新生兒呼吸窘迫綜合征RespiratoryDis課件

新生兒呼吸窘迫綜合征

RespiratoryDistressSyndrome(RDS)

中南大學(xué)兒科學(xué)教研室陳平洋第七章第九節(jié)新生兒呼吸窘迫綜合征RespiratoryDistres1

Purpose

Tobefamiliarwithetiology（病因）andmechanism（發(fā)病機(jī)制）Tomasterclinicalmanifestation（臨床表現(xiàn)）anddifferentialdiagnosis（鑒別診斷）Tomasterpreventionandtreatment

RDSPurposeTobefamiliarwith2

SummaryNRDS（新生兒呼吸窘迫綜合征）

isprimarilydevelopmentaldeficiencyintheamountof

pulmonarysurfactant(PS,肺表面活性物質(zhì)),attheair-liquidinterfaceofthelungRDS

frequentlyreferredtoashyalinemembranedisease(HMD,肺透明膜病)SummaryNRDS（新生兒呼吸3

Summary

RDSisadiseaseprimarilyofthe

prematureinfant

（未成熟兒）Pulmonaryhyalinemembranes（肺透明膜）andatelectasis（肺不張）arefindingsatautopsy（尸體解剖）RDSSummary

RDSisadisea4

EtiologyandMechanismPS

productionand/orreleasebytypeIIalveolarcells（II型肺泡細(xì)胞）PSappearsintheamnioticfluid（羊水）between28～32weeksMaturelevelsofPSareusuallypresentafter

35weeks

EtiologyandMechanismPS5

PS↓

→

surfacetension（表面張力）↑→atelectasis（肺不張）→hypoxia（低氧血癥）andacidosis（酸中毒）→pavasoconstriction（肺動(dòng)脈收縮）→right–to-leftshunting（右向左分流）→ischemicinjury（缺血性損傷）tothevascularbed→effusionofproteinaceousmaterial（蛋白樣物質(zhì)）→pulmonaryhyalinemembrane（肺透明膜）→hypoxiaandacidosis

↑↑PS↓→surfacetension（6新生兒呼吸窘迫綜合征RespiratoryDis課件7新生兒呼吸窘迫綜合征RespiratoryDis課件8

WhoIsRiskbaby?

Theincidenceisinverselyproportionaltogestationalage（胎齡）

<28wk:60%～80%ofinfants32～34wk:15%～30%ofinfants>37wk:5%ofinfantsInfantsofdiabeticmothers（糖尿病母親之嬰兒）

WhoIsRiskbaby?

The9

ClinicalManifestationsTheinfantwithRDSismostlyprematureRespiratorydistress（呼吸窘迫）usuallybegin2to6hoursafterbirthdyspnea（呼吸困難）,cyanosis（發(fā)紺）,andanexpiratorygrunt（呼氣性呻吟）ClinicalManifestation10

Theclinicalmanifestationisprogressiveworsening（進(jìn)行性加重）Uncomplicated（無并發(fā)癥）casesarecharacterizedbyworseningofthediseasefor2～3dwithrecoveryat72hrRDSTheclinicalmanifestationi11胃液泡沫穩(wěn)定試驗(yàn)

1mlofgastricjuice（胃液）withanequalvolumeof95%ethanol（酒精）→shake15sec→staticstate15secFetallungmaturity：（＋）

RDS：（-）胃液泡沫穩(wěn)定試驗(yàn)12

RadiologicFeatures

Groundglass（毛玻璃樣）withairbronchograms（支氣管充氣征)Asthediseaseprogresses,thelungmaybecomewhite-outlung(白肺)RadiologicFeatures13新生兒呼吸窘迫綜合征RespiratoryDis課件14

Treatment一.Specifictherapy1.Surfactantreplacement（表面活性物質(zhì)替代）Themammalian（哺乳動(dòng)物）surfactantiscurrentlypreferredPSshouldbegivenunderconditionsofadequatemechanicalventilation（機(jī)械通氣）Treatment一.Specifi15

2.Continuouspositiveairwaypressure(CPAP,持續(xù)氣道壓力)

CPAPmaybeadministeredbynasalprongs（鼻塞）,mechanicalventilation(機(jī)械通氣）3.Closureofthepatentductusarteriosus（PDA）

PDAshouldbeclosed,eitherwithindomethacin（消炎痛）therapyorwithsurgery

2.Continuouspositiveairwa16

二.

