新生兒肺動脈高壓管理

1、女walsh-sukys, et. al: j pediatr 105:14,2000高阻力肺循環(huán)低阻力胎盤循環(huán)胎盤為主要氧氣交換器官胎兒動脈磚形平滑肌細(xì)胞， 管腔狹窄過渡期細(xì)胞變長，變薄成為紡錘形細(xì)胞血管內(nèi)皮細(xì)胞變平，血管腔擴(kuò)大臍帶結(jié)臍帶結(jié)扎扎肺循環(huán)阻力下降體循環(huán)阻力升高呼吸呼吸:肺擴(kuò)張pao2升高ph 升高通過卵圓孔動脈導(dǎo)管左右分流 no 鳥甘酸 環(huán)化酶 腺甘酸 環(huán)化酶 前列環(huán)素環(huán)氧化酶 campcgmp正常肺血管擴(kuò)張不發(fā)生肺血流阻力高于體循環(huán)阻力非氧合血分流入體循環(huán)分類n生后過度障礙n血管肌肉過度增生n血管發(fā)育不良病因n敗血癥肺炎n圍生期吸綜合癥 (胎糞，血，羊水)n慢性宮內(nèi)缺氧n宮內(nèi)動

2、脈導(dǎo)管早閉n肺發(fā)育不良或畸形:n先天性膈疝n肺發(fā)育不良n肺泡毛細(xì)血管發(fā)育不良hernandez-diaz s, et al. pediatrics 2007:1195-201lakshminrusimha et al. j appl physiol. 2011; 111 :1441一氧化氮途徑前列環(huán)素途徑內(nèi)皮素途徑 et1+vain et al. lancet. 2004; 364:597halliday & sweet. cochrane 2001 1; cd000500. oi=map*fio2/pao2walsh mc, et al. clin perinatol 28(3):

3、609-627response of the pulmonary vasculature to hypoxia and h+ ion concentration changes. rudolph & yuan j clin invest. 1966; 45:399walsh-sukys m c et al. pediatrics 2000;105:14-20walsh-sukys m c et al. pediatrics 2000;105:14-20 et1sildenafilmilrinonebostentanprostacyclins+dont forget- the bag n

4、eeds no too!shah ps, ohlsson a. cochrane database syst rev. 2011; (8): cd005494 ecmo- use of ecmo decreased mortality from 60% to 30% in a uk studyvariableodds of neonatal death odds ratio 95% confidence interval p valuegestational age 37 wk 1.7 1.22.5 0.01ph7.20 1.51.12.1 0.02sao2 65% 1.51.12.1 0.0

5、1ecmo initiateddol 5 1.81.22.6 0.01duration of ecmo 7 d 3.42.54.7 0.01the use of ecmo for persistent pulmonary hypertension of the newborn: a decade of experience. lazar et al. j surg res 2012 (177):263-267uk collaborative randomised trial of neonatal extracorporeal membrane oxygenation: follow-up to age 4 years. bennett cc et