Emergency paediatrics / Neonatal respiratory distress Syndrome (NRDS): ua rau, muaj feem cuam tshuam, pathophysiology

By Cristiano Antonino On Jun 3, 2022

Neonatal respiratory distress Syndrome (NRDS) yog ib qho mob ua pa uas tshwm sim los ntawm qhov muaj cov kab mob ntsws pulmonary atelectasis thiab ua pa tsis ua haujlwm uas feem ntau kuaj pom hauv cov menyuam yug ntxov ntxov, uas tseem tsis tau ua tiav lub ntsws kom loj hlob thiab tsim cov surfactant txaus.

Synonyms ntawm infant respiratory distress syndrome yog:

ARDS ntawm tus me nyuam mos (ARDS sawv cev rau mob hnyav ua pa nyuaj siab syndrome);
ARDS ntawm cov me nyuam mos;
Neonatal ARDS;
Pediatric ARDS;
Neonatal RDS (RDS sawv cev rau 'kev ua pa nyuaj siab');
yug me nyuam ua pa nyuaj siab syndrome;
mob ua pa nyuaj syndrome ntawm tus menyuam;
mob ua pa nyuaj syndrome ntawm tus me nyuam mos.

Kev ua pa nyuaj siab yav dhau los hu ua 'hyaline membrane kab mob' yog li lub npe 'MMI' (tam sim no poob rau hauv kev tsis siv)

Infant respiratory distress syndrome hauv lus Askiv hu ua:

infantile respiratory distress syndrome (IRDS);
ua pa nyuaj syndrome ntawm tus me nyuam mos;
neonatal respiratory distress syndrome (NRDS);
Surfactant deficiency Disorder (SDD).

Cov kab mob no yav dhau los hu ua 'hyaline membrane kab mob' yog li lub npe 'HMD'.

Epidemiology ntawm tus me nyuam mos ua pa nyuaj siab syndrome

Qhov tshwm sim ntawm tus mob yog 1-5 / 10,000.

Tus mob no cuam tshuam txog li 1% ntawm cov menyuam yug tshiab.

Qhov tshwm sim txo qis nrog rau lub hnub nyoog gestational, txij li 50% ntawm cov menyuam yug ntawm 26-28 lub lis piam mus txog 25% ntawm 30-31 lub lis piam.

Cov tsos mob no feem ntau tshwm sim hauv cov txiv neej, Caucasians, cov me nyuam mos ntawm cov niam mob ntshav qab zib thiab cov menyuam ntxaib yug thib ob.

Txawm hais tias muaj ntau hom kev ua pa tsis ua haujlwm cuam tshuam rau tus menyuam yug tshiab, NRDS yog qhov ua rau ntxov ntxov.

Kev nce qib hauv kev tiv thaiv kev yug ntxov ntxov thiab kev kho mob ntawm tus menyuam yug tshiab NRDS tau ua rau muaj kev txo qis ntawm cov neeg tuag los ntawm tus mob no, txawm hais tias, NRDS tseem yog ib qho tseem ceeb ntawm kev mob thiab kev tuag.

Nws kwv yees tias kwv yees li 50 feem pua ntawm cov menyuam yug tshiab tuag muaj NRSD.

Vim tias muaj neeg tuag coob heev, txhua tus kws kho mob uas muaj menyuam yaus yuav tsum