Supportivemanagement

1.Maintainaneutralthermaltemperature(中性溫度)2.Administeradequatefluidsandelectrolytes（水、電解質(zhì)）Preventfluidoverload3.

Correctacid-basedisturbances（酸堿失衡）

17

CPAPbynasalprongs

CPAPbynasalprongs18

Prevention

1.Preventprematurelabor（早產(chǎn)）2.PredicttheriskofRDSbytestingofamnioticfluid：lecithin/sphingomyelin(L/S,卵磷脂/鞘磷脂)ratio〉2.0,indicatesfetallungmaturity

Prevention

1.Pre19

3.

Acceleratefetallungmaturation(加快胎肺成熟）Administrationofdexamethasone（地塞米松）towomen48hrbeforedelivery

4.AdministrationofafirstdoseofPS（肺表面活性物質(zhì)）intothetracheaofinfantsimmediatelyafterbirthorduringthefirst24hroflife

20Differentialdiagnosis(鑒別診斷)

1.Meconiumpneumonitis（胎糞性肺炎）

Gestationalagefullterminfant（足月兒）EtiologyHypoxia（缺氧）HistoryClinicalmanifestationsRadiologicfeaturesMeconium–stainedamnioticfluid（胎糞性羊水）Signsappearwithinminutsofbirth,barrel-shapedchest（桶狀胸）,Prolongedexpiration,andrales（羅音）maybeaudible.Hyperinflation（肺氣腫）,irregular,streakydensities

withareasofatelectasis（肺不張）,Pneumothorax（氣胸）

Differentialdia21

2.InfectiouspneumoniaGestationalageEtiologyHistoryClinicalmanifestationsRadiologicfeatures

EachGestationalage（各胎齡）Bacteria,virusandothermicrobeInfection,Prolongedruptureofmembranes（早破水）,URI（上呼吸道感染）Mayoccuratanytimewithnasalobstruction（鼻塞）,coughing（咳嗽）,Tachypnea（呼吸急促）Thesignisindefinite2.Infectious22Pneumomediastinum

Pneumonia

（縱隔積氣）（肺炎）PneumomediastinumPneumonia23新生兒呼吸窘迫綜合征

RespiratoryDistressSyndrome(RDS)

中南大學(xué)兒科學(xué)教研室陳平洋第七章第九節(jié)新生兒呼吸窘迫綜合征RespiratoryDistres24

Purpose

Tobefamiliarwithetiology（病因）andmechanism（發(fā)病機(jī)制）Tomasterclinicalmanifestation（臨床表現(xiàn)）anddifferentialdiagnosis（鑒別診斷）Tomasterpreventionandtreatment

RDSPurposeTobefamiliarwith25

SummaryNRDS（新生兒呼吸窘迫綜合征）

isprimarilydevelopmentaldeficiencyintheamountof

pulmonarysurfactant(PS,肺表面活性物質(zhì)),attheair-liquidinterfaceofthelungRDS

frequentlyreferredtoashyalinemembranedisease(HMD,肺透明膜病)SummaryNRDS（新生兒呼吸26

Summary

RDSisadiseaseprimarilyofthe

prematureinfant

（未成熟兒）Pulmonaryhyalinemembranes（肺透明膜）andatelectasis（肺不張）arefindingsatautopsy（尸體解剖）RDSSummary

RDSisadisea27

EtiologyandMechanismPS

productionand/orreleasebytypeIIalveolarcells（II型肺泡細(xì)胞）PSappearsintheamnioticfluid（羊水）between28～32weeksMaturelevelsofPSareusuallypresentafter

