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01.新生儿呼吸困难PPT精选文档
PPHN
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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
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Nonpulmonary causes of tachypnea
Neurologic Postasphyxial state Subarachnoid hemorrhage Infections—meningitis
Metabolic Metabolic acidosis Hypoglycemia Hypocalcemia
Airway anomalies Choanal stenosis, atresia Laryngeal web Laryngotracheomalacia Bronchomalcia Subglottic stenosis
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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
新生儿呼吸困难
浙江大学医学院附属儿童医院 孙眉月
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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
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• 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)
Prolonged rupture of Sepsis, pneumonia
membranes (PROM)
Anesthesia/Analgesia Depression, apnea, cynosis
Asphyxia
Cerebral edema, metabolic
acidosis
Chorioamnionitis
• 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)
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治疗原则
• 氧疗 CPAP及机械通气 Fio2>0.5 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
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Pulmonary causes of tachypnea
Mechanical (restrictive) Rib cage anomalies (asphyxiating thoracic dystrophy) Pneumothorax Pneumomediastinum Pleural effusion Chylothorax Severe abdominal distension
Sepsis
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Nonpulmonary causes of tachypnea
Miscellaneous Hyperthermia Hypothermia Narcotic withdrawal Pain Hirschsprung’s Large for gestational age-infant of diabetic mother (LGA-IDM) Trisomy-21
Sepsis
C-section without labor TTN, RDS, PPHN
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Clinical history and diagnosis of causes for tachypnea (cont’)
History
Likely diagnosis
Newborn
Onset at birth
Pregnancy induced (IUGR),
Intrauterine growth retardation
hypertension (PIH) polycythemia, hypoglycemia
Polyhydramnios
TEF
Previous sibling with
SPB deficiency, GBS pneumonia
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Pulmonary causes of tachypnea
Developmental abnormality TEF CCAM CDH Sequestration Pulmonary hypoplasia Lobar emphysema Lung cyst
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Pulmonary causes of tachypnea
respiratory distress
Oligohydramnios
Pulmonary hypoplasia
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Clinical history and diagnosis of causes for tachypnea (cont’)
History
Likely diagnosis
Labor and delivery
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Clinical history and diagnosis of causes for tachypnea
Historyory
Diabetes CHD
TTN, RDS,hypoglycemia, LGA,
Asthma
TTN
Drugs
Narcotic withdrawal