pulmonary hemorrhage 儿科学

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1、Pulmonaryhemorrhage:Whatdoweknow?Whatdoweneedtolearn?PulmonaryhemorrhageandPDAPulmonaryhemorrhageandexogenoussurfactant(PS)ManagementofPulmonaryhemorrhage(PH)SurfactantuseforPulmonaryhemorrhagebeyondRDS2PulmonaryhemorrhageandPDACurrently,PHcomplicatesthehospitalcourseof3-5%ofpre

2、terminfantswithRDS.ThecauseofPHisthoughttobeduetoarapidloweringofintrapulmonarypressure,whichfacilitatesL→RshuntingacrossaPDAandanincreaseinpulmonarybloodflow.Hemorrhagicedemafluidratherthanwholeblood3PulmonaryhemorrhageandexogenoussurfactantThesurfactantitselfhasnoeffectonductal

3、contractilityRapiddeclineinpulmonaryvascularresistancefavoringanearlierclinicalpresentationoftheductusinpreterminfantsandinexperimentalanimalmodels4PulmonaryhemorrhageandexogenoussurfactantWhetherPStherapyincreasestheriskofPH?(controversial)Themeta-analysissupportsanincreaseinthe

4、riskofPDAandPHassociatedwithprophylacticsyntheticsurfactantadministrationCochraneDatabaseSystRev.2000;(2):CD001079.NaturalsurfactantextractforpreventionandtreatmentofRDSNodifferencesarereportedintheriskofPDACochraneDatabaseSystRev.2009Apr15;(2):CD007836.5ManagementofPulmonaryhemo

5、rrhagePathogenesisofthisdisorderisnotwellunderstoodTherapyremainsnonspecificandsupportiveNopublishedtrialsareavailableinpreventionortreatmentofPH6ManagementofPulmonaryhemorrhageAllowadequateventilationMechanicalventilationPEEP:6-8cmH2O↓effluxofhemorrhagicfluid→alveolarspace↓L→Rdu

6、ctalshuntingHFVvsCMV(effective?)7ManagementofPulmonaryhemorrhageTreatthemetabolicacidosisMaintainadequatetissueperfusionFluid(blood,NS,oralbumin),pressorsPharmacologicclosureofPDAIbuprofenversusindomethacinAggressivecorrectionofcoagulopathy(FFP,cryoprecipitate)8SurfactantuseforPu

7、lmonaryhemorrhageRetrospectivecasereportsandoneprospectiveuncontrolledstudythatusedsurfactantforPHinneonateshaveshownpromisingresultsintreatingPH.Pulmonaryhaemorrhage,whichsomeconsideracomplicationofPStherapy,hasalsobeeneffectivelymanagedusingsurfactantinstillation.TheHbandRBClip

8、idsmayacttoinhibitnaturalsurfactantandtr