新生儿疾病-新生儿呼吸窘迫综合征英文.ppt

NeonatalRespiratoryDistressSyndromeNRDS新生儿呼吸窘迫综合征,Definition,Hyalinemembranedisease，HMDDeficiencyofpulmonarysurfactant，PSPulmonaryalveolicollapseattheendofexpirationProgressivelyaggravatedrespiratorydistressshortlyafterbirthMainlyinpreterminfantHigherincidenceratewithsmallergestationalageInfantofDMmother,cesareansection,thesecondbabyoftwins,Etiology,PSaresecretedbytypeIIepithelialcellsofpulmonaryalveoli.Dipalmitoyllecithin（DPPC）isthemainsubstance.Surfactantprotein（SP）PSareproducedfrom1820wtill3536wwhenlungismature.,Etiology,PScovertheinnersurfaceofpulmonaryalveoli,whichcan:decreasealveolarsurfacetensionpreventalveolicollapseattheendofexpirationkeepfunctionalresidualcapacity（FRC）keepstablepulmonaryalveoluspressuredecreasefluidexudefromcapillarytopulmonaryalveoli,Etiology,PretermbirthpHofbodyfluid,bodytemperature,volumeofpulmonarybloodflowandhormonecaninfluencePSsecretion.Asphyxia,hypothermia,placentaprevia,placentalabruptionandhypotensionofmother,whichcaninfluencebloodflowoffetus.HighlevelinsulinofIDMmayresistthepromotioneffectofadrenalcortexhormonetoPSsynthesis,Pathogenesis,PSdeficiency,alveolarsurfacetension,alveoluscollapseandpulmonarycompliance,workatinspirationdifficultyatalveolusopening,tidalvolume,alveolarventilation,CO2retention,respiratoryacidosis,V/A,hypoxia,metabolicacidosis,Alveolarpermeability,interstitiumedema,fibrindepositionintheinnersurfaceofalveoli,eosinphilichyalinemembrane,gasdiffusiondisorder,Clinicalmanifestation,Respiratorydistress26hafterbirth:dyspnea,cyanosis,flaringofalaenasi,inspiratorythree-concavesign,expiratorygroanProgressivelyaggravatedrespiratorydistressFlatthorax,lowbreathsound,wetralesArterialductopeningatconvalescencestageConditionwillimproveafter3dbutthecoursewilllongerifcomplicationsexist.,Assistantexamination,Laboratoryexaminations：foamtestlecithin/sphingomyelin（L/S）bloodgasanalysisChestXray：frostedglass-likechangesairbronchogramwhitelungcolorDopplerultraphonic：PPHN,PDA,Diagnosis,ClinicalmanifestationsChestXray,Differentialdiagnosis,wetlunggroupBstreptococcalpneumoniadiaphragmatichernia,Therapy,Generaltreatment：incubationmonitoringofT,R,HR,BP,bloodgasliquidandnutritionSupplyRectificationofacidosisshutoffarterialductusantibiotics,Oxygentherapyandassistantventilation：oxygeninhalansconstantpositiveairwaypressure(CPAP)ventilationcommonfrequencyventilatorhighfrequencyoscillationventilator,highfrequencyejectionventilatorextracorporealmembraneoxygenator(ECMO),Therapy,Therapy,PSsubstitutiontherapy：Natural,semisynthesis,artificialsynthesisutilization：pumpintoairwaythroughintra-trachealtubewi