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ID:5867877
大小:4.87 MB
页数:38页
时间:2017-12-14
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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
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