【摘要】：目的:回顧性分析新生兒氣胸(Neonatal pneumothorax,NP)的臨床資料,探討NP的臨床相關(guān)危險(xiǎn)因素及臨床診療要點(diǎn)。為NP的預(yù)防、早期識(shí)別及治療,降低其發(fā)生率、提高搶救成功率提供理論依據(jù)。方法:本研究采用回顧性臨床調(diào)查分析的方法,通過(guò)對(duì)2012年12月至2015年12月期間鹽城市婦幼保健院新生兒科及蘇州大學(xué)附屬兒童醫(yī)院新生兒重癥監(jiān)護(hù)室(Neonatal Intensive Care Unit,NICU)住院患兒中NP病例118例的臨床資料進(jìn)行匯集分析,同期選取未發(fā)生NP的118例作為對(duì)照組,危險(xiǎn)因素分析的資料中包括母親產(chǎn)次、胎齡、生產(chǎn)方式、有無(wú)產(chǎn)兆、有無(wú)胎兒宮內(nèi)窘迫、性別、出生體重、Apgar評(píng)分、羊水情況、臍帶情況、胎盤(pán)情況、機(jī)械通氣、單胎/多胎、有無(wú)酸中毒、白細(xì)胞計(jì)數(shù)、有無(wú)合并肺炎、RDS、MAS、濕肺、畸形、先天性心臟病、妊娠期高血壓、妊娠期糖尿病等共計(jì)23個(gè)因素,上述因素在SPSS21.軟件中進(jìn)行單因素分析和多因素Logistic回歸分析。同時(shí)對(duì)118例NP組中使用常頻機(jī)械通氣和高頻機(jī)械通氣進(jìn)行了對(duì)比。結(jié)果:1、NP發(fā)生率及臨床預(yù)后:本組資料顯示2012年12月至2015年12月期間鹽城市婦幼保健院新生兒科及蘇州大學(xué)附屬兒童醫(yī)院NICU住院患兒共計(jì)9371例。其中確診NP118例,NP患病率為1.26%,死亡共計(jì)10例,病死率為8.47%。2、單因素分析顯示:NP的發(fā)病與生產(chǎn)方式、機(jī)械通氣、酸中毒、白細(xì)胞計(jì)數(shù)、感染性肺炎、妊娠期高血壓等6個(gè)指標(biāo)密切相關(guān),P值分別為0.004、0.001、0.002、0.003、0.000、0.004。3、二值多元Logistic回歸分析結(jié)果表明:發(fā)現(xiàn)5個(gè)與NP相關(guān)的獨(dú)立因素,分別是:生產(chǎn)方式(OR-2.683,95%CI 1.399-5.148,P=0.004)、機(jī)械通氣(OR-2.791,95%CI1.266-6.150,P=0.001)、白細(xì)胞計(jì)數(shù)(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)、妊娠期高血壓(OR-4.882,95%CI 1.508-15.811,P=0.004)。4、新生兒氣胸重在預(yù)防。正確使用復(fù)蘇囊及有創(chuàng)呼吸機(jī),可積極預(yù)防氣胸的發(fā)生。其治療的關(guān)鍵是早期診斷,及時(shí)鎮(zhèn)靜、吸氧、胸腔穿刺、胸腔閉式引流、呼吸機(jī)輔助通氣及對(duì)新生兒基礎(chǔ)疾病等的綜合治療。結(jié)論:1、NP目前仍是危及新生兒生存的危重病癥,發(fā)生率高;2、患兒生產(chǎn)方式、機(jī)械通氣、酸中毒、白細(xì)胞計(jì)數(shù)、感染性肺炎、妊娠期高血壓是新生兒發(fā)生氣胸的主要危險(xiǎn)因素;3、在此基礎(chǔ)上建立的Logistic回歸模型能較好地預(yù)測(cè)新生兒氣胸的發(fā)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.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R722.1

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王斌;新生兒氣胸簡(jiǎn)易處理方法[J];新生兒科雜志;2001年01期

2 汪琴 ,吳冬雅;新生兒氣胸及肺不張的急救與護(hù)理[J];現(xiàn)代醫(yī)藥衛(wèi)生;2001年01期

3 高武紅,謝雨芳,李成榮,韓玉昆,田彎英;新生兒氣胸13例報(bào)告[J];江西醫(yī)學(xué)院學(xué)報(bào);2003年03期

4 劉濤,王廣宇,胡元軍,孫立泉,馮立林;新生兒氣胸20例臨床分析[J];臨床小兒外科雜志;2003年04期

5 吳麗燕,張泓,黃輝文,王道紅;新生兒氣胸26例臨床分析[J];遼寧醫(yī)學(xué)雜志;2003年02期

6 陳秀英,劉紹基;新生兒氣胸7例分析[J];小兒急救醫(yī)學(xué);2003年01期

7 林建軍;新生兒氣胸1例[J];實(shí)用醫(yī)學(xué)雜志;2003年02期

8 劉建平;新生兒氣胸12例診治體會(huì)[J];實(shí)用臨床醫(yī)藥雜志;2003年06期

9 王文祥;新生兒氣胸14例臨床分析[J];醫(yī)學(xué)文選;2005年03期

10 高衛(wèi)華;白劍;戴豐華;何時(shí)鳴;張水堂;;新生兒氣胸的病因、發(fā)生機(jī)理和治療方法探討[J];廣州醫(yī)學(xué)院學(xué)報(bào);2006年03期

相關(guān)會(huì)議論文 前10條

1 張燕萍;季亞平;;新生兒氣胸58例臨床分析[A];第六屆江浙滬兒科學(xué)術(shù)會(huì)議暨兒科學(xué)基礎(chǔ)與臨床研究進(jìn)展學(xué)術(shù)班論文匯編[C];2009年

2 王麗雪;李曉春;;新生兒氣胸42例臨床分析[A];新世紀(jì)全國(guó)首屆小兒綜合研究學(xué)術(shù)會(huì)議論文匯編[C];2001年

3 郭紅苗;呂勤;;新生兒氣胸相關(guān)因素分析與防治[A];浙江省醫(yī)學(xué)會(huì)圍產(chǎn)醫(yī)學(xué)分會(huì)成立大會(huì)暨“圍產(chǎn)醫(yī)學(xué)熱點(diǎn)問(wèn)題”學(xué)術(shù)會(huì)議論文匯編[C];2008年

4 吉玲;陳丹;李智瑞;;新生兒氣胸危險(xiǎn)因素分析[A];中華醫(yī)學(xué)會(huì)第十七次全國(guó)兒科學(xué)術(shù)大會(huì)論文匯編（下冊(cè)）[C];2012年

5 徐敏娟;;新生兒氣胸的高危因素分析及護(hù)理措施[A];2012年浙江省婦產(chǎn)科學(xué)及圍產(chǎn)醫(yī)學(xué)學(xué)術(shù)年會(huì)暨《婦產(chǎn)科常見(jiàn)疾病規(guī)范化治療新進(jìn)展》及《圍產(chǎn)醫(yī)學(xué)熱點(diǎn)追蹤》學(xué)習(xí)班論文集[C];2012年

6 吳宏偉;李振光;楊夏;劉金鳳;;新生兒氣胸50例臨床分析[A];2012年江浙滬兒科學(xué)術(shù)年會(huì)暨浙江省醫(yī)學(xué)會(huì)兒科學(xué)分會(huì)學(xué)術(shù)年會(huì)、兒內(nèi)科疾病診治新進(jìn)展國(guó)家級(jí)學(xué)習(xí)班論文匯編[C];2012年

7 郭紅苗;呂勤;;新生兒氣胸相關(guān)因素分析與防治(附45例病例報(bào)告)[A];2008年浙江省兒科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2008年

8 崔玉濤;李克華;樊尋梅;;窒息所致新生兒氣胸的臨床探討[A];中華醫(yī)學(xué)會(huì)全國(guó)第五次急診醫(yī)學(xué)學(xué)術(shù)會(huì)議論文集[C];1994年

9 陳杰;;新生兒氣胸的護(hù)理[A];2013年河南省兒科優(yōu)質(zhì)護(hù)理服務(wù)規(guī)范管理培訓(xùn)班及學(xué)術(shù)交流會(huì)論文集[C];2013年

10 曹云濤;;深靜脈導(dǎo)管胸腔閉式引流在新生兒氣胸中的應(yīng)用[A];2013年貴州省醫(yī)學(xué)會(huì)圍產(chǎn)醫(yī)學(xué)學(xué)術(shù)分會(huì)圍產(chǎn)適宜技術(shù)資料匯編[C];2013年

相關(guān)碩士學(xué)位論文 前3條

1 鄭繼峰;常頻機(jī)械通氣與高頻機(jī)械通氣治療新生兒呼吸窘迫綜合征、新生兒胎糞吸入綜合征、新生兒氣胸的對(duì)比性研究[D];泰山醫(yī)學(xué)院;2014年

2 金青;新生兒氣胸臨床及高危因素分析[D];蘇州大學(xué);2016年

3 李恒;60例新生兒氣胸高危因素臨床分析[D];吉林大學(xué);2009年

，

本文編號(hào)：2297927