新生儿呼吸窘迫综合征RespiratoryDis课件

新生儿呼吸窘迫综合征

RespiratoryDistressSyndrome(RDS)

中南大学儿科学教研室陈平洋第七章第九节新生儿呼吸窘迫综合征RespiratoryDistres1

Purpose

Tobefamiliarwithetiology（病因）andmechanism（发病机制）Tomasterclinicalmanifestation（临床表现）anddifferentialdiagnosis（鉴别诊断）Tomasterpreventionandtreatment

RDSPurposeTobefamiliarwith2

SummaryNRDS（新生儿呼吸窘迫综合征）

isprimarilydevelopmentaldeficiencyintheamountof

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

frequentlyreferredtoashyalinemembranedisease(HMD,肺透明膜病)SummaryNRDS（新生儿呼吸3

Summary

RDSisadiseaseprimarilyofthe

prematureinfant

（未成熟儿）Pulmonaryhyalinemembranes（肺透明膜）andatelectasis（肺不张）arefindingsatautopsy（尸体解剖）RDSSummary

RDSisadisea4

EtiologyandMechanismPS

productionand/orreleasebytypeIIalveolarcells（II型肺泡细胞）PSappearsintheamnioticfluid（羊水）between28～32weeksMaturelevelsofPSareusuallypresentafter

35weeks

EtiologyandMechanismPS5

PS↓

→

surfacetension（表面张力）↑→atelectasis（肺不张）→hypoxia（低氧血症）andacidosis（酸中毒）→pavasoconstriction（肺动脉收缩）→right–to-leftshunting（右向左分流）→ischemicinjury（缺血性损伤）tothevascularbed→effusionofproteinaceousmaterial（蛋白样物质）→pulmonaryhyalinemembrane（肺透明膜）→hypoxiaandacidosis

↑↑PS↓→surfacetension（6新生儿呼吸窘迫综合征RespiratoryDis课件7新生儿呼吸窘迫综合征RespiratoryDis课件8

WhoIsRiskbaby?

Theincidenceisinverselyproportionaltogestationalage（胎龄）

<28wk:60%～80%ofinfants32～34wk:15%～30%ofinfants>37wk:5%ofinfantsInfantsofdiabeticmothers（糖尿病母亲之婴儿）

WhoIsRiskbaby?

The9

ClinicalManifestationsTheinfantwithRDSismostlyprematureRespiratorydistress（呼吸窘迫）usuallybegin2to6hoursafterbirthdyspnea（呼吸困难）,cyanosis（发绀）,andanexpiratorygrunt（呼气性呻吟）ClinicalManifestation10

Theclinicalmanifestationisprogressiveworsening（进行性加重）Uncomplicated（无并发症）casesarecharacterizedbyworseningofthediseasefor2～3dwithrecoveryat72hrRDSTheclinicalmanifestationi11胃液泡沫稳定试验

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

RDS：（-）胃液泡沫稳定试验12

RadiologicFeatures

Groundglass（毛玻璃样）withairbronchograms（支气管充气征)Asthediseaseprogresses,thelungmaybecomewhite-outlung(白肺)RadiologicFeatures13新生儿呼吸窘迫综合征RespiratoryDis课件14

Treatment一.Specifictherapy1.Surfactantreplacement（表面活性物质替代）Themammalian（哺乳动物）surfactantiscurrentlypreferredPSshouldbegivenunderconditionsofadequatemechanicalventilation（机械通气）Treatment一.Specifi15

2.Continuouspositiveairwaypressure(CPAP,持续气道压力)

CPAPmaybeadministeredbynasalprongs（鼻塞）,mechanicalventilation(机械通气）3.Closureofthepatentductusarteriosus（PDA）

PDAshouldbeclosed,eitherwithindomethacin（消炎痛）therapyorwithsurgery

2.Continuouspositiveairwa16

二.

Supportivemanagement

1.Maintainaneutralthermaltemperature(中性温度)2.Administeradequatefluidsandelectrolytes（水、电解质）Preventfluidoverload3.

Correctacid-basedisturbances（酸碱失衡）

17

CPAPbynasalprongs

CPAPbynasalprongs18

Prevention

1.Preventprematurelabor（早产）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（肺表面活性物质）intothetracheaofinfantsimmediatelyafterbirthorduringthefirst24hroflife

20Differentialdiagnosis(鉴别诊断)

1.Meconiumpneumonitis（胎粪性肺炎）

Gestationalagefullterminfant（足月儿）EtiologyHypoxia（缺氧）HistoryClinicalmanifestationsRadiologicfeaturesMeconium–stainedamnioticfluid（胎粪性羊水）Signsappearwithinminutsofbirth,barrel-shapedchest（桶状胸）,Prolongedexpiration,andrales（罗音）maybeaudible.Hyperinflation（肺气肿）,irregular,streakydensities

withareasofatelectasis（肺不张）,Pneumothorax（气胸）

Differentialdia21

2.InfectiouspneumoniaGestationalageEtiologyHistoryClinicalmanifestationsRadiologicfeatures

