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【PPT】湘雅兒科精品課件-Respiratory Dist - 醫學資源下載
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【ppt】湘雅兒科精品課件-Respiratory Dist 新生兒呼吸窘迫綜合征 Respiratory Distress Syndrome ( RDS ) 中南大學兒科學教研室 陳平洋 Purpose To be familiar with etiology（病因） and mechanism（發病機制） To master clinical manifestation（臨床表現） and differential diagnosis（鑒別診斷） To master prevention and treatment Summary NRDS（新生兒呼吸窘迫綜合征） is primarily developmental deficiency in the amount of pulmonary surfactant ( PS,肺表面活性物質) , at the air-liquid interface of the lung RDS frequently referred to as hyaline membrane disease (HMD, 肺透明膜病) Summary RDS is a disease primarily of the premature infant （未成熟兒） Pulmonary hyaline membranes（肺透明膜） and atelectasis（肺不張） are findings at autopsy（尸體解剖） Etiology and Mechanism PS production and /or release by type II alveolar cells（ II型肺泡細胞） PS appears in the amniotic fluid（羊水）between 28 ～ 32 weeks Mature levels of PS are usually present after 35 weeks PS ↓ → surface tension（表面張力）↑ → atelectasis（肺不張） → hypoxia（低氧血癥） and acidosis（酸中毒） → pa vasoconstriction （肺動脈收縮）→ right–to-left shunting（右向左分流） → ischemic injury（缺血性損傷） to the vascular bed → effusion of proteinaceous material （ 蛋白樣物質）→ pulmonary hyaline membrane（肺透明膜） → hypoxia and acidosis ↑↑ Who Is Risk baby? The incidence is inversely proportional to gestational age（胎齡） 37 wk: 5% of infants Infants of diabetic mothers（糖尿病母親之嬰兒） Clinical Manifestations The infant with RDS is mostly premature Respiratory distress（呼吸窘迫） usually begin 2 to 6 hours after birth dyspnea（呼吸困難）, cyanosis（發紺）, and an expiratory grunt（呼氣性呻吟） The clinical manifestation is progressive worsening（進行性加重） Uncomplicated（無并發癥）cases are characterized by worsening of the disease for 2～3 d with recovery at 72 hr 胃液泡沫穩定試驗 1 ml of gastric juice（胃液） with an equal volume of 95% ethanol（酒精） → shake 15 sec → static state 15 sec Fetal lung maturity： （＋） RDS： （ - ） Radiologic Features  Ground glass（毛玻璃樣） with air bronchograms（支氣管充氣征) As the disease progresses, the lung may become white-out lung (白肺) Treatment 一. Specific therapy 1. Surfactant replacement（表面活性物質替代） The mammalian（哺乳動物） surfactant is currently preferred PS should be given under conditions of adequate mechanical ventilation （機械通氣） 2.Continuous positive airway pressure (CPAP, 持續氣道壓力) CPAP may be administered by nasal prongs（鼻塞） , mechanical ventilation(機械通氣） 3.Closure of the patent ductus arteriosus（PDA ） PDA should be closed , either with indomethacin（消炎痛） therapy or with surgery ? 二 . Supportive management 1. Maintain a neutral thermal temperature(中性溫度) 2. Administer adequate fluids and electrolytes （水、電解質） Prevent fluid overload 3.? Correct acid-base disturbances （酸堿失衡） 　 CPAP by nasal prongs　　  Prevention  1. Prevent premature labor（早產） 2. Predict the risk of RDS by testing of amniotic fluid ：lecithin/sphingomyelin ( L/S,卵磷脂/鞘磷脂) ratio 〉 2.0 , indicates fetal lung maturity 3. Accelerate fetal lung maturation(加快胎肺成熟） Administration of dexamethasone（地塞米松）to women 48hr before delivery 4. Administration of a first dose of PS（肺表面活性物質） into the trachea of infants immediately after birth or during the first 24hr of life Differential diagnosis(鑒別診斷)  1. Meconium pneumonitis（胎糞性肺炎） Pneumomediastinum Pneumonia （縱隔積氣） （肺炎）

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