新生儿呼吸窘迫综合征.ppt

Respiratorydistresssyndrome新生儿呼吸窘迫综合征,Contents,BackgroundEpidemiologyEtiologyPresentationTreatmentPrevention,Background,GA：21weeks,BW:280g,Apulmonarydisorderthataccompaniesprematurity,specificallyimmaturityofthelungs.Tendstooccurinneonatesyoungerthan32weekGA.,Causedbypulmonarysurfactant（肺表面活性物质）deficiency.canleadtosevererespiratoryfailureanddeath,OutcomehasimprovedwithUseofantenatalsteroids（产前使用激素）Appropriateresuscitation（复苏）:immediateuseofCPAPEarlyadministrationofsurfactant,1、Epidemiology（流行病学）,9,GA（week）,5%,15%30%,60%80%,36-37,3234,26-28,Infantofdiabeticmother:5-6timeshigherthannon-IDM（糖尿病母亲患儿）,2、Etiology（病因）,PrematurityofthelungPulmonarysurfactantdeficiency,Surfactantformationandphysiology（生理）,12,1820周,28周,35周,Surfactantmetabolism,FunctionsofPS,Microscopicfindings,Hyalinemembranes（肺透明膜）,.,exudationoffibrinousmatrix（纤维素渗出）derivedfromblood,3、Presentation,History,RDSfrequentlyoccursinthefollowinginfants:PrematureinfantsInfantsborntomotherswithdiabetesInfantsbornbymeansofcesareandelivery（剖宫产）Second-borntwinsInfantswithafamilyhistoryofrespiratorydistresssyndrome,PhysicalExamination,Tachypnea（气促）Expiratorygrunting（呼气相呻吟）Subcostalandintercostalretractions（三凹征）Cyanosis（发绀）Nasalflaring（鼻翼扇动）Extremelyimmatureneonatesmaydevelopapnea（呼吸暂停）and/orhypothermia（低氧血症）.,Chestretraction,Laboratoryexamination,1.MeasurethelevelsofPSfromamnioticfluid（羊水）ortrachealaspirateL/S(lecithin/sphingomyelin)2maturityoflung2.Bloodgas:PH,Paco2,Pao2,(mixacidosis),Chestradiography,：bilateral,diffuse,reticulargranular（双肺弥漫网状颗粒）,：airbronchogram（支气管充气征）,：ground-glassappearances（毛玻璃样），cardiacbordermaybenotclear,：poorlungexpansion,(“white-lung”),4、Diagnosis,HistoryClinicalsignsofrespiratorydistressRadiographicfindingsLaboratoryabnormalities,5、Treatment,Establishadequategasexchange,1.OxygentherapyNasalcanula,maskKeepPao2:50-70mmhg,Sao2:90-95%2.CPAPPreventalveolarcollapseatendexpiratoryIndication:Fio260%,PaCO250mmhg,Pao250mmhgorSao260mmhg)（高碳酸血症）Hypoxemia(Pao250mmhg)（低氧血症）DecreasedrespiratorydriveorapneaNeedtomaintainairwaypatencyPlantoadministersurfactantreplacementtherapy,PSreplacement,1.Clinicaleffect:RDSmortalitylungcomplianceandgasexchange2.NatralPS/sytheticPS3.Dose:200mg/kg/dose(treatment),100mg/kg(prophylatictherapy)4.method:viaendotrachealtubeafterbirthassoonaspossible,PStreatedRDS,Generaltherapy,1.Temperaturemaintenance2.Monitoring:T,HR,R,Spo2,BPandbloodgas3.Fluidtherapy4.Correctionofacidosis5.Closure