Goldberg R N
Pediatrics. 1981 Dec;68(6):775-7.
The diagnosis of pneumothorax in the neonate is often heralded by such signs as deterioration of arterial blood gases, arterial hypotension, and cardiac arrest. An awareness of more subtle clinical signs of accumulating extra-alveolar gas may lead to earlier intervention and a decrease in morbidity. Fourteen episodes of pneumothorax developed in seven of 69 neonates who received ventilatory assistance (mean birth weight 1,828 +/- 295 gm), of whom six were ventilated for hyaline membrane disease and one for pneumonia. Instantaneous heart rate and arterial blood pressure (ABP) were monitored continuously in all patients. Changes in vital signs were noted at a mean of 48 minutes (range 12 to 116 minutes) prior to thoracentesis. There was an increase in systolic ABP (7 to 26 mm Hg) associated with 70% of the episodes, and an increase in heart rate and pulse pressure associated with 57% of the episodes. By 20 minutes after thoracentesis there was a rapid decrease in ABP values toward levels not significantly different from base line. A sustained increase in ABP may be an early sign of accumulating extra-alveolar gas. Continuous monitoring and graphic representation of vital signs in the ventilated neonate may suggest the diagnosis of pneumothorax before clinical decompensation occurs.
新生儿气胸的诊断常常由动脉血气恶化、动脉低血压和心脏骤停等迹象预示。认识到肺泡外气体积聚的更细微临床体征可能会导致更早的干预并降低发病率。在接受通气辅助的69例新生儿中的7例发生了14次气胸发作（平均出生体重1828±295克），其中6例因透明膜病接受通气，1例因肺炎接受通气。所有患者均持续监测即时心率和动脉血压（ABP）。在胸腔穿刺术前平均48分钟（范围12至116分钟）记录生命体征变化。70%的发作伴有收缩压ABP升高（7至26毫米汞柱），57%的发作伴有心率和脉压升高。胸腔穿刺术后20分钟，ABP值迅速下降至与基线无显著差异的水平。ABP持续升高可能是肺泡外气体积聚的早期迹象。对通气新生儿的生命体征进行连续监测和图形显示可能在临床失代偿发生之前提示气胸的诊断。