35weeks

EtiologyandMechanismPS28

PS↓

→

surfacetension（表面張力）↑→atelectasis（肺不張）→hypoxia（低氧血癥）andacidosis（酸中毒）→pavasoconstriction（肺動(dòng)脈收縮）→right–to-leftshunting（右向左分流）→ischemicinjury（缺血性損傷）tothevascularbed→effusionofproteinaceousmaterial（蛋白樣物質(zhì)）→pulmonaryhyalinemembrane（肺透明膜）→hypoxiaandacidosis

↑↑PS↓→surfacetension（29新生兒呼吸窘迫綜合征RespiratoryDis課件30新生兒呼吸窘迫綜合征RespiratoryDis課件31

WhoIsRiskbaby?

Theincidenceisinverselyproportionaltogestationalage（胎齡）

<28wk:60%～80%ofinfants32～34wk:15%～30%ofinfants>37wk:5%ofinfantsInfantsofdiabeticmothers（糖尿病母親之嬰兒）

WhoIsRiskbaby?

The32

ClinicalManifestationsTheinfantwithRDSismostlyprematureRespiratorydistress（呼吸窘迫）usuallybegin2to6hoursafterbirthdyspnea（呼吸困難）,cyanosis（發(fā)紺）,andanexpiratorygrunt（呼氣性呻吟）ClinicalManifestation33

Theclinicalmanifestationisprogressiveworsening（進(jìn)行性加重）Uncomplicated（無并發(fā)癥）casesarecharacterizedbyworseningofthediseasefor2～3dwithrecoveryat72hrRDSTheclinicalmanifestationi34胃液泡沫穩(wěn)定試驗(yàn)

1mlofgastricjuice（胃液）withanequalvolumeof95%ethanol（酒精）→shake15sec→staticstate15secFetallungmaturity：（＋）

RDS：（-）胃液泡沫穩(wěn)定試驗(yàn)35

RadiologicFeatures

Groundglass（毛玻璃樣）withairbronchograms（支氣管充氣征)Asthediseaseprogresses,thelungmaybecomewhite-outlung(白肺)RadiologicFeatures36新生兒呼吸窘迫綜合征RespiratoryDis課件37

Treatment一.Specifictherapy1.Surfactantreplacement（表面活性物質(zhì)替代）Themammalian（哺乳動(dòng)物）surfactantiscurrentlypreferredPSshouldbegivenunderconditionsofadequatemechanicalventilation（機(jī)械通氣）Treatment一.Specifi38

2.Continuouspositiveairwaypressure(CPAP,持續(xù)氣道壓力)

CPAPmaybeadministeredbynasalprongs（鼻塞）,mechanicalventilation(機(jī)械通氣）3.Closureofthepatentductusarteriosus（PDA）

PDAshouldbeclosed,eitherwithindomethacin（消炎痛）therapyorwithsurgery

2.Continuouspositiveairwa39

二.

Supportivemanagement

1.Maintainaneutralthermaltemperature(中性溫度)2.Administeradequatefluidsandelectrolytes（水、電解質(zhì)）Preventfluidoverload3.

Correctacid-basedisturbances（酸堿失衡）

40

CPAPbynasalprongs

CPAPbynasalprongs41

Prevention

1.Preventprematurelabor（早產(chǎn)）2.PredicttheriskofRDSbytestingofamnioticfluid：lecithin/sphingomyelin(L/S,卵磷脂/鞘磷脂)ratio〉2.0,indicatesfetallungmaturity

Prevention

1.Pre42

3.

Acceleratefetallungmaturation(加快胎肺成熟）Administrationofdexamethasone（地塞米松）towomen48hrbeforedelivery

4.AdministrationofafirstdoseofPS（肺表面活性物質(zhì)）intothetracheaofinfantsimmediatelyafterbirthorduringthefirst24hroflife

43Differentialdiagnosis(鑒別診斷)

1.