,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式文本样式文本,样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,新生儿呼吸窘迫综合征（NRDS）英文,新生儿呼吸窘迫综合征（NRDS）英文,1,Neonatal Respiratory Distress Syndrome(NRDS)or:Hyaline Membrane Disease(HMD),Most common cause of respiratory failure in the first days,Occurring in 12%of newborn infants(GA 2628w,50%,3031w,less than 2025%),Mortality 50%at 20 yrs ago,Survive 8090%now,High risk:IDM,GA37w,multi preg.,C-section,asphyxia,cold stress,history of prior affected,male or white infants,Low risk:chronic or pregnancy-associated hypertension,maternal opiate addiction,PROM,antenatal corticosteroid,Neonatal Respiratory Distress,2,新生儿呼吸窘迫综合征(nrds英文教学ppt课件,3,新生儿呼吸窘迫综合征(nrds英文教学ppt课件,4,新生儿呼吸窘迫综合征(nrds英文教学ppt课件,5,新生儿呼吸窘迫综合征(nrds英文教学ppt课件,6,新生儿呼吸窘迫综合征(nrds英文教学ppt课件,7,新生儿呼吸窘迫综合征(nrds英文教学ppt课件,8,Surfactant Composition,Phospholipid,90%(neutral 5%),saturated 50unsaturated 35,Protein10(albumin 5%),SP-A,3035kDa,18 ologomer,hydrophilic,D,43kDa,12 oligomer,SP-B,8kDa,dimer,hydrophobic,C,4kDa,dimer,Surfactant CompositionPhosphol,9,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),Function of Pulmonary Surfacta,10,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,Etiology and Pathophysilogy Su,11,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,),Pathologyatelectasis,pulmonar,12,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 shunting through ductus arteriousus,intrapulmanary ventilation-perfusion mismatch,PathophysiologyLack of alveola,13,Clinical Presentation,Present at birth or within several hours after birth:,tachypnea,grunting,retractions,cyanosis with increasing oxygen requirements,Physical findings:,rales,poor air exchange,use of accessory muscles of breathing,nasal flaring,abnormal patterns of respiration with apnea,Clinical PresentationPresent a,14,Radiographic Changes of RDS,a bell shaped thorax with diffuse and symmetrical,“ground glass”,infiltrates,air bronchograms and decreased lung volume,or severe bilateral opacity characterized by the term of,“white out”,Radiographic Changes of RDS a,15,Laboratory Findings,Respiratory and metabolic acidosis,Phospholipid(PL)/Sphingomyelin(S)0.6,PaO,2,50mmHg or TcSO,2,85%,Pressure:,410cm H,2,O,flow 5L/min,32,C,humidity 100%,Conventional Mechanical Ventilation(CMV),Indication:,PaO,2,50mmHg or TcSO,2,70mmHg;or frequent apnea,Complication:,PAL(pulmonary air leak),BPD(bronchopulmonary dysplasia;or CLD),RLF(retrolental fibroplasia),VAP(ventilator-associated pneumonia),Respiratory ManagementContinuo,19,Application of Pulmonary Surfactant,Intratracheal instillation:50200mg/kg,612h interval,Neonatal Respiratory Distress Syndrome(NRDS),meconium aspiration syndrome(MAS),Pneumonic Respiratory failure,Acute lung injury,ARDS,Respiratory failure after open-chest surgery or lung transplantation,Application of Pulmonary Surfa,20,Prevention,Careful maternal care and fetal monitoring,Avoidance of asphyxia and infection at birth,Maternal glucocorticoids,(betamethasone,12mgX2,im,24h apart,dexamethasone,6mgX4,im,6h apart),Preventive use of surfactant,The most effective way to prevent RDS is to prevent preterm delivery.If preterm delivery is inevitable,attempts to“mature the fetus”are reasonable.,PreventionCareful maternal car,21,新生儿呼吸窘迫综合征(nrds英文教学ppt课件,22,结束语,谢谢大家聆听！,23,结束语谢谢大家聆听！23,