湘雅儿科课件-respiratory distress syndrome（可编辑）

湘雅儿科课件RESPIRATORYDISTRESSSYNDROME新生儿呼吸窘迫综合征RESPIRATORYDISTRESSSYNDROMERDS中南大学儿科学教研室陈平洋第七章第九节PURPOSETOBEFAMILIARWITHETIOLOGY病因ANDMECHANISM发病机制TOMASTERCLINICALMANIFESTATION临床表现ANDDIFFERENTIALDIAGNOSIS鉴别诊断TOMASTERPREVENTIONANDTREATMENTSUMMARYNRDS新生儿呼吸窘迫综合征ISPRIMARILYDEVELOPMENTALDEFICIENCYINTHEAMOUNTOFPULMONARYSURFACTANTPS,肺表面活性物质,ATTHEAIRLIQUIDINTERFACEOFTHELUNGRDSFREQUENTLYREFERREDTOASHYALINEMEMBRANEDISEASEHMD,肺透明膜病SUMMARYRDSISADISEASEPRIMARILYOFTHEPREMATUREINFANT未成熟儿PULMONARYHYALINEMEMBRANES肺透明膜ANDATELECTASIS肺不张AREFINDINGSATAUTOPSY尸体解剖ETIOLOGYANDMECHANISMPSPRODUCTIONAND/ORRELEASEBYTYPEIIALVEOLARCELLSII型肺泡细胞PSAPPEARSINTHEAMNIOTICFLUID羊水BETWEEN2832WEEKSMATURELEVELSOFPSAREUSUALLYPRESENTAFTER35WEEKSPSSURFACETENSION表面张力ATELECTASIS肺不张HYPOXIA低氧血症ANDACIDOSIS酸中毒PAVASOCONSTRICTION肺动脉收缩RIGHTTOLEFTSHUNTING右向左分流ISCHEMICINJURY缺血性损伤TOTHEVASCULARBEDEFFUSIONOFPROTEINACEOUSMATERIAL蛋白样物质PULMONARYHYALINEMEMBRANE肺透明膜HYPOXIAANDACIDOSISWHOISRISKBABYTHEINCIDENCEISINVERSELYPROPORTIONALTOGESTATIONALAGE胎龄28WK6080OFINFANTS3234WK1530OFINFANTS37WK5OFINFANTSINFANTSOFDIABETICMOTHERS糖尿病母亲之婴儿CLINICALMANIFESTATIONSTHEINFANTWITHRDSISMOSTLYPREMATURERESPIRATORYDISTRESS呼吸窘迫USUALLYBEGIN2TO6HOURSAFTERBIRTHDYSPNEA呼吸困难,CYANOSIS发绀,ANDANEXPIRATORYGRUNT呼气性呻吟THECLINICALMANIFESTATIONISPROGRESSIVEWORSENING进行性加重UNCOMPLICATED无并发症CASESARECHARACTERIZEDBYWORSENINGOFTHEDISEASEFOR23DWITHRECOVERYAT72HR胃液泡沫稳定试验1MLOFGASTRICJUICE胃液WITHANEQUALVOLUMEOF95ETHANOL酒精SHAKE15SECSTATICSTATE15SECFETALLUNGMATURITYRDSRADIOLOGICFEATURESGROUNDGLASS毛玻璃样WITHAIRBRONCHOGRAMS支气管充气征ASTHEDISEASEPROGRESSES,THELUNGMAYBECOMEWHITEOUTLUNG白肺TREATMENT一SPECIFICTHERAPY1SURFACTANTREPLACEMENT表面活性物质替代THEMAMMALIAN哺乳动物SURFACTANTISCURRENTLYPREFERREDPSSHOULDBEGIVENUNDERCONDITIONSOFADEQUATEMECHANICALVENTILATION机械通气2CONTINUOUSPOSITIVEAIRWAYPRESSURECPAP,持续气道压力CPAPMAYBEADMINISTEREDBYNASALPRONGS鼻塞,MECHANICALVENTILATION机械通气3CLOSUREOFTHEPATENTDUCTUSARTERIOSUSPDAPDASHOULDBECLOSED,EITHERWITHINDOMETHACIN消炎痛THERAPYORWITHSURGERY二SUPPORTIVEMANAGEMENT1MAINTAINANEUTRALTHERMALTEMPERATURE中性温度2ADMINISTERADEQUATEFLUIDSANDELECTROLYTES水、电解质PREVENTFLUIDOVERLOAD3CORRECTACIDBASEDISTURBANCES酸碱失衡CPAPBYNASALPRONGSPREVENTION1PREVENTPREMATURELABOR早产2PREDICTTHERISKOFRDSBYTESTINGOFAMNIOTICFLUIDLECITHIN/SPHINGOMYELINL/S,卵磷脂/鞘磷脂RATIO20,INDICATESFETALLUNGMATURITY3ACCELERATEFETALLUNGMATURATION加快胎肺成熟ADMINISTRATIONOFDEXAMETHASONE地塞米松TOWOMEN48HRBEFOREDELIVERY4ADMINISTRATIONOFAFIRSTDOSEOFPS肺表面活性物质INTOTHETRACHEAOFINFANTSIMMEDIATELYAFTERBIRTHORDURINGTHEFIRST24HROFLIFEDIFFERENTIALDIAGNOSIS鉴别诊断1MECONIUMPNEUMONITIS胎粪性肺炎MECONIUMSTAINEDAMNIOTICFLUID胎粪性羊水SIGNSAPPEARWITHINMINUTSOFBIRTH,BARRELSHAPEDCHEST桶状胸,PROLONGEDEXPIRATION,ANDRALES罗音MAYBEAUDIBLEHYPERINFLATION肺气肿,IRREGULAR,STREAKYDENSITIESWITHAREASOFATELECTASIS肺不张,PNEUMOTHORAX气胸HISTORYCLINICALMANIFESTATIONSRADIOLOGICFEATURESHYPOXIA缺氧ETIOLOGYFULLTERMINFANT足月儿GESTATIONALAGEEACHGESTATIONALAGE各胎龄BACTERIA,VIRUSANDOTHERMICROBEINFECTION,PROLONGEDRUPTUREOFMEMBRANES早破水,URI上呼吸道感染MAYOCCURATANYTIMEWITHNASALOBSTRUCTION鼻塞,COUGHING