新生儿呼吸窘迫综合征 课件

新生儿呼吸窘迫综合征 Respiratory Distress Syndrome ( RDS ),第七章第九节,Purpose,To be familiar with etiology（病因） and mechanism（发病机制） To master clinical manifestation（临床表现） and differential diagnosis（鉴别诊断） To master prevention and treatment,RDS,Summary,NRDS（新生儿呼吸窘迫综合征） is primarily developmental deficiency in the amount of pulmonary surfactant ( PS,肺表面活性物质) , at the air-liquid interface of the lung RDS frequently referred to as hyaline membrane disease (HMD, 肺透明膜病),Summary,RDS is a disease primarily of the premature infant （未成熟儿） Pulmonary hyaline membranes（肺透明膜） and atelectasis（肺不张） are findings at autopsy（尸体解剖）,RDS,Etiology and Mechanism,PS production and /or release by type II alveolar cells（ II型肺泡细胞） PS appears in the amniotic fluid（羊水）between 28 32 weeks Mature levels of PS are usually present after 35 weeks,PS surface tension（表面张力） atelectasis（肺不张） hypoxia（低氧血症） and acidosis（酸中毒） pa vasoconstriction （肺动脉收缩） rightto-left shunting（右向左分流） ischemic injury（缺血性损伤） to the vascular bed effusion of proteinaceous material （ 蛋白样物质） pulmonary hyaline membrane（肺透明膜） hypoxia and acidosis ,Who Is Risk baby?,The incidence is inversely proportional to gestational age（胎龄） 37 wk: 5% of infants Infants of diabetic mothers（糖尿病母亲之婴儿）,Clinical Manifestations,The infant with RDS is mostly premature Respiratory distress（呼吸窘迫） usually begin 2 to 6 hours after birth dyspnea（呼吸困难）, cyanosis（发绀）, and an expiratory grunt（呼气性呻吟）,The clinical manifestation is progressive worsening（进行性加重） Uncomplicated（无并发症）cases are characterized by worsening of the disease for 23 d with recovery at 72 hr,RDS,胃液泡沫稳定试验,1 ml of gastric juice（胃液） with an equal volume of 95% ethanol（酒精） shake 15 sec static state 15 sec Fetal lung maturity： （） RDS： （ - ）,Radiologic Features,Ground glass（毛玻璃样） with air bronchograms（支气管充气征) As the disease progresses, the lung may become white-out lung (白肺),Treatment,一. Specific therapy 1. Surfactant replacement（表面活性物质替代） The mammalian（哺乳动物） surfactant is currently preferred PS should be given under conditions of adequate mechanical ventilation （机械通气）,2.Continuous positive airway pressure (CPAP, 持续气道压力) CPAP may be administered by nasal prongs（鼻塞） , mechanical ventilation(机械通气） 3.Closure of the patent ductus arteriosus（PDA ） PDA should be closed , either with indomethacin（消炎痛） therapy or with surgery,二 . Supportive management 1. Maintain a neutral thermal temperature(中性温度) 2. Administer adequate fluids and electrolytes （水、电解质） Prevent fluid overload 3. Correct acid-base disturbances （酸碱失衡）,CPAP by nasal prongs,Prevention,1. Prevent premature labor（早产） 2. Predict the risk of RDS by testing of amniotic fluid ：lecithin/sphingomyelin ( L/S,卵磷脂/鞘磷脂) ratio 2.0 , indicates fetal lung maturity,3. Accelerate fetal lung maturation(加快胎肺成熟） Administration of dexamethasone（地塞米松）to women 48hr before delivery 4. Administration of a first dose of PS（肺表面活性物质） into the trachea of infants immed