汕头大学医学院儿科学课件 Hyaline Membrane Disease.pptVIP

Hyaline Membrane Disease Li wei-zhong Introduction HMD, frequently referred to as neonatal respiratory distress syndrome (NRDS), occurs primarily in premature infant. There is rapid or labored breathing, beginning at or immediately after birth. Surfactant deficiency is the primary cause of HMD. Epidemiology HMD occurs primarily in Premature infant Infants less than 28 wk of GA: 60-80% Infants between 28 and 32 wk: 60% Infants between 32 and 36wk of GA: 15-30% Infants beyond 37 wk of GA: 5% Epidemiology The incidence of HMD is highest among premature male or white infants. The incidence is higher for cesarean section without labor than vaginal delivery. HMD is more common in gestational diabetes and in insulin-dependent mother. Second-born twin is at greater risk. Etiology Surfactant Deficiency Prematurity predisposes Cesarean section Male female White nonwhite Second- born twin Etiology Maternal diabetes Maternal hemorrhage Maternal stress Intrauterine growth retardation Prolonged rupture of membranes (16 hr) Asphyxia Etiology Hypoxemia Pulmonary Ischemia Hypovolemia and Hypotension Cold Stress High Oxygen concentration Pathophysiology Surfactant deficiency increases surface tension in Alveolus Surfactant decreases surface tension in the alveolus during expiration, allowing the alveolus to remain partly expanded and in that way maintaining a functional residual capacity. Pathophysiology The surface tension in the alveolus results in poor lung compliance and atelectasis. decreased tidal volumes increased physiologic dead space Poor lung distensibility Poor alveolar stability Pathophysiology increased work of breathing perfused but not ventilated alveoli Ventilated but not perfused alveoli Respiratory failure Pathophysiology The combination of hypercarbia, hypoxia and acidosis produces pulmonary arterial vasoconstriction with increased right-to-left shunting through the foramen ovale and ductus arteriosus and within the lung itself. Reduc