新生兒呼吸窘迫綜合征nrds英文教學(xué)課件

新生兒呼吸窘迫綜合征（NRDS）英文新生兒呼吸窘迫綜合征（NRDS）英文1NeonatalRespiratoryDistressSyndrome(NRDS)

or:HyalineMembraneDisease(HMD)MostcommoncauseofrespiratoryfailureinthefirstdaysOccurringin1~2%ofnewborninfants(GA26~28w,50%,30~31w,lessthan20~25%)Mortality~50%at20yrsago,Survive80~90%nowHighrisk:IDM,GA<37w,multipreg.,C-section,asphyxia,coldstress,historyofprioraffected,maleorwhiteinfantsLowrisk:chronicorpregnancy-associatedhypertension,maternalopiateaddiction,PROM,antenatalcorticosteroidNeonatalRespiratoryDistress2新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件3新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件4新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件5新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件6新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件7新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件8SurfactantCompositionPhospholipid90%(neutral5%) saturated 50％ unsaturated 35％Protein 10％ (albumin5%) SP-A,30~35kDa,18ologomer,hydrophilicD,43kDa,12oligomer SP-B,8kDa,dimer,hydrophobicC,4kDa,dimerSurfactantCompositionPhosphol9FunctionofPulmonarySurfactantDecreasealveolarsurfacetension,reducerespiratoryworkMaintainalveoliinflationandfunctionalresidualcapacityAcceleratelungfluidabsorption,reducealveolareffusionPathogenOpsonization,alveolarmacrophageactivation

Effects:improveoxygenation,ameliorateventilation/perfusionanti-inflammationFluidsurfacetensionPressure(P)=2xsurfacetension()radius(r)FunctionofPulmonarySurfacta10EtiologyandPathophysilogySurfactantlowersthesurfacetensionofalveolarmembranePulmonaryimmaturityresultsinsurfactantdeficiencyAlveolicollapseattheendofexpirationleadstorespiratoryfailureSurfactantdeficiencycanariseafterasphyxia/shockandacidosisEtiologyandPathophysilogySu11Pathologyatelectasis,pulmonaryedema,vascularcongestion,hemorrhage,generalizedcapillaryleakandmucosalnecrosisleadstothesmallairfilledterminalairways,therespiratorybronchiolesandalveolarducts,beingsurroundedbycollapsedalveolifilledwithdebrisinanearuniformdistribution(hyalinemembranes)Pathologyatelectasis,pulmonar12PathophysiologyLackofalveolarsurfactantinthelungsofinfants

AveryandMead,AmJDisChild1959

progressiveatelectasislossoffunctionalresidualcapacity(FRC)alterationofventilation-perfusionratioWeakrespiratorymusclesandcompliantchestwallimpairalveolarventilation

Diminishedoxygenation,cyanosisandacidosisincreasedpulmonaryvascularresistance(PVR)right-to-leftshuntingthroughductusarterioususintrapulmanaryventilation-perfusionmismatchPathophysiologyLackofalveola13ClinicalPresentationPresentatbirthorwithinseveralhoursafterbirth:tachypneagruntingretractionscyanosiswithincreasingoxygenrequirementsPhysicalfindings:ralespoorairexchangeuseofaccessorymusclesofbreathingnasalflaringabnormalpatternsofrespirationwithapneaClinicalPresentationPresenta14RadiographicChangesofRDSabellshapedthoraxwithdiffuseandsymmetrical“groundglass”infiltrates,airbronchogramsanddecreasedlungvolumeorseverebilateralopacitycharacterizedbythetermof“whiteout”

RadiographicChangesofRDSa15LaboratoryFindingsRespiratoryandmetabolicacidosis

Phospholipid(PL)/Sphingomyelin(S)<2:1;orPhosphatidylglycerol(PG)negativeShakingTest

Add1mLof95%alcoholto1mLofgastricfluid,shakefor15seconds,watchforfoamformationLaboratoryFindingsRespirator16DiagnosisandDifferentialDiagnosis“Wetlung”ortransientrespiratorydistress

AmnioticfluidormeconiumaspirationsyndromeGroupBhemolyticStreptococcuspneumoniaDiaphragmaticherniaDiagnosisandDifferentialDia17TreatmentCarefulassessmentandresuscitationAdequateventilation,oxygenation,circulationandtemperaturemustbeassuredSurfactantreplacementtherapy(natural/synthetic)Ventilatorymanagement(CPAP,IPPV,PEEP)Acid-baseandelectrolytehomeostasisClosureofpatentductusarteriousus(PDA)SupportivetreatmentAntibioticTreatmentCarefulassessmentan18RespiratoryManagementContinuousPositiveAirwayPressure(CPAP)

Indication:whenFiO2>0.6,PaO2<50mmHgorTcSO2<85%

Pressure:4~10cmH2O,flow5L/min,32°C,humidity100%ConventionalMechanicalVentilation(CMV)

Indication:PaO2<50mmHgorTcSO2<85%withCPAP(8cm);PCO2>70mmHg;orfrequentapnea

Complication:PAL(pulmonaryairleak)BPD(bronchopulmonarydysplasia;orCLD)RLF(retrolentalfibroplasia)VAP(ventilator-associatedpneumonia)RespiratoryManagementContinuo19ApplicationofPulmonarySurfactantIntratrachealinstillation:50~200mg/kg,6~12hintervalNeonatalRespiratoryDistressSyndrome(NRDS)meconiumaspirationsyndrome(MAS)PneumonicRespiratoryfailureAcutelunginjury,ARDSRespiratoryfailureafteropen-chestsurgeryorlungtransplantationApplicationofPulmonarySurfa20PreventionCarefulmaternalcareandfetalmonitoringAvoidanceofasphyxiaandinfectionatbirthMaternalglucocorticoids(betamethasone,12mgX2,im,24hapart,dexamethasone,6mgX4,im,6hapart)

