Tsai Y F, Kao H A, Chang P Y
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1993 May-Jun;34(3):223-7.
Persistent pneumothorax is infrequently seen in the neonate. Persistent pneumothorax with a large air leak and empyema may indicate the presence of a bronchopleural fistula which often results in mortality in infants requiring ventilator support. A ten-day-old female neonate with meconium aspiration syndrome was found to have respiratory distress after birth. During ventilator therapy, persistent pneumothorax with a large air leak from the chest tube was found. Empyema occurred three days later. Despite insertion of multiple chest tubes and use of bronchial balloon occlusion, a large air leak and empyema still were noted. Following thoracotomy and suture of the bronchopleural fistula, the air leak stopped. The patient was smoothly weaned from the ventilator. She was able to be discharged in good condition six weeks later. In management of the bronchopleural fistula, bronchial balloon occlusion enabled the patient to be maintained until more specific therapy could be attempted. Thoracotomy is definite therapy for selected infants requiring ventilator support who demonstrate a large air leak, persistent pneumothorax, and progressive hypoxia which is unresponsive to chest tube insertion.
持续性气胸在新生儿中并不常见。伴有大量漏气和脓胸的持续性气胸可能提示存在支气管胸膜瘘，这在需要呼吸机支持的婴儿中常导致死亡。一名患有胎粪吸入综合征的10日龄女婴出生后出现呼吸窘迫。在呼吸机治疗期间，发现持续性气胸且胸腔引流管有大量漏气。三天后发生脓胸。尽管插入了多根胸腔引流管并使用了支气管球囊封堵术，但仍存在大量漏气和脓胸。开胸手术并缝合支气管胸膜瘘后，漏气停止。患者顺利脱机。六周后她状况良好地出院。在支气管胸膜瘘的治疗中，支气管球囊封堵术能使患者维持到可以尝试更具体的治疗方法。对于选定的需要呼吸机支持、出现大量漏气、持续性气胸以及对插入胸腔引流管无反应的进行性低氧血症的婴儿，开胸手术是确切的治疗方法。
