Ryan C A, Barrington K J, Phillips H J, Finer N N
Pediatrics. 1987 Mar;79(3):417-21.
A prospective study was performed to ascertain the incidence of, and risk factors for, the development of a contralateral pneumothorax in 32 neonates with respiratory distress, without evidence of pulmonary hypoplasia, who had an initial unilateral air leak requiring pleural drainage. The mean postnatal age of occurrence of the first pneumothorax was 31.04 hours (range 0.1 to 92 hours); a subsequent contralateral pneumothorax developed in 14 infants (44%) at a mean postnatal age of 61.5 hours (range 8 to 106 hours). Thirteen of the 14 infants with a subsequent contralateral pneumothorax had pulmonary interstitial emphysema visible on the chest radiograph taken immediately after drainage of the first pneumothorax, compared with eight of the 18 infants without a contralateral pneumothorax (P less than .005). Other factors significantly associated with a contralateral pneumothorax were alveolar-arterial oxygen gradient (P less than .01) and FiO2 (P less than .005), both measured one hour after the pneumothorax, and gestational age (P less than .05). Multivariate discriminant function analysis did not usefully add to the predictive power of pulmonary interstitial emphysema alone. Infants with pulmonary interstitial emphysema at the time of an initial unilateral pneumothorax are at significant risk for the development of a contralateral pneumothorax.
对32例无肺发育不全证据、因最初单侧气胸需胸腔引流而出现呼吸窘迫的新生儿进行了一项前瞻性研究，以确定对侧气胸的发生率及危险因素。首次气胸发生时的平均出生后年龄为31.04小时（范围0.1至92小时）；14例婴儿（44%）随后出现对侧气胸，平均出生后年龄为61.5小时（范围8至106小时）。在首次气胸引流后立即拍摄的胸部X光片上，14例随后出现对侧气胸的婴儿中有13例可见肺间质气肿，而18例未出现对侧气胸的婴儿中有8例可见（P<0.005）。与对侧气胸显著相关的其他因素包括气胸后1小时测量的肺泡-动脉氧梯度（P<0.01）和吸入氧浓度（P<0.005），以及胎龄（P<0.05）。多变量判别函数分析并未显著增强仅靠肺间质气肿的预测能力。初始单侧气胸时出现肺间质气肿的婴儿发生对侧气胸的风险显著增加。