EachGestationalage（各胎龄）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

（纵隔积气）（肺炎）PneumomediastinumPneumonia23新生儿呼吸窘迫综合征

RespiratoryDistressSyndrome(RDS)

中南大学儿科学教研室陈平洋第七章第九节新生儿呼吸窘迫综合征RespiratoryDistres24

Purpose

Tobefamiliarwithetiology（病因）andmechanism（发病机制）Tomasterclinicalmanifestation（临床表现）anddifferentialdiagnosis（鉴别诊断）Tomasterpreventionandtreatment

RDSPurposeTobefamiliarwith25

SummaryNRDS（新生儿呼吸窘迫综合征）

isprimarilydevelopmentaldeficiencyintheamountof

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

frequentlyreferredtoashyalinemembranedisease(HMD,肺透明膜病)SummaryNRDS（新生儿呼吸26

Summary

RDSisadiseaseprimarilyofthe

prematureinfant

（未成熟儿）Pulmonaryhyalinemembranes（肺透明膜）andatelectasis（肺不张）arefindingsatautopsy（尸体解剖）RDSSummary

RDSisadisea27

EtiologyandMechanismPS

productionand/orreleasebytypeIIalveolarcells（II型肺泡细胞）PSappearsintheamnioticfluid（羊水）between28～32weeksMaturelevelsofPSareusuallypresentafter

35weeks

EtiologyandMechanismPS28

PS↓

→

surfacetension（表面张力）↑→atelectasis（肺不张）→hypoxia（低氧血症）andacidosis（酸中毒）→pavasoconstriction（肺动脉收缩）→right–to-leftshunting（右向左分流）→ischemicinjury（缺血性损伤）tothevascularbed→effusionofproteinaceousmaterial（蛋白样物质）→pulmonaryhyalinemembrane（肺透明膜）→hypoxiaandacidosis

↑↑PS↓→surfacetension（29新生儿呼吸窘迫综合征RespiratoryDis课件30新生儿呼吸窘迫综合征RespiratoryDis课件31

WhoIsRiskbaby?

Theincidenceisinverselyproportionaltogestationalage（胎龄）

<28wk:60%～80%ofinfants32～34wk:15%～30%ofinfants>37wk:5%ofinfantsInfantsofdiabeticmothers（糖尿病母亲之婴儿）

WhoIsRiskbaby?

The32

ClinicalManifestationsTheinfantwithRDSismostlyprematureRespiratorydistress（呼吸窘迫）usuallybegin2to6hoursafterbirthdyspnea（呼吸困难）,cyanosis（发绀）,andanexpiratorygrunt（呼气性呻吟）ClinicalManifestation33

Theclinicalmanifestationisprogressiveworsening（进行性加重）Uncomplicated（无并发症）casesarecharacterizedbyworseningofthediseasefor2～3dwithrecoveryat72hrRDSTheclinicalmanifestationi34胃液泡沫稳定试验

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

RDS：（-）胃液泡沫稳定试验35

RadiologicFeatures

Groundglass（毛玻璃样）withairbronchograms（支气管充气征)Asthediseaseprogresses,thelungmaybecomewhite-outlung(白肺)RadiologicFeatures36新生儿呼吸窘迫综合征RespiratoryDis课件37

Treatment一.Specifictherapy1.Surfactantreplacement（表面活性物质替代）Themammalian（哺乳动物）surfactantiscurrentlypreferredPSshouldbegivenunderconditionsofadequatemechanicalventilation（机械通气）Treatment一.Specifi38

2.Continuouspositiveairwaypressure(CPAP,持续气道压力)

CPAPmaybeadministeredbynasalprongs（鼻塞）,mechanicalventilation(机械通气）3.Closureofthepatentductusarteriosus（PDA）

PDAshouldbeclosed,eitherwithindomethacin（消炎痛）therapyorwithsurgery

2.Continuouspositiveairwa39

二.

Supportivemanagement

1.Maintainaneutralthermaltemperature(中性温度)2.Administeradequatefluidsandelectrolytes（水、电解质）Preventfluidoverload3.

Correctacid-basedisturbances（酸碱失衡）

40

CPAPbynasalprongs

CPAPbynasalprongs41

Prevention

1.Preventprematurelabor（早产）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（肺表面活性物质）intothetracheaofinfantsimmediatelyafterbirthorduringthefirst24hroflife

43Differentialdiagnosis(鉴别诊断)

1.