新生儿肺动脉高压管理课件

1、女Walsh-Sukys, et. Al: J Pediatr 105:14,2000高阻力肺循环低阻力胎盘循环胎盘为主要氧气交换器官胎儿动脉砖形平滑肌细胞， 管腔狭窄过渡期细胞变长，变薄成为纺锤形细胞血管内皮细胞变平，血管腔扩大脐带结脐带结扎扎肺循环阻力下降体循环阻力升高呼吸呼吸:肺扩张PaO2升高pH 升高通过卵圆孔动脉导管左右分流 NO 鸟甘酸 环化酶 腺甘酸 环化酶 前列环素环氧化酶 cAMPcGMP正常肺血管扩张不发生肺血流阻力高于体循环阻力非氧合血分流入体循环分类n生后过度障碍n血管肌肉过度增生n血管发育不良病因n败血症肺炎n围生期吸综合症 (胎粪，血，羊水)n慢性宫内缺氧n宫内动

2、脉导管早闭n肺发育不良或畸形:n先天性膈疝n肺发育不良n肺泡毛细血管发育不良Hernandez-Diaz S, et al. Pediatrics 2007:1195-201Lakshminrusimha et al. J Appl Physiol. 2011; 111 :1441一氧化氮途径前列环素途径内皮素途径 ET1+Vain et al. Lancet. 2004; 364:597Halliday & Sweet. Cochrane 2001 1; CD000500. OI=MAP*FiO2/PaO2Walsh MC, et al. Clin Perinatol 28(3):

3、609-627Response of the pulmonary vasculature to hypoxia and H+ ion concentration changes. Rudolph & Yuan J Clin Invest. 1966; 45:399Walsh-Sukys M C et al. Pediatrics 2000;105:14-20Walsh-Sukys M C et al. Pediatrics 2000;105:14-20 ET1sildenafilmilrinonebostentanProstacyclins+Dont forget- the bag n

4、eeds NO too!Shah PS, Ohlsson A. Cochrane Database Syst Rev. 2011; (8): CD005494 ECMO- Use of ECMO decreased mortality from 60% to 30% in a UK studyVariableOdds of neonatal death Odds ratio 95% confidence interval P valueGestational age 37 wk 1.7 1.22.5 0.01pH7.20 1.51.12.1 0.02SaO2 65% 1.51.12.1 0.0

5、1ECMO initiatedDOL 5 1.81.22.6 0.01Duration of ECMO 7 d 3.42.54.7 0.01The use of ECMO for persistent pulmonary hypertension of the newborn: A decade of experience. Lazar et al. J Surg Res 2012 (177):263-267UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation: follow-up to age 4 years. Bennett CC et