01.新生儿呼吸困难.ppt

新生儿呼吸困难新生儿呼吸困难浙江大学医学院附属儿童医院孙眉月病因分三类肺部疾病 RDS 、 TTN 、 MAS 、肺气漏、肺炎、肺出血、肺发育不良、慢性肺部疾病气道及肺阻塞性疾病气道阻塞(喉气管软化)、肺受压(膈疝) 非肺部疾病先心、心功能不全、贫血、多血、低体温、窒息后病史注意点妊娠周龄母亲情况糖尿病产前大出血宫内生长迟缓多胎妊娠感染史(羊膜早破、母亲发热) 以往 RDS 史胎儿窘迫、脐血 pH 、复苏情况体检注意点胎龄评估, 紫绀情况, 呼吸困难严重度, 呼吸节律、呼吸次数, 全身情况(灌注, 心功中枢) 治疗原则氧疗 CPAP 及机械通气 Fio2> 才能维持 PaO2 50mmHg 开放气道及气道物理治疗置于中性环境温度,维持正常体温容量及心功能维持液体需 24小时匀速输入抗菌素治疗病因学诊断胸部 X光片、血细胞计数、血气血培养、透光试验 Pulmonary causes of tachypnea Mechanical (restrictive) Rib cage anomalies (asphyxiating thoracic dystrophy) Pneumothorax Pneumomediastinum Pleural effusion Chylothorax Severe abdominal distension Pulmonary causes of tachypnea Developmental abnormality TEF CCAM CDH Sequestration Pulmonary hypoplasia Lobar emphysema Lung cyst Pulmonary causes of tachypnea Airway anomalies Choanal stenosis, atresia Laryngeal web Laryngotracheomalacia Bronchomalcia Subglottic stenosis Pulmonary causes of tachypnea Parenchymal TTN,HMD Pulmonary edema Delayed maturation of epithelial sodium channel(ENaC) Aspiration syndromes-meconium, mucus, milk, blood Pneumonia Pneumatocele Pulmonary hemorrhage Interstitial pneumonitis PPHN Nonpulmonary causes of tachypnea Cardiac Left-to-right shunt – pulmonary blood flow Congestive cardiac failure PDA Truncus Coarctation/interrupted aortic arch Atrioventricular (AV) canal AV malformation with high output failure Nonpulmonary causes of tachypnea Neurologic Postasphyxial state Subarachnoid hemorrhage Infections — meningitis Metabolic Metabolic acidosis Hypoglycemia Hypocalcemia Sepsis