新生儿气胸床旁X线诊断及临床治疗.docVIP

新生儿气胸床旁X线诊断及临床治疗 　 作者：韦永南，赵浙民，廖源，郑敏英 【摘要】 目的：分析新生儿气胸床旁胸片的X线表现特征和临床治疗方法，提高X线诊断水平，指导临床治疗。方法：60例新生儿气胸均摄有床旁前后仰卧位胸片，58例有1次或多次随访胸片；3例又摄前后立位胸片，10例又行胸部CT扫描。结果：胸部X线表现为少量气胸的30侧，需外科穿刺或引流术的16侧；多量气胸的49侧，需外科处理的44侧，两者比较有显著性意义，χ2=13.54，Plt;0.001。结论：新生儿气胸床旁前后仰卧位胸片检查基本能满足临床的要求；若以单侧肺野透亮度增强，心缘和膈面异常锐利清晰为多量气胸，则约90％需要外科处理，对指导选择治疗方法有一定帮助，可作为参考。 【关键词】 气胸；新生儿；X线摄影；治疗 　　Bedside Radiographic Diagnosis and Clinical Treatment of Pneumothorax in Neonates 　　Abstract： Objective To analyze radiographic characteristics of bedside chest radiographs of pneumothorax in neonates, to improve its diagnostic quality, and guide the clinical treatment. Methods Supine anteroposterior chest film at bedside was taken in 60 neonates with pneumothorax, One or more radiographic followups were made in 58 cases. Of which additional anteroposterior chest film with erect position and CT scanning of chest was carried out in 3 and 10. Results Of the total 60 cases, mild pneumothorax in 30 sides, 16 need surgical treatments (closed thoracic drainage or aspirated air from pneumothorax). Severe pneumothorax in 49 sides, 44 need the surgical treatment. Difference between two groups were statistically significant (χ2=13.54，Plt;0.001). Conclusion The Xray changes of supine AP chest films of pneumothorax in neonates are characteristic .It basically meets the clinical requisition of pneumothorax in neonates. About 90% severe pneumothorax (that transparent of the whole affected lung field enhancement, cardiac margin and diaphragmatic surface is sharpedged and clear) need surgical treatment. It would be useful in guiding the treatment of pneumothorax in neonates. 　　Key words： Pneumothorax；Neonate；Radiography；Treatment 　　随着新生儿复苏气管插管、球囊加压呼吸和呼吸机的应用，新生儿危重患者的抢救率显著增加，新生儿气胸特别是医源性气胸的发生也相应增多，并且病情多急重，需要及时诊断、处理，否则将危及生命。现将我院新生儿科自2002年1月至2006年12月收治60例新生儿气胸的床旁X线表现和临床治疗进行分析总结，报告如下。 　　1 资料与方法 　　1.1 一般资料 本组60例中，男46例，女14例。早产儿16例，足月儿43例，过期产儿1例。顺产36例，剖宫产20例，吸引产2例，产钳助产、臀位牵引产各1例。生后当天出现气胸的42例，第2天的15例，第3天、第6天、第7天的各1例。自发性气胸14例，均无明显肺部疾患及心肺复苏等有关病理性及医源