Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Study of the risk factors for pulmonary interstitial emphysema related to mechanical ventilator care

인공호흡기 치료와 관련된 폐간질기종 발생의 위험인자에 대한 연구

  • 김상엽 (대구파티마병원 소아과청소년과) ;
  • 이필상 (대구파티마병원 소아과청소년과) ;
  • 이상길 (대구파티마병원 소아과청소년과)
  • Received : 2008.03.25
  • Accepted : 2008.09.07
  • Published : 2008.11.15
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Abstract

Purpose : Pulmonary interstitial emphysema (PIE) primarily occurs in preterm infants suffering from respiratory distress syndrome (RDS) and kept under mechanical ventilator care. Therefore, this study aimed to examine various risk factors for PIE, to identify conditions that can decrease the possibility of PIE development. Methods : PIE classification was conducted for 183 patients diagnosed to have RDS and receiving mechanical ventilator care with pulmonary surfactant between March 2000 and February 2007. The characteristics of each patient were analyzed through retrospective examination of their medical histories. Results : Among 183 patients, 17 had PIE; all factors, including birth weight, gestational age, RDS grade III or above, chorioamnionitis, and premature rupture of membranes, were statistically significant (P<0.05). The period of mechanical ventilator use was statistically significant, but the peak mean airway pressure and peak partial pressure of inspired oxygen were not. PIE mainly occurred on the right side or both sides rather than the left side and mostly developed within 72 h. The PIE group showed higher mortality rate than the control group, and the major cause of mortality was pneumothorax. Conclusion : Risk factors for PIE in infants suffering from RDS and kept under mechanical ventilator care include low gestational age, low birth weight, chorioamnionitis, and premature rupture of membranes. If any risk factors are noted, the infant must be observed closely for at least 72 h after birth.

목 적: 폐간질기종은 인공호흡기치료를 받는 신생아 호흡곤란 증후군 환아에서 주로 발생하며 낮은 재태 연령, 인공호흡기사용에 있어서의 높은 최대흡기압력 등과 관련이 있다고 알려졌다. 이에 저자들은 자궁내 염증반응을 포함한 폐간질기종에 대한 여러 위험인자들을 알아보고 폐간질기종을 줄일 수 있는 기본 여건 마련과 향후 인공호흡기 치료방향에 도움을 주고자 본 연구를 시행하였다. 방 법: 2000년 3월부터 2007년 2월까지 7년간 대구 파티마병원 신생아 집중치료실에서 신생아 호흡곤란 증후군을 진단받고 폐표면활성제 및 인공호흡기 치료를 받은 183명을 대상으로 하여 폐간질기종의 분류를 시행하였으며 후향적 병력고찰을 통해 각 환아의 특징을 분석하였다. 결 과: 총 183예의 미숙아중 폐간질기종은 17예에서 발생하였으며 폐간질기종이 있었던 군에서 출생 체중, 재태 연령, RDS grade III 이상, 융모양막염, 조기양막파수 모두 통계적으로 의미가 있었다(P<0.05). 인공호흡기 사용기간은 통계적으로 의미가 있었지만(P<0.05), 최대 평균기도압과 최대 흡입산소분압은 의미가 없었다. 폐간질기종은 우측 또는 양측에서 많이 발생하였으며, 발생시간을 보면 대부분이 72시간내에 발생하였다. 폐간질기종이 있었던 군은 대조군에 비해 사망률이 높게 나타났으며 사망원인은 폐기흉이 가장 많은 원인을 차지하였다. 결 론: 폐간질기종의 위험인자로는 인공호흡기치료를 받는 신생아 호흡곤란 증후군 환아에서 낮은 재태 연령과 출생 체중, 그리고 융모양막염과 조기양막파수의 위험인자가 있을 시 최소 생후 72시간동안은 태아를 주의 깊게 관찰하여야 되며 증상이 없을 경우라도 흉부사진을 주기적으로 관찰하면서 폐간질기종 여부를 집중 관찰하여야 할 것으로 사료된다.

Keywords

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