新生儿呼吸窘迫综合征（NRDS）英文.ppt

Neonatal Respiratory Distress Syndrome (NRDS) Neonatal Respiratory Distress Syndrome (NRDS)or: Hyaline Membrane Disease (HMD) Most common cause of respiratory failure in the first days Occurring in 1~2% of newborn infants (GA 26~28w, 50%, 30~31w, less than 20~25%) Mortality ~50% at 20 yrs ago, Survive 80~90% now High risk: IDM, GA37w, multi preg., C-section, asphyxia, cold stress, history of prior affected, male or white infants Low risk: chronic or pregnancy-associated hypertension, maternal opiate addiction, PROM, antenatal corticosteroid Lung Development Embryonic Lung Development Fetal Lung Development Fetal Lung Development Postnatal Lung Development Phospholipid 90% (neutral 5%) saturated 50％ unsaturated 35％ Protein 10％ (albumin 5%) SP-A, 30~35kDa, 18 ologomer, hydrophilic D, 43kDa, 12 oligomer SP-B, 8kDa, dimer, hydrophobic C, 4kDa, dimer Decrease alveolar surface tension, reduce respiratory work Maintain alveoli inflation and functional residual capacity Accelerate lung fluid absorption, reduce alveolar effusion Pathogen Opsonization, alveolar macrophage activation Effects: improve oxygenation, ameliorate ventilation/perfusion anti-inflammation Fluid surface tension Pressure (P) = * * Tongji Hospital Embryonic Lung Development Fetal Lung Development (Pseudoglandular, Canalicular, Terminal Saccular) Postnatal Lung Development primitive lung main bronchi lobar bronchi segmental bronchi Pseudoglandular Stage ~ 7th – 16th week Primitive bronchial tree Terminal bronchioles Canalicular Stage ~ 16th – 24th week Terminal Saccular Stage ~ 24th – 36th week Respiratory bronchioles Transitory saccules and ducts Postnatal Development ~ birth – 8 year Alveolar period Secondary alveolar septa Alveolar ducts and alveoli Surfactant