新生儿呼吸窘迫综合征课件

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1、Respiratorydistresssyndrome新生儿呼吸窘迫综合征ContentsBackgroundEpidemiologyEtiologyPresentationTreatmentPreventionBackgroundGA：21weeks,BW:280gApulmonarydisorderthataccompaniesprematurity,specificallyimmaturityofthelungs.Tendstooccurinneonatesyoungerthan32weekGA.Causedbypulmonarysurfactant（肺表面活性物质）de

2、ficiency.canleadtosevererespiratoryfailureanddeathOutcomehasimprovedwithUseofantenatalsteroids（产前使用激素）Appropriateresuscitation（复苏）:immediateuseofCPAPEarlyadministrationofsurfactant1、Epidemiology（流行病学）9GA（week）5%15%~30%60%~80%36-3732~3426-28Infantofdiabeticmother:5-6timeshigherthannon-IDM（糖尿病

3、母亲患儿）2、Etiology（病因）PrematurityofthelungPulmonarysurfactantdeficiencySurfactantformationandphysiology（生理）1218~20周28周35周SurfactantmetabolismFunctionsofPSMicroscopicfindingsHyalinemembranes（肺透明膜）.exudationoffibrinousmatrix（纤维素渗出）derivedfromblood3、PresentationHistoryRDSfrequentlyoccursinthefollo

4、winginfants:PrematureinfantsInfantsborntomotherswithdiabetesInfantsbornbymeansofcesareandelivery（剖宫产）Second-borntwinsInfantswithafamilyhistoryofrespiratorydistresssyndromePhysicalExaminationTachypnea（气促）Expiratorygrunting（呼气相呻吟）Subcostalandintercostalretractions（三凹征）Cyanosis（发绀）Nasalflaring（

5、鼻翼扇动）Extremelyimmatureneonatesmaydevelopapnea（呼吸暂停）and/orhypothermia（低氧血症）.ChestretractionLaboratoryexamination1.MeasurethelevelsofPSfromamnioticfluid（羊水）ortrachealaspirateL/S(lecithin/sphingomyelin)>2maturityoflung2.Bloodgas:PH,Paco2,Pao2,(mixacidosis)ChestradiographyⅠ：bilateral,diffuse,ret

6、iculargranular（双肺弥漫网状颗粒）Ⅱ：airbronchogram（支气管充气征）Ⅲ：ground-glassappearances（毛玻璃样），cardiacbordermaybenotclearⅣ：poorlungexpansion,(“white-lung”)4、DiagnosisHistoryClinicalsignsofrespiratorydistressRadiographicfindingsLaboratoryabnormalities5、TreatmentEstablishadequategasexchange1.OxygentherapyNas

7、alcanula,maskKeepPao2:50-70mmhg,Sao2:90-95%2.CPAPPreventalveolarcollapseatendexpiratoryIndication:Fio2>60%,PaCO2>50mmhg,Pao2<50mmhgorSao2<85%Pressure:5-6cmh2oCPAP3.MechanicalventilationHypercarbia(Paco2>60mmhg)（高碳酸血症）Hypoxemia(Pao2<50mmhg)（低氧血症）Dec