新生儿疾病-新生儿呼吸窘迫综合征英文.ppt

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1、Neonatal Respiratory Neonatal Respiratory Distress Syndrome Distress Syndrome NRDS新生儿呼吸窘迫综合征新生儿呼吸窘迫综合征DefinitionHyaline membrane disease，HMDDeficiency of pulmonary surfactant，PSPulmonary alveoli collapse at the end of expirationProgressively aggravated respiratory distress shortly after birthMainly

2、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 til

3、l 3536w when lung is mature.EtiologyPS cover the inner surface of PS cover the inner surface of pulmonary alveoli,which can:pulmonary alveoli,which can:ndecrease alveolar surface tensionnprevent alveoli collapse at the end of expirationnkeep functional residual capacity（FRC）nkeep stable pulmonary al

4、veolus pressure ndecrease 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

5、 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 ret

6、entionrespiratory acidosisV/Ahypoxiametabolic acidosisAlveolar permeability interstitium edemafibrin deposition in the inner surface of alveolieosinphilic hyaline membranegas diffusion disorderClinical manifestationRespiratory distress 26h after birth:ndyspnea,cyanosis,flaring of alaenasi,inspirator

7、y three-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：nfoam tes

8、tnlecithin/sphingomyelin（L/S）nblood gas analysisChest X ray：nfrosted glass-like changesnair bronchogramnwhite lungcolor Doppler ultraphonic：PPHN,PDADiagnosisClinical manifestationsChest X ray Differential diagnosiswet lunggroup B streptococcal pneumoniadiaphragmatic herniaTherapyGeneral treatment：ni

9、ncubationnmonitoring of T,R,HR,BP,blood gasnliquid and nutrition SupplynRectification of acidosisnshut off arterial ductusnantibioticsOxygen therapy and assistant ventilation：noxygen inhalansnconstant positive airway pressure(CPAP)ventilationncommon frequency ventilatornhigh frequency oscillation ve

10、ntilator,high frequency ejection ventilatornextracorporeal membrane oxygenator(ECMO)TherapyTherapyPS substitution therapy：nNatural,semisynthesis,artificial synthesisnutilization：pump into airway through intra-tracheal tube within 24h after birth nRepeat 24 times if requirementPreventionPrevention of preterm laborPromotion of fetal lung maturityProphylactic using PSSummary