新生兒肺動脈高壓管理

1、精選ppt精選ppt精選ppt女Walsh-Sukys, et. Al: J Pediatr 105:14,2000精選ppt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胞， 管腔狹窄過渡期細胞變長，變薄成為紡錘形細胞血管內(nèi)皮細胞變平，血管腔擴大精選ppt臍帶結(jié)扎臍帶結(jié)扎肺循環(huán)阻力下降體循環(huán)阻力升高呼吸呼吸:肺擴張PaO2升高pH 升高通過卵圓孔動脈導管左右分流 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精選ppt正常肺血管擴張不發(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)精選ppt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

2、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)動脈導管早閉n肺發(fā)育不良或畸形:n先天性膈疝n肺發(fā)育不良n肺泡毛細血管發(fā)育不良精選pptHernandez-Diaz S, et al. Pediatrics 2007:1195-201精選pptLakshminrusimha et al. J Appl Physiol. 2011; 111 :1441精選ppt一氧化氮途徑前列環(huán)素途徑內(nèi)皮素途徑 ET1+精選ppt精選ppt精選ppt精選pptVain et al. Lancet. 2004; 364:597精選pptHalliday & Sweet. Cochran

3、e 2001 1; CD000500. 精選ppt精選ppt精選ppt精選ppt精選ppt精選ppt精選pptOI=MAP*FiO2/PaO2精選ppt精選pptWalsh MC, et al. Clin Perinatol 28(3): 609-627精選ppt精選ppt精選pptResponse of the pulmonary vasculature to hypoxia and H+ ion concentration changes. Rudolph & Yuan J Clin Invest. 1966; 45:399精選pptWalsh-Sukys M C et al. P

4、ediatrics 2000;105:14-20精選pptWalsh-Sukys M C et al. Pediatrics 2000;105:14-20精選ppt精選ppt 精選ppt精選ppt ET1sildenafilmilrinonebostentanProstacyclins+精選ppt精選ppt精選pptDont forget- the bag needs NO too!精選pptShah PS, Ohlsson A. Cochrane Database Syst Rev. 2011; (8): CD005494精選ppt ECMO- Use of ECMO decreased m

5、ortality from 60% to 30% in a UK study精選pptVariableOdds 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 0.01ECMO 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):263-267精選ppt精選pptUK collaborative randomised trial of neonatal extracorporeal membrane oxygenation: follow-up to age 4 years. Bennett CC et al.