新生儿呼吸窘迫综合征

新生儿呼吸窘迫综合征，又称新生儿肺透明膜病。指新生儿出生后不久即出现进行性呼吸困难和呼吸衰竭等症状。别名：Atemnot-Syndromofnewbornhyalinemembranediseaseofnewbornrespiratorydistresssyndromeofnewborn英文名：respiratorydistresssyndromeofnewborn发病部位：肺就诊科室：新生儿科症状：呼噜样呼吸音多发人群：儿童治疗手段：药物康复疗法并发疾病：脑死亡是否遗传：否是否传染：否

症状患婴多为早产儿，刚出生时哭声可以正常，6～12小时内出现呼吸困难，逐渐加重，伴呻吟。呼吸不规则，间有呼吸暂停。面色因缺氧变得灰白或青灰，发生右向左分流后青紫明显，供氧不能使之减轻。缺氧重者四肢肌张力低下。体征有鼻翼搧动，胸廓开始时隆起，以后肺不张加重，胸廓随之下陷，以腋下较明显。吸气时胸廓软组织凹陷，以肋缘下、胸骨下端最明显。肺呼吸音减低，吸气时可听到细湿啰音。本症为自限性疾病，能生存三天以上者肺成熟度增加，恢复希望较大。但不少婴儿并发肺炎，使病情继续加重，至感染控制后方好转。病情严重的婴儿死亡大多在三天以内，以生后第二天病死率最高。本症也有轻型，可能因表面活性物质缺乏不多所致，起病较晚，可迟至24～48小时，呼吸困难较轻，无呻吟，发绀不明显，三、四天后即好转。

病因主要是由于缺乏肺泡表面活性物质所引起，导致肺泡进行性萎陷。

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诊断1.血液生化检查由于通气不良PaO低，PaO增高。由于代谢性酸中毒血pH降低，需定期取动脉血直接检验。代谢性酸中毒时碱剩余减少，二氧化碳结合力下降。疾病过程中血液易出出低Na、K、和高Cl.2.X线表现肺透明膜的早期两侧肺野普遍性透亮度减低，内有均匀分布的细小颗粒和网状阴影，小颗粒代表肺泡的细小不张，网状阴影代表充血的小血管。支气管则有充气征，但易被心脏和胸腺影所遮盖，至节段和末梢支气管则显示清楚。

治疗产前单疗程应用激素对新生儿呼吸窘迫综合征有预防作用，表面活性物质替代治疗在新生儿呼吸窘迫综合征管理中至关重要.机械通气这一呼吸支持形式可以挽救患儿的生命，治疗策略应该尽可能使用经鼻持续气道正压通气或鼻腔通气，尽量避免机械通气.为使新生儿呼吸窘迫综合征患儿获得最佳预后，必须给予良好的支持性治疗，包括维持正常的体温、恰当的体液疗法、良好的营养支持、处理动脉导管开放，以及循环支持维持适当的组织灌注。

预后新生儿呼吸窘迫综合征预后不好易导致肺动脉高压、呼吸与心力衰竭甚至死亡。原因如下1.气漏由于肺泡壁的损伤，气体溢至肺间质，或由于机械通气时吸气峰压或平均气道压(MAP)过高引起间质性肺气肿，气体沿血管至纵隔，引起纵膈气胸。间质气肿也可引起气胸，气漏时呼吸更为困难。2，氧中毒当吸入氧浓度(FiO2)过高，或供氧时间过长，可能发生氧中毒，以支气管肺发育不良(bronchopulmonarydysplasia，BPD)和眼晶体后纤维增生最常见，前者为肺本身的病变，使呼吸机不易撤除，后者表现为晶体后视网膜增生或视网膜剥离，使视力减退，甚至失明。3.恢复期的动脉导管开放本症经机械呼吸和供氧治疗后，在恢复期约30%病例出现动脉导管未闭，早产儿动脉导管的组织未成熟，不能自发关闭，但在肺透明膜病的早期肺血管阻力增加，不但不发生左向右分流，有时却相反发生右向左分流，至恢复期肺血管阻力下降，即可出现左向右分流，此时因肺动脉血流增加而致肺水肿，出现间歇性呼吸暂停和充血性心力衰竭，甚至危及生命。在心前区胸骨左缘可听到收缩期杂音，以第2～3肋间最响，如肺血管阻力下降幅度大，甚至可出现连续性杂音。胸部X线片显示心脏影扩大，肺野充血。B型超声心动图可直接探得未闭的动脉导管。

预防1.产前预防：准妈妈要按时去产检，关注胎宝宝成长。如果产前检查被诊断为高危妊娠的准妈妈，一定要积极配合医生治疗，通过治疗，能有效预防早产、难产等情况的发生。不是高危妊娠的准妈妈也要定时进行产检，并监测好胎动、胎心，如果胎儿在宫内有什么情况能通过胎动显示出来，胎心也能在一定程度上看出宝宝是否正常。在孕中、晚期，产检时需要做胎心监护，以监测胎儿的发育情况，看是否正常。2.产后预防：被诊断为高危妊娠的准妈妈，产科医生将会采取有效措施以防止分娩时出现意外，并对分娩出的宝宝进行提前干预。医生对早产儿或低体重儿等高危宝宝进行详细检查，提前干预。

产前单疗程应用激素对新生儿呼吸窘迫综合征有预防作用，表面活性物质替代治疗在新生儿呼吸窘迫综合征管理中至关重要.