（精选课件）新生儿湿肺.pptVIP

* 新 生 儿 湿 肺TTN 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* * 概 述 新生儿湿肺（TTN）： 又称新生儿暂时性呼吸困难或Ⅱ型呼吸窘迫综合征。是由于经肺内淋巴管排除肺内液体延迟使之积聚引起。 湿肺多见于足月儿，亦可见于早产儿 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* * 0.3%-12%（其中经阴道分娩为0.3%-3%，择期剖宫产为0.9%-12%。 发病率 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* 发病的危险因素 如肺泡内及间质内液体过多，吸收延迟，或有液体运转困难，以致出生24小时内肺泡存留较多液体而影响气体交换，出现呼吸困难，这是本病发生的主要机理。 * 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* 发病的危险因素 1.早产 2.剖宫产 3.男性 4.围生期因素：如围生期窒息，妊娠期高血压疾病 5.高黏血症 6.麻醉镇静剂使用 * 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* * 临 床 表 现 （一）轻症 TTN主要表现为出生后立即或在数小时内出现呼吸急促、呻吟、发绀、三凹征、鼻翼煽动、氧饱和度降低等，胸部X线检查可见肺泡及间质积液、肺纹理增多增粗、肺淤血、肺气肿及胸腔积液等，一般轻症的TTN可自行缓解，多为自限性。 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* * 临 床 表 现 （二）重症 表现为难以纠正的严重低氧血症，如果12小时内未缓解，常并发RDS、持续肺动脉高压等，胸片显示爽肺呈白肺，肺动脉压力高，病情危重，需要机械通气等治疗，病死率高。 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* * 1.主要依据病史、临床表现及肺影像学检查 TTN一般于出生后立即或数小时内出现呼吸困难，轻症者症状持续数小时逐渐减轻，重症病例呼吸困难严重，症状可持续数天。 诊 断 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* * 2.X线胸片 可见双肺透亮度下降、斑片状渗出影、网状、增粗、肺泡及间质积液、肺淤血、肺气肿及叶间、胸腔积液等。 诊 断 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* * 3.双肺点 是湿肺的特异性超声征象，敏感性和特异性可达100%，胸膜线异常、A线异常、胸腔积液也是TTN的超声特点。 诊 断 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* TTN肺部超声 * 24. ‘Time above MIC greater than or equal to 40 percent is associated with low mortality in animal models* 轻症TTN与RDS鉴别比较容易，