新生儿呼吸窘迫综合征(NRDS)PPT课件.pptVIP

Surfactant Composition 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 * Function of Pulmonary Surfactant 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) = 2xsurface tension(?) radius (r) * Etiology and Pathophysilogy Surfactant lowers the surface tension of alveolar membrane Pulmonary immaturity results in surfactant deficiency Alveoli collapse at the end of expiration leads to respiratory failure Surfactant deficiency can arise after asphyxia/shock and acidosis * Pathology atelectasis, pulmonary edema, vascular congestion, hemorrhage, generalized capillary leak and mucosal necrosis leads to the small air filled terminal airways, the respiratory bronchioles and alveolar ducts, being surrounded by collapsed alveoli filled with debris in a near uniform distribution (hyaline membranes) * Pathophysiology Lack of alveolar surfactant in the lungs of infants Avery and Mead, Am J Dis Child 1959 progressive atelectasis loss of functional residual capacity (FRC) alteration of ventilation-perfusion ratio Weak respiratory muscles and compliant chest wall impair alveolar ventilation Diminished oxygenation, cyanosis and acidosis increased pulmonary vascular resistance (PVR) right-to-left shunti