新生儿肺动脉高压管理

1、精选ppt精选ppt精选ppt女Walsh-Sukys, et. Al: J Pediatr 105:14,2000精选ppt高阻力肺循环低阻力胎盘循环胎盘为主要氧气交换器官胎儿动脉砖形平滑肌细胞， 管腔狭窄过渡期细胞变长，变薄成为纺锤形细胞血管内皮细胞变平，血管腔扩大精选ppt脐带结扎脐带结扎肺循环阻力下降体循环阻力升高呼吸呼吸:肺扩张PaO2升高pH 升高通过卵圆孔动脉导管左右分流 NO 鸟甘酸 环化酶 腺甘酸 环化酶 前列环素环氧化酶 cAMPcGMP精选ppt正常肺血管扩张不发生肺血流阻力高于体循环阻力非氧合血分流入体循环精选ppt分类n生后过度障碍n血管肌肉过度增生n血管发育不良病因

2、n败血症肺炎n围生期吸综合症 (胎粪，血，羊水)n慢性宫内缺氧n宫内动脉导管早闭n肺发育不良或畸形:n先天性膈疝n肺发育不良n肺泡毛细血管发育不良精选pptHernandez-Diaz S, et al. Pediatrics 2007:1195-201精选pptLakshminrusimha et al. J Appl Physiol. 2011; 111 :1441精选ppt一氧化氮途径前列环素途径内皮素途径 ET1+精选ppt精选ppt精选ppt精选pptVain et al. Lancet. 2004; 364:597精选pptHalliday & Sweet. Cochran

3、e 2001 1; CD000500. 精选ppt精选ppt精选ppt精选ppt精选ppt精选ppt精选pptOI=MAP*FiO2/PaO2精选ppt精选pptWalsh MC, et al. Clin Perinatol 28(3): 609-627精选ppt精选ppt精选pptResponse of the pulmonary vasculature to hypoxia and H+ ion concentration changes. Rudolph & Yuan J Clin Invest. 1966; 45:399精选pptWalsh-Sukys M C et al. P

4、ediatrics 2000;105:14-20精选pptWalsh-Sukys M C et al. Pediatrics 2000;105:14-20精选ppt精选ppt 精选ppt精选ppt ET1sildenafilmilrinonebostentanProstacyclins+精选ppt精选ppt精选pptDont forget- the bag needs NO too!精选pptShah PS, Ohlsson A. Cochrane Database Syst Rev. 2011; (8): CD005494精选ppt ECMO- Use of ECMO decreased m

5、ortality from 60% to 30% in a UK study精选pptVariableOdds of neonatal death Odds ratio 95% confidence interval P valueGestational age 37 wk 1.7 1.22.5 0.01pH7.20 1.51.12.1 0.02SaO2 65% 1.51.12.1 0.01ECMO initiatedDOL 5 1.81.22.6 0.01Duration of ECMO 7 d 3.42.54.7 0.01The use of ECMO for persistent pulmonary hypertension of the newborn: A decade of experience. Lazar et al. J Surg Res 2012 (177):263-267精选ppt精选pptUK collaborative randomised trial of neonatal extracorporeal membrane oxygenation: follow-up to age 4 years. Bennett CC et al.