hyaline membrane disease英文课件

《hyaline membrane disease英文课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、HyalineMembraneDiseaseIntroductionHMD,frequentlyreferredtoasneonatalrespiratorydistresssyndrome(NRDS),occursprimarilyinprematureinfant.Thereisrapidorlaboredbreathing,beginningatorimmediatelyafterbirth.SurfactantdeficiencyistheprimarycauseofHMD.EpidemiologyHMDoccursprimar

2、ilyinPrematureinfantInfantslessthan28wkofGA:60-80%Infantsbetween28and32wk:60%Infantsbetween32and36wkofGA:15-30%Infantsbeyond37wkofGA:5%EpidemiologyTheincidenceofHMDishighestamongprematuremaleorwhiteinfants.Theincidenceishigherforcesareansectionwithoutlaborthanvaginaldeli

3、very.HMDismorecommoningestationaldiabetesandininsulin-dependentmother.Second-borntwinisatgreaterrisk.EtiologySurfactantDeficiencyPrematuritypredisposesCesareansectionMale>femaleWhite>nonwhiteSecond-borntwinEtiologyMaternaldiabetesMaternalhemorrhageMaternalstressIntrauter

4、inegrowthretardationProlongedruptureofmembranes(>16hr)AsphyxiaEtiologyHypoxemiaPulmonaryIschemiaHypovolemiaandHypotensionColdStressHighOxygenconcentrationPathophysiologySurfactantdeficiencyincreasessurfacetensioninAlveolusSurfactantdecreasessurfacetensioninthealveolusdur

5、ingexpiration,allowingthealveolustoremainpartlyexpandedandinthatwaymaintainingafunctionalresidualcapacity.PathophysiologyThesurfacetensioninthealveolusresultsinpoorlungcomplianceandatelectasis.decreasedtidalvolumesincreasedphysiologicdeadspacePoorlungdistensibilityPooral

6、veolarstabilityPathophysiologyincreasedworkofbreathingperfusedbutnotventilatedalveoliVentilatedbutnotperfusedalveoliRespiratoryfailurePathophysiologyThecombinationofhypercarbia,hypoxiaandacidosisproducespulmonaryarterialvasoconstrictionwithincreasedright-to-leftshuntingt

7、hroughtheforamenovaleandductusarteriosusandwithinthelungitself.ReducedeffectivepulmonarybloodflowPathologyLungextensiveatelectasisInjurytoepithelialcallsLungcongestionandedemaLunghemorrhageHyalinemembranescontainsfibrinandcellularproductsClinicalFindingsOnsetnearthetimeo

8、fbirthorwithin4-6hrafterbirthRapid,shallowrespirations≥60/minIntercostalandsubcostalretractionsandprogr