新生儿呼吸窘迫综合征RespiratoryDis课件.ppt

1、Respiratory Distress Syndrome ( RDS ) 中南大学儿科学教研室中南大学儿科学教研室陈平洋陈平洋第七章第九节 nTo be familiar with etiology（病因病因） and mechanism（发病机制发病机制） nTo master clinical manifestation（临临床表现床表现） and differential diagnosis（鉴别诊断鉴别诊断） nTo master prevention and treatment SummarynNRDS（新生儿呼吸窘迫综合征新生儿呼吸窘迫综合征） is primarily deve

2、lopmental deficiency in the amount of pulmonary surfactant ( PS,肺表面活性物质肺表面活性物质) , at the air-liquid interface of the lungnRDS frequently referred to as hyaline membrane disease (HMD, 肺透明膜肺透明膜病病) ) SummarynRDS is a disease primarily of the premature infant （未成熟儿未成熟儿）nPulmonary hyaline membranes（肺透肺透明

3、膜明膜） and atelectasis（肺肺不张不张） are findings at autopsy（尸体解剖尸体解剖） Etiology and MechanismnPS production and /or release by type II alveolar cells（ IIII型肺泡细胞型肺泡细胞）nPS appears in the amniotic fluid（羊羊水水）between 28 32 weeks nMature levels of PS are usually present after 35 weeks PS surface tension（表面张力表面张力

4、） atelectasis（肺不张肺不张） hypoxia（低氧血低氧血症症） and acidosis（酸中毒酸中毒） pa vasoconstriction （肺动脉收缩肺动脉收缩） rightto-left shunting（右向左分流）右向左分流） ischemic injury（缺血性损伤缺血性损伤） to the vascular bed effusion of proteinaceous material （ 蛋白样物质蛋白样物质） pulmonary hyaline membrane（肺透明膜肺透明膜） hypoxia and acidosis Who Is Risk baby

5、?nThe incidence is inversely proportional to gestational age（胎龄胎龄） 37 wk: 5% of infantsnInfants of diabetic mothers（糖尿病母糖尿病母亲之婴儿亲之婴儿） Clinical ManifestationsnThe infant with RDS is mostly prematurenRespiratory distress（呼吸窘迫呼吸窘迫） usually begin 2 to 6 hours after birthndyspnea（呼吸困难呼吸困难）, cyanosis（发发绀绀

6、）, and an expiratory grunt（呼呼气性呻吟）气性呻吟） nThe clinical manifestation is progressive worsening（进行性加重进行性加重） Uncomplicated（无无并发症并发症）cases are characterized by worsening of the disease for 23 d with recovery at 72 hr 胃液泡沫稳定试验胃液泡沫稳定试验n 1 ml of gastric juice（胃液胃液） with an equal volume of 95% ethanol（酒精酒精）

7、shake 15 sec static state 15 secnFetal lung maturity： （）（） RDS： （ - ） Radiologic Features nGround glass（毛玻璃样毛玻璃样） with air bronchograms（支气管充气征支气管充气征) nAs the disease progresses, the lung may become white-out lung (白肺白肺) Treatment一一. Specific therapy1. Surfactant replacement（表面活性物表面活性物质替代）质替代） nThe m

8、ammalian（哺乳动物哺乳动物） surfactant is currently preferredn PS should be given under conditions of adequate mechanical ventilation （机械通气机械通气） 2.Continuous positive airway pressure (CPAP, 持续气道压力持续气道压力) ) CPAP may be administered by nasal prongs（鼻塞鼻塞） , mechanical ventilation(机械通气机械通气） 3.Closure of the pate

9、nt ductus arteriosus（PDA ） PDA should be closed , either with indomethacin（消炎痛消炎痛） therapy or with surgery 二二 . Supportive management 1. Maintain a neutral thermal temperature(中性温度中性温度) 2. Administer adequate fluids and electrolytes （水、电解质水、电解质） Prevent fluid overload 3. Correct acid-base disturbanc

10、es （酸碱失衡）酸碱失衡） CPAP by nasal prongs Prevention 1. Prevent premature labor（早产早产）2. Predict the risk of RDS by testing of amniotic fluid ：lecithin/sphingomyelin ( L/S,卵磷卵磷脂脂/ /鞘磷脂鞘磷脂) ratio 2.0 , indicates fetal lung maturity 3. Accelerate fetal lung maturation(加快加快胎肺成熟）胎肺成熟） Administration of dexamet

11、hasone（地地塞米松塞米松）to women 48hr before delivery 4. Administration of a first dose of PS（肺表面活性物质）肺表面活性物质） into the trachea of infants immediately after birth or during the first 24hr of life Differential diagnosis(鉴别诊断鉴别诊断) 1. Meconium pneumonitis（胎粪性肺炎胎粪性肺炎）Gestational agefullterm infant （足月儿足月儿）Etiol

12、ogyHypoxia（缺氧缺氧）HistoryClinical manifestationsRadiologic featuresMeconium stained amniotic fluid（胎粪性羊胎粪性羊水）水）Signs appear with in minuts of birth, barrel-shaped chest（桶状胸）桶状胸）, Prolonged expiration, and rales（罗音罗音） may be audible. Hyperinflation（肺气肿肺气肿） , irregular, streaky densities with areas of a

13、telectasis（肺不张肺不张）, Pneumothorax（气胸气胸） 2. Infectious pneumoniaGestational ageEtiologyHistoryClinical manifestationsRadiologic features Each Gestational age（各胎龄各胎龄）Bacteria, virus and other microbeInfection,Prolonged rupture of membranes（早破水早破水 ）,URI（上呼吸道上呼吸道感染）感染）May occur at any time with nasal obstruction（鼻塞）（鼻塞）, coughing（咳咳嗽嗽）,Tachypnea（呼吸急促（呼吸急促） The sign is indefinitePneumomediastinum PneumoniaPneumonia （纵隔积气） （肺炎）