湘雅儿科精品课件-Respiratory-Distress-Syndrome知识分享.ppt
湘雅儿科精品课件-Respiratory-Distress-SyndromeSummarynNRDS（新新生生儿儿呼呼吸吸窘窘迫迫综综合合征征）isprimarilydevelopmentaldeficiencyintheamountofpulmonarysurfactant(PS,肺肺表表面面活活性性物物质质),attheair-liquidinterfaceofthelungnRDSfrequentlyreferredtoashyalinemembranedisease(HMD,肺肺透透明明膜膜病病)SummarynRDSisadiseaseprimarilyoftheprematureinfant（未成熟儿未成熟儿）nPulmonaryhyalinemembranes（肺透肺透明膜明膜）andatelectasis（肺肺不张不张）arefindingsatautopsy（尸体解剖尸体解剖）EtiologyandMechanismnPSproductionand/orreleasebytypeIIalveolarcells（IIII型肺泡细胞型肺泡细胞）nPSappearsintheamnioticfluid（羊水羊水）between2832weeksnMaturelevelsofPSareusuallypresentafter35weeksPSsurfacetension（表面张力表面张力）atelectasis（肺不张肺不张）hypoxia（低氧血低氧血症症）andacidosis（酸中毒酸中毒）pavasoconstriction（肺动脉收缩肺动脉收缩）rightto-leftshunting（右向左分流）右向左分流）ischemicinjury（缺血性损伤缺血性损伤）tothevascularbedeffusionofproteinaceousmaterial（蛋白样物质蛋白样物质）pulmonaryhyalinemembrane（肺透明膜肺透明膜）hypoxiaandacidosisWhoIsRiskbaby?nThe incidence is inversely proportionaltogestationalage（胎龄胎龄）37wk:5%ofinfantsnInfantsofdiabeticmothers（糖糖尿尿病病母母亲亲之婴儿之婴儿）ClinicalManifestationsnThe infant with RDS is mostlyprematurenRespiratory distress（呼呼吸吸窘窘迫迫）usuallybegin2to6hoursafterbirthndyspnea（呼呼吸吸困困难难）,cyanosis（发发绀绀）,andanexpiratorygrunt（呼呼气性呻吟）气性呻吟）nTheclinicalmanifestationisprogressiveworsening（进进行行性性加加重重）Uncomplicated（无无并并发发症症）casesarecharacterized by worsening of thediseasefor23dwithrecoveryat72hr胃液泡沫稳定试验胃液泡沫稳定试验n1mlofgastricjuice（胃胃液液）withanequalvolumeof95%ethanol（酒酒精精）shake15secstaticstate15secnFetallungmaturity：（）（）RDS：（-）RadiologicFeaturesnGroundglass（毛毛玻玻璃璃样样）withairbronchograms（支气管充气征支气管充气征)nAsthediseaseprogresses,thelungmaybecomewhite-outlung(白肺白肺)Treatment一一.Specifictherapy1.Surfactantreplacement（表面活性物表面活性物质替代）质替代）nThemammalian（哺乳动物哺乳动物）surfactantiscurrentlypreferrednPSshouldbegivenunderconditionsofadequatemechanicalventilation（机械通气机械通气）2.Continuouspositiveairwaypressure(CPAP,持续气道压力持续气道压力)CPAPmaybeadministeredbynasalprongs（鼻鼻塞塞）,mechanicalventilation(机械通气机械通气）3.Closureofthepatentductusarteriosus（PDA）PDAshouldbeclosed,eitherwithindomethacin（消消炎炎痛痛）therapyorwithsurgery 二二.Supportivemanagement1.Maintainaneutralthermaltemperature(中性温度中性温度)2.Administer adequate fluids andelectrolytes（水、电解质水、电解质）Preventfluidoverload3.Correctacid-basedisturbances（酸碱失衡）酸碱失衡）CPAPbynasalprongsPrevention1.Preventprematurelabor（早产早产）2.PredicttheriskofRDSbytestingofamnioticfluid：lecithin/sphingomyelin(L/S,卵卵磷磷脂脂/鞘鞘磷磷脂脂)ratio2.0,indicatesfetallungmaturity 3.Acceleratefetallungmaturation(加加快快胎肺成熟）胎肺成熟）Administrationofdexamethasone（地地塞塞 米米 松松）to women 48hr beforedelivery4.AdministrationofafirstdoseofPS（肺肺表表面面活活性性物物质质）intothetracheaofinfantsimmediatelyafterbirthorduringthefirst24hroflifeDifferentialdiagnosis(鉴别诊断鉴别诊断)1.Meconiumpneumonitis（胎粪性肺炎胎粪性肺炎）Gestationalagefullterminfant（足月儿足月儿）EtiologyHypoxia（缺氧缺氧）HistoryClinicalmanifestationsRadiologicfeaturesMeconiumstainedamnioticfluid（胎粪性胎粪性羊水）羊水）Signsappearwithinminutsofbirth,barrel-shapedchest（桶状胸）桶状胸）,Prolongedexpiration,andrales（罗音罗音）maybeaudible.Hyperinflation（肺气肿肺气肿）,irregular,streakydensitieswithareasofatelectasis（肺不张肺不张）,Pneumothorax（气胸气胸）2.InfectiouspneumoniaGestationalageEtiologyHistoryClinicalmanifestationsRadiologicfeaturesEachGestationalage（各胎龄各胎龄）Bacteria,virusandothermicrobeInfection,Prolongedruptureofmembranes（早破水早破水）,URI（上呼吸道上呼吸道感染）感染）Mayoccuratanytimewithnasalobstruction（鼻塞）（鼻塞）,coughing（咳嗽咳嗽）,Tachypnea（呼吸急促（呼吸急促）ThesignisindefinitePneumomediastinum PneumoniaPneumonia （纵隔积气）（肺炎）此课件下载可自行编辑修改，仅供参考！此课件下载可自行编辑修改，仅供参考！感谢您的支持，我们努力做得更好！谢谢感谢您的支持，我们努力做得更好！谢谢
