精品课件新生儿呼吸窘迫综合征

Neonatal Respiratory Neonatal Respiratory Distress Syndrome Distress Syndrome NRDSNRDS 新生儿呼吸窘迫综合征新生儿呼吸窘迫综合征 Pediatric department of First Affiliated Hospital of Shantou university medical college DefinitionDefinition定义定义 EtiologyEtiology病因病因 PathogenesisPathogenesis发病机制发病机制 Clinical manifestationClinical manifestation临床表现临床表现 Assistant examinationAssistant examination辅助检查辅助检查 DiagnosisDiagnosis诊断诊断 Differential diagnosisDifferential diagnosis鉴别诊断鉴别诊断 TherapyTherapy治疗治疗 PreventionPrevention预防预防 DefinitionDefinition wHyaline membrane disease， HMD wDeficiency of pulmonary surfactant，PS wPulmonary alveoli collapse at the end of expiration wProgressively aggravated respiratory distress shortly after birth wMainly in preterm infant wHigher incidence rate with smaller gestational age wInfant of DM mother, cesarean section, the second baby of twins EtiologyEtiology wPS are secreted by type II epithelial cells of pulmonary alveoli. wDipalmitoyllecithin（DPPC） is the main substance. wSurfactant protein（SP） wPS are produced from 1820w till 3536w when lung is mature. EtiologyEtiology wPS cover the inner surface of pulmonary alveoli, which can: ndecrease alveolar surface tension nprevent alveoli collapse at the end of expiration nkeep functional residual capacity（FRC） nkeep stable pulmonary alveolus pressure ndecrease fluid exude from capillary to pulmonary alveoli EtiologyEtiology wPreterm birth wpH of body fluid, body temperature, volume of pulmonary blood flow and hormone can influence PS secretion. wAsphyxia, hypothermia, placenta previa, placental abruption and hypotension of mother, which can influence blood flow of fetus. wHigh level insulin of IDM may resist the promotion effect of adrenal cortex hormone to PS synthesis PathogenesisPathogenesis PS deficiencyPS deficiency alveolar surface tension alveolus collapse and pulmonary compliance work at inspirationdifficulty at alveolus opening tidal volumealveolar ventilation CO2 retention respiratory acidosis V/A hypoxia metabolic acidosis Alveolar permeability interstitium edema fibrin deposition in the inner surface of alveoli eosinphilic hyaline membrane gas diffusion disorder Clinical manifestationClinical manifestation wRespiratory distress 26h after birth: ndyspnea, cyanosis, flaring of alaenasi, inspiratory three-concave sign, expiratory groan wProgressively aggravated respiratory distress wFlat thorax, low breath sound, wet rales wArterial duct opening at convalescence stage wCondition will improve after 3d but the course will longer if complications exist. Assistant examinationAssistant examination wLaboratory examinations： nfoam test nlecithin/sphingomyelin（L/S） nblood gas analysis wChest X ray： nfrosted glass-like changes nair bronchogram nwhite lung wcolor Doppler ultraphonic：PPHN, PDA DiagnosisDiagnosis wClinical manifestations wChest X ray Differential diagnosisDifferential diagnosis wwet lung wgroup B streptococcal pneumonia wdiaphragmatic hernia TherapyTherapy w w General treatmentGeneral treatment： nincubation nmonitoring of T, R, HR, BP, blood gas nliquid and nutrition Supply nRectification of acidosis nshut off arterial ductus nantibiotics w w Oxygen therapy and assistant ventilationOxygen therapy and assistant ventilation： noxygen inhalans nconstant positive airway pressure(CPAP) ventilation ncommon frequency ventilator nhigh frequency oscillation ventilator, high frequency ejection ventilator nextracorporeal membrane oxygenator (ECMO) TherapyTherapy TherapyTherapy w w PS substitution therapyPS substitution therapy： nNatural, semisynthesis, artificial synthesis nutilization：pump into airway through intra-tracheal tube within 24h after birth nRepeat 24 times if requirement PreventionPrevention wPrevention of preterm labor wPromotion of fetal lung maturity wProphylactic using PS SummarySummary 肝炎，通常是指由多种致病因素-如病毒、细 急性重型肝炎 菌、寄生虫、化学毒物、药物和毒物、酒精等，侵害肝脏，使得肝脏的细胞受到破坏，肝 脏的功能受到损害，它可以引起身体珠一系列不适症状，以及肝功能指标的异常。 需要注意的是，通常我们生活中所说的肝炎，多数指的是由甲型、乙型、丙型、丁型 、戊型等肝炎病毒引起的病毒性肝炎，这只是“肝炎”家庭中一个最重要的分支，而上文中 所说的肝炎则是指广义上的肝炎，并不仅仅限于病毒性肝炎。有时人体营养不良、劳累， 甚至一个小小的感冒发烧，都有可能造成肝功能的一过性受损。 肝炎通常可以分为多种不同的类型：根据病因来分，可以分为病