。4、新生儿气胸重在预防。正确使用复苏囊及有创呼吸机,可积极预防气胸的发生。其治疗的关键是早期诊断,及时镇静、吸氧、胸腔穿刺、胸腔闭式引流、呼吸机辅助通气及对新生儿基础疾病等的综合治疗。结论:1、NP目前仍是危及新生儿生存的危重病症,发生率高;2、患儿生产方式、机械通气、酸中毒、白细胞计数、感染性肺炎、妊娠期高血压是新生儿发生气胸的主要危险因素;3、在此基础上建立的Logistic回归模型能较好地预测新生儿气胸的发生概率。
[Abstract]:Objective: to retrospectively analyze the clinical data of neonatal pneumothorax (Neonatal pneumothorax,NP) and explore the clinical risk factors and clinical diagnosis and treatment of NP. It provides a theoretical basis for the prevention, early identification and treatment of NP, the reduction of its incidence and the improvement of rescue success rate. Methods: by retrospective clinical investigation and analysis, (Neonatal Intensive Care Unit, in neonatal intensive care unit of Yancheng Maternal and Child Health Hospital and affiliated Children's Hospital of Suzhou University was studied from December 2012 to December 2015. The clinical data of 118 cases of NP were collected and analyzed in NICU. 118 cases without NP were selected as control group. The data of risk factors analysis included maternal birth, gestational age, mode of production, and whether there were signs of labor. Fetal distress, sex, birth weight, Apgar score, amniotic fluid, umbilical cord, placenta, mechanical ventilation, single fetal / multiple fetus, acidosis, white blood cell count, pneumonia, RDS,MAS, wet lung, malformation. Congenital heart disease, hypertension complicating pregnancy, gestational diabetes mellitus were 23 factors. Single factor analysis and multivariate Logistic regression analysis were carried out in the software. At the same time, the frequency mechanical ventilation and high frequency mechanical ventilation were compared in 118 cases of NP group. Results: 1 incidence of NP and clinical prognosis: from December 2012 to December 2015, there were 9371 hospitalized children in NICU of Yancheng Maternal and Child Health Hospital and affiliated Children's Hospital of Suzhou University. Among them, the prevalence rate of NP was 1.26% and the mortality rate was 8.47.2.The single factor analysis showed that the incidence and production mode of NP, mechanical ventilation, acidosis, white blood cell count, infectious pneumonia, and so on. Hypertension complicating pregnancy was closely related to six indexes (P = 0.004, P = 0.002, 0.002, 0.003, 0.0000.0004.3respectively). The results of binary multivariate Logistic regression analysis showed that five independent factors related to NP were found. They are: mode of production (OR-2.683,95%CI 1.399-5.148), mechanical ventilation (OR-2.791,95%CI1.266-6.150,P=0.001), white blood cell count (OR-1.085,95%CI 1.030-1.143), mechanical ventilation (OR-2.791,95%CI1.266-6.150,P=0.001), leukocyte count (OR-1.085,95%CI 1.030-1.143), mechanical ventilation (OR-2.791,95%CI1.266-6.150,P=0.001) and leukocyte count (OR-1.085,95%CI 1.030-1.143). P0. 003), infective pneumonia (OR-9.642,95%CI 4. 786-19. 426), gestational hypertension (OR-4.882,95%CI 1. 508-15. 811 P0. 004). 4. Prevention of pneumothorax in neonates. Correct use of resuscitation sac and invasive ventilator can prevent the occurrence of pneumothorax. The key points of treatment are early diagnosis, timely sedation, oxygen inhalation, thoracic puncture, closed thoracic drainage, ventilator assisted ventilation and comprehensive treatment of basic diseases of newborn. Conclusion: (1) NP is still a serious disease which endangers the survival of newborns, and the incidence of NP is high; 2. Production mode, mechanical ventilation, acidosis, white blood cell count, infectious pneumonia and hypertension complicating pregnancy were the main risk factors of pneumothorax in neonates. 3. The Logistic regression model established on this basis can predict the probability of pneumothorax in neonates.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R722.1

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