新生儿疾病-新生儿呼吸窘迫综合征英文.ppt

Neonatal Respiratory Neonatal Respiratory Distress Syndrome Distress Syndrome NRDS新生儿呼吸窘迫新生儿呼吸窘迫综综合征合征Definition定定义Etiology病因病因Pathogenesis发病机制病机制Clinical manifestation临床表床表现Assistant examination辅助助检查Diagnosis诊断断Differential diagnosis鉴别诊断断Therapy治治疗Prevention预防防DefinitionHyaline membrane disease，HMDDeficiency of pulmonary surfactant，PSPulmonary alveoli collapse at the end of expirationProgressively aggravated respiratory distress shortly after birthMainly in preterm infantHigher incidence rate with smaller gestational ageInfant of DM mother,cesarean section,the second baby of twinsEtiologyPS are secreted by type II epithelial cells of pulmonary alveoli.Dipalmitoyllecithin（DPPC）is the main substance.Surfactant protein（SP）PS are produced from 1820w till 3536w when lung is mature.EtiologyPS cover the inner surface of pulmonary alveoli,which can:decrease alveolar surface tensionprevent alveoli collapse at the end of expirationkeep functional residual capacity（FRC）keep stable pulmonary alveolus pressure decrease fluid exude from capillary to pulmonary alveoliEtiologyPreterm birthpH of body fluid,body temperature,volume of pulmonary blood flow and hormone can influence PS secretion.Asphyxia,hypothermia,placenta previa,placental abruption and hypotension of mother,which can influence blood flow of fetus.High level insulin of IDM may resist the promotion effect of adrenal cortex hormone to PS synthesisPathogenesisPS deficiencyalveolar surface tensionalveolus collapse and pulmonary compliancework at inspirationdifficulty at alveolus opening tidal volumealveolar ventilationCO2 retentionrespiratory acidosisV/Ahypoxiametabolic acidosisAlveolar permeability interstitium edemafibrin deposition in the inner surface of alveolieosinphilic hyaline membranegas diffusion disorderClinical manifestationRespiratory distress 26h after birth:dyspnea,cyanosis,dyspnea,cyanosis,flaring of alaenasi,inspiratory flaring of alaenasi,inspiratory three-concave sign,expiratory groanthree-concave sign,expiratory groanProgressively aggravated respiratory distressFlat thorax,low breath sound,wet ralesArterial duct opening at convalescence stageCondition will improve after 3d but the course will longer if complications exist.Assistant examinationLaboratory examinations：foam testlecithin/sphingomyelin（L/S）blood gas analysisChest X ray：frosted glass-like changesair bronchogramwhite lungcolor Doppler ultraphonic：PPHN,PDADiagnosisClinical manifestationsChest X ray Differential diagnosiswet lunggroup B streptococcal pneumoniadiaphragmatic herniaTherapyGeneral treatment：incubationmonitoring of T,R,HR,BP,blood gasliquid and nutrition SupplyRectification of acidosisshut off arterial ductusantibioticsOxygen therapy and assistant ventilation：oxygen inhalansconstant positive airway pressure(CPAP)ventilationcommon frequency ventilatorhigh frequency oscillation ventilator,high frequency ejection ventilatorextracorporeal membrane oxygenator(ECMO)TherapyTherapyPS substitution therapy：Natural,semisynthesis,artificial synthesisutilization：pump into airway through intra-tracheal tube within 24h after birth Repeat 24 times if requirementPreventionPrevention of preterm laborPromotion of fetal lung maturityProphylactic using PSSummary