01.新生儿呼吸困难.ppt

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
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