黄疸PPT课件.ppt

1,新生儿疾病（二）,2,新生儿疾病（二）,新生儿黄疸新生儿溶血病新生儿肺透明膜病,新生儿败血症新生儿寒冷损伤综合征新生儿肺炎,3,新生儿黄疸,新生儿黄疸NEONATALJAUNDICE,HyperbilirubinemiaorJaundiceofNewborn,4,新生儿黄疸NEONATALJAUNDICE,5,Adult,jaundice,pathological,Newborn,？,新生儿黄疸NEONATALJAUNDICE,新生儿黄疸NEONATALJAUNDICE,60%fulltermbaby80%pretermbaby,6,新生儿为什么易发生黄疸？specialmetabolismofbilirubin,新生儿黄疸NEONATALJAUNDICE,新生儿黄疸NEONATALJAUNDICE,问题1,7,Wheredoesbilirubincomefrom?,8,衰老红细胞的分解代谢80%,无效的血红素形成（旁路）,网状内皮系统,肝脏,肝内血红素组织血红素,胆红素+血浆白蛋白-血液内,胆红素+Y、Z蛋白,结合作用,结合胆红素,毛细胆管,光面内质网,结合胆红素,重吸收后90%,肠肝循环,-肝细胞,葡萄糖醛酸90%0-葡萄糖结合物0-木糖结合物,-肠腔,细菌作用,尿胆原80%排出,10%,肾脏,门V,尿：尿胆原（0-4毫克/日）,粪：尿胆原（40-280毫克/日）,图正常胆红素代谢,9,Overproduction,每日生成胆红素8.8mg/kg(成人3.8mg/kg),THEFEATURESOFNEONATALBILIRUBINMETABOLISM,Acidosis,lowconcentrationofserumprotein.,Lowerconveyingcapability,新生儿黄疸NEONATALJAUNDICE,10,Defectionofliverfunction,THEFEATURESOFNEONATALBILIRUBINMETABOLISM,新生儿黄疸NEONATALJAUNDICE,肝细胞内Y，Z蛋白含量低,尿苷二磷酸葡萄糖醛酸基转移酶（UDPGT）活性不足，为正常30%以下,排泄结合胆红素的功能差,11,Increasedenterohepaticcirculation(肠肝循环增加),THEFEATURESOFNEONATALBILIRUBINMETABOLISM,新生儿黄疸NEONATALJAUNDICE,12,Jaundicemaybenormal!,Jaundiceofnewborn,physiological,pathological,新生儿黄疸NEONATALJAUNDICE,新生儿黄疸NEONATALJAUNDICE,问题2,怎样区分病理性和生理性黄疸？,13,新生儿生理黄疸与病理性黄疸鉴别,新生儿黄疸NEONATALJAUNDICE,14,Causesofpathologicaljaundice,overproduction,Lowerliverfunction,新生儿黄疸NEONATALJAUNDICE,新生儿黄疸NEONATALJAUNDICE,问题3,Obstructivedisease,1,2,3,15,overproduction,hemolyticdisease（溶血病）Polycythemia（红细胞增多症）extravascularhemolysis（血管外溶血）Infection（感染）,16,increasedenterohepaticcirculationhemoglobindiseaseabnormalmembraneofRBC,overproduction,17,Lowerliverfunction,缺氧(hypoxia):窒息(asphyxia)；心力衰竭(heartfailure)Crigler-Najjar综合征Gilbert综合征Lucey-Driscoll综合征药物：磺胺；消炎痛其他：甲状腺功能低下(hypothyroidism)；21-三体综合征(Dawnssyndrome),18,胆道闭锁(biliaryatresia)新生儿肝炎(hepatitisofnewborn)先天性代谢缺陷病（IEM）Dubin-Johnson综合征,Obstructivedisease,19,思考题,为何新生儿出现生理性黄疸?诊