新生儿疾病新生儿呼吸窘迫综合征英文.pptxVIP

新生儿疾病新生儿呼吸窘迫综合征英文第1页/共17页 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预防第2页/共17页 DefinitionHyaline membrane disease， HMDDeficiency of pulmonary surfactant，PSPulmonary alveoli collapse at the end of expirationProgressively aggravated respiratory distress shortly after birthMainly in preterm infantHigher incidence rate with smaller gestational ageInfant of DM mother, cesarean section, the second baby of twins第3页/共17页 EtiologyPS 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.第4页/共17页 EtiologyPS cover the inner surface of pulmonary alveoli, which can: decrease alveolar surface tensionprevent alveoli collapse at the end of expirationkeep functional residual capacity（FRC）keep stable pulmonary alveolus pressure decrease fluid exude from capillary to pulmonary alveoli第5页/共17页 EtiologyPreterm birthpH 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第6页/共17页 PathogenesisPS deficiencyalveolar surface tension↑alveolus collapse and pulmonary compliance↓work at inspiration↑difficulty at alveolus opening tidal volume↓alveolar ventilation↓CO2 retentionrespiratory acidosisV/A↓hypoxiametabolic acidosisAlveolar permeability↑ interstitium edemafibrin deposition in the inner surface of alveolieosinphilic hyaline membranegas diffusion disorder}第7页/共17页 Clinical manifestationRespiratory distress 2~6h after birth:dyspnea, cyanosis, flaring of alaenasi, inspiratory three-concave sign, expiratory groanProgressively aggravated respiratory distressFlat thorax, low breath sound,