复旦大学：《儿科学》课程教学资源（PPT课件讲稿，英文版）第四讲 新生儿呼吸

Case report 一例27岁孕妇,孕31周,胎膜早破26小时 产科医师请新生儿科会诊,怎么办? 1、保胎,继续妊娠? 2、终止妊娠,分娩?

Case report 一例27岁孕妇，孕31周，胎膜早破26小时， 产科医师请新生儿科会诊，怎么办？ 1、保胎，继续妊娠？ 2、终止妊娠，分娩？

Case report 新生儿科医师建议终止妊娠,提前分娩。 娩出一男婴,体重1450克,生后2小时出现 呼吸增快,呻吟 1、患儿可能发生了什么问题? 2、怎么处理?

Case report 新生儿科医师建议终止妊娠，提前分娩。 娩出一男婴，体重1450克，生后2小时出现 呼吸增快，呻吟。 1、患儿可能发生了什么问题？ 2、怎么处理？

Neonatal respiratory diseases

Neonatal respiratory diseases

NRDS: neonatal respiratory distress syndrome 新生儿呼吸窘迫综合症 HMD: hyaline membrane disease 肺透明膜病

NRDS：neonatal respiratory distress syndrome 新生儿呼吸窘迫综合症 HMD ：hyaline membrane disease 肺透明膜病

1. Etiology and mechanism Pulmonary surfactant( PS )deficiency 肺表面活性物质缺乏 Premature infants infants of diabetes mother asphyxia cesarean section Sp-B deficiency

1. Etiology and mechanism Pulmonary surfactant( PS ) deficiency 肺表面活性物质缺乏 Premature infants infants of diabetes mother asphyxia cesarean section Sp-B deficiency

Single alveolur Aqueous layer Lamellar body (stores surfactant) Alveolar macrophage cO type l pneumocyte Capillary Type I lining

肺表面张力 液体薄层 肺泡腔 液面压力 表面张力

表面张力 液体薄层 肺泡腔 液面压力 肺表面张力

1. Etiology and mechanism nypoxIa、 acidosis Permeability of capillary Lung edema, exudation of plasma protein hyaline membrane

1. Etiology and mechanism hypoxia、acidosis ↑permeability of capillary Lung edema、exudation of plasma protein hyaline membrane

Normal Alveolus Injured Alveolus during the Acute Phase Alveolar air space Protein-rich edema fluid loughing of bronchial epithelium Necrotic or apoptotic type I cell Inactivated surfactant Epithelial Red cell Interstitium Type ll cell intact type ll cell Aleolar PAF macrophage Proteas ellul Denuded TNF-cE basement membrane Hyaline membrane leola Migrating neutrophil Widened Surfactant layer edematous interstitium collagen basement Platelets Neutrophil Capillary Red cell Swollen, injured endothelial cells Fibroblast Fibroblast

manifestation distress in 6 hours after birth tachypnea, dyspnea groan(呻吟)、 three depressions sing(吸凹) cyanosis, decrease of breathing sound respiratory feilure progressive distress

2、manifestation distress in 6 hours after birth tachypnea, dyspnea groan(呻吟)、three depressions sing(吸凹) cyanosis、decrease of breathing sound respiratory feilure progressive distress