新生儿疾病新生儿呼吸窘迫综合征英文课件篇.ppt

* * Neonatal Respiratory Distress Syndrome NRDS新生儿呼吸窘迫综合征 * Definition 定义 Etiology 病因 Pathogenesis 发病机制 Clinical manifestation 临床表现 Assistant examination 辅助检查 Diagnosis 诊断 Differential diagnosis 鉴别诊断 Therapy 治疗 Prevention 预防 * Definition Hyaline membrane disease， HMD Deficiency of pulmonary surfactant，PS Pulmonary alveoli collapse at the end of expiration Progressively aggravated respiratory distress shortly after birth Mainly in preterm infant Higher incidence rate with smaller gestational age Infant of DM mother, cesarean section, the second baby of twins * Etiology PS are secreted by type II epithelial cells of pulmonary alveoli. Dipalmitoyllecithin（DPPC） is the main substance. Surfactant protein（SP） PS are produced from 18~20w till 35~36w when lung is mature. * Etiology PS cover the inner surface of pulmonary alveoli, which can: decrease alveolar surface tension prevent alveoli collapse at the end of expiration keep functional residual capacity（FRC） keep stable pulmonary alveolus pressure decrease fluid exude from capillary to pulmonary alveoli * Etiology Preterm birth pH of body fluid, body temperature, volume of pulmonary blood flow and hormone can influence PS secretion. Asphyxia, hypothermia, placenta previa, placental abruption and hypotension of mother, which can influence blood flow of fetus. High level insulin of IDM may resist the promotion effect of adrenal cortex hormone to PS synthesis * Pathogenesis PS deficiency alveolar surface tension↑ alveolus collapse and pulmonary compliance↓ work at inspiration↑difficulty at alveolus opening tidal volume↓ alveolar ventilation↓ CO2 retention respiratory acidosis V/A↓ hypoxia metabolic acidosis Alveolar permeability↑ interstitium edema fibrin deposition in the inner surface of alveoli eosinphilic hyaline membrane gas diffusion disorder } * Clinical manifestation Respiratory distress 2~6h after birth: dyspnea, cyanosis, flaring of alaenasi, inspiratory three-concave sign, expiratory groan Progressively ag