新生儿呼吸窘迫综合征NRDS英文.pptxVIP

新生儿呼吸窘迫综合征NRDS英文第1页/共23页 Neonatal Respiratory Distress Syndrome (NRDS)or: Hyaline Membrane Disease (HMD)Most common cause of respiratory failure in the first daysOccurring 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% nowHigh risk: IDM, GA37w, multi preg., C-section, asphyxia, cold stress, history of prior affected, male or white infantsLow risk: chronic or pregnancy-associated hypertension, maternal opiate addiction, PROM, antenatal corticosteroid第2页/共23页 Lung Development Embryonic Lung Development Fetal Lung Development (Pseudoglandular, Canalicular, Terminal Saccular) Postnatal Lung Development第3页/共23页 Embryonic Lung Development primitive lungmain bronchilobar bronchisegmental bronchi 第4页/共23页 Fetal Lung DevelopmentPseudoglandular Stage ~ 7th – 16th weekPrimitive bronchial treeTerminal bronchioles第5页/共23页 Fetal Lung DevelopmentCanalicular Stage ~ 16th – 24th weekTerminal Saccular Stage ~ 24th – 36th weekRespiratory bronchioles Transitory saccules and ducts第6页/共23页 Postnatal Lung DevelopmentPostnatal Development ~ birth – 8 yearAlveolar periodSecondary alveolar septaAlveolar ducts and alveoli第7页/共23页 Surfactantstart synthesis in 20~24wincrease in 28~32wmeet demands after 35wdouble in alveolar within 24hadult level after 3~7dhalf-life 12~24hrenew in 24~48,90% reuse第8页/共23页 Surfactant CompositionPhospholipid 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 第9页/共23页 Function of Pulmonary SurfactantDecrease alveolar surface tension, reduce respiratory workMaintain alveoli inflation and functional residual capacity Accelerate lung fluid absorption, reduce alveolar effusionPathogen Opsonization, alveolar macrophage activation