新生儿肺气漏临床X线分析  

Radiologic and clinical analysis of pulmonary air leak symptoms in neonates

作　　者：曹志坚[1] 秦占雄[1] 张茂琴[1] 

机构地区：[1]昆明市妇幼保健院放健科,昆明650031

出　　处：《放射学实践》2011年第5期538-542,共5页Radiologic Practice

摘　　要：目的:探讨新生儿肺气漏的临床及X线表现特征。方法:回顾性分析47例新生儿肺气漏的临床及X线表现,包括自发性气漏6例,病理性气漏24例,医源性气漏17例。均摄有卧位正位胸片,14例摄侧位片,7例摄水平侧位片。42例有复查胸片。结果:基础疾病有胎粪吸入综合征(MAS)13例、肺透明膜病(HMD)10例、重度窒息8例,新生儿肺炎6例,宫内感染肺炎2例,湿肺2例。辅助通气中气囊加压4例,持续气道内正压通气(CPAP)7例,呼气末正压通气(PEEP)6例,气管插管过深4例。X线表现为肺间质气肿4例,纵隔积气8例,单纯气胸22例,纵隔积气并发气胸8例,间质气肿伴纵隔积气或气胸各1例,间质气肿+纵隔积气+气胸3例。其中内侧气胸4例,前部气胸单侧19例、双侧6例,张力性气胸4例。结论:基础疾病及人工通气/机械通气是新生儿肺气漏的主要原因。因新生儿为仰卧位摄片,气体多聚集在胸腔前部,主要表现为前内部气胸和纵隔积气。水平侧位胸片对诊断有重要价值。Objective：To study the clinical and radiologic features of pulmonary air leaks in neonates.Methods：The X-ray and clinical findings of 47 cases of neonate pulmonary air leak were reviewed,including spontaneous air leak 6 cases,pathological air leak 24 cases and iatrogenic 17 cases.Supine anteroposterior chest film was taken in all cases;lateral chest film was taken in 14 cases and horizontal lateral film carried out in 7 cases.Radiographic follow-ups were made in 42 cases.Results：As for the primary diseases,there were meconium aspiration syndrome（MAS） 13 cases,hyaline membrane disease（HMD） 10 cases,asphyxia 8 cases,pneumonia 6 cases,intrauterine infection 2 cases and wet lung 2 cases.assissted ventilation with pneumatophore pressure in 4 cases,CPAP in 7 cases and PEEP in 6 cases.Of the 47 cases,pulmonary interstitial emphysema（PIE） in 4 cases,pneumomediastinum（PM） in 8 cases,simple pneumothorax（PN） in 22 cases,PN＋PM in 8 cases,PIE＋PM＋PN in 3 cases,etc.Among these,medial PN was seen in 4 cases,anterior PN on one side in 19 cases and bilateral in 6 cases,and tensile PN in 4 cases.Conclusion：The newborn pulmonary air leak develops usually owing to underlying pulmonary disease and assissted ventilation aeration or mechanical ventilation.Since the chest film is usually taken in supine position in newborns,there-fore,pulmonary air leak in newborns makes its appearance different from those seen in children and adults.In newborns,the pneumothorax is mainly located in the anterior or medial area of the thorax,and pneumomediastinum is commonly accompanied.The horizontal lateral chest film has very important diagnostic value.

关 键 词：婴儿 新生 肺疾病 放射摄影术 

分 类 号：R722.1[医药卫生—儿科]