PreventiveuseofsurfactantThemosteffectivewaytopreventRDSistopreventpretermdelivery.Ifpretermdeliveryisinevitable,attemptsto“maturethefetus”arereasonable.PreventionCarefulmaternalcar21新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件22

結(jié)束語謝謝大家聆聽?。。?3

結(jié)束語謝謝大家聆聽?。。?3新生兒呼吸窘迫綜合征（NRDS）英文新生兒呼吸窘迫綜合征（NRDS）英文24NeonatalRespiratoryDistressSyndrome(NRDS)

or:HyalineMembraneDisease(HMD)MostcommoncauseofrespiratoryfailureinthefirstdaysOccurringin1~2%ofnewborninfants(GA26~28w,50%,30~31w,lessthan20~25%)Mortality~50%at20yrsago,Survive80~90%nowHighrisk:IDM,GA<37w,multipreg.,C-section,asphyxia,coldstress,historyofprioraffected,maleorwhiteinfantsLowrisk:chronicorpregnancy-associatedhypertension,maternalopiateaddiction,PROM,antenatalcorticosteroidNeonatalRespiratoryDistress25新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件26新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件27新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件28新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件29新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件30新生兒呼吸窘迫綜合征(nrds英文教學(xué)課件31SurfactantCompositionPhospholipid90%(neutral5%) saturated 50％ unsaturated 35％Protein 10％ (albumin5%) SP-A,30~35kDa,18ologomer,hydrophilicD,43kDa,12oligomer SP-B,8kDa,dimer,hydrophobicC,4kDa,dimerSurfactantCompositionPhosphol32FunctionofPulmonarySurfactantDecreasealveolarsurfacetension,reducerespiratoryworkMaintainalveoliinflationandfunctionalresidualcapacityAcceleratelungfluidabsorption,reducealveolareffusionPathogenOpsonization,alveolarmacrophageactivation

Effects:improveoxygenation,ameliorateventilation/perfusionanti-inflammationFluidsurfacetensionPressure(P)=2xsurfacetension()radius(r)FunctionofPulmonarySurfacta33EtiologyandPathophysilogySurfactantlowersthesurfacetensionofalveolarmembranePulmonaryimmaturityresultsinsurfactantdeficiencyAlveolicollapseattheendofexpirationleadstorespiratoryfailureSurfactantdeficiencycanariseafterasphyxia/shockandacidosisEtiologyandPathophysilogySu34Pathologyatelectasis,pulmonaryedema,vascularcongestion,hemorrhage,generalizedcapillaryleakandmucosalnecrosisleadstothesmallairfilledterminalairways,therespiratorybronchiolesandalveolarducts,beingsurroundedbycollapsedalveolifilledwithdebrisinanearuniformdistribution(hyalinemembranes)Pathologyatelectasis,pulmonar35PathophysiologyLackofalveolarsurfactantinthelungsofinfants

AveryandMead,AmJDisChild1959

progressiveatelectasislossoffunctionalresidualcapacity(FRC)alterationofventilation-perfusionratioWeakrespiratorymusclesandcompliantchestwallimpairalveolarventilation

Diminishedoxygenation,cyanosisandacidosisincreasedpulmonaryvascularresistance(PVR)right-to-leftshuntingthroughductusarterioususintrapulmanaryventilation-perfusionmismatchPathophysiologyLackofalveola36ClinicalPresentationPresentatbirthorwithinseveralhoursafterbirth:tachypneagruntingretractionscyanosiswithincreasingoxygenrequirementsPhysicalfindings:ralespoorairexchangeuseofaccessorymusclesofbreathingnasalflaringabnormalpatternsofrespirationwithapneaClinicalPresentationPresenta37RadiographicChangesofRDSabellshapedthoraxwithdiffuseandsymmetrical“groundglass”infiltrates,airbronchogramsanddecreasedlungvolumeorseverebilateralopacitycharacterizedbythetermof“whiteout”

RadiographicChangesofRDSa38LaboratoryFindingsRespiratoryandmetabolicacidosis

Phospholipid(PL)/Sphingomyelin(S)<2:1;orPhosphatidylglycerol(PG)negativeShakingTest

Add1mLof95%alcoholto1mLofgastricfluid,shakefor15seconds,watchforfoamformationLaboratoryFindingsRespirator39DiagnosisandDifferentialDiagnosis“Wetlung”ortransientrespiratorydistress

AmnioticfluidormeconiumaspirationsyndromeGroupBhemolyticStreptococcuspneumoniaDiaphragmaticherniaDiagnosisandDifferentialDia40TreatmentCarefulassessmentandresuscitationAdequateventilation,oxygenation,circulationandtemperaturemustbeassuredSurfactantreplacementtherapy(natural/synthetic)Ventilatorymanagement(CPAP,IPPV,PEEP)Acid-baseandelectrolytehomeostasisClosureofpatentductusarteriousus(PDA)SupportivetreatmentAntibioticTreatmentCarefulassessmentan41RespiratoryManagementContinuousPositiveAirwayPressure(CPAP)

Indication:whenFiO2>0.6,PaO2<50mmHgorTcSO2<85%

Pressure:4~10cmH2O,flow5L/min,32°C,humidity100%ConventionalMechanicalVentilation(CMV)

Indication:PaO2<50mmHgorTcSO2<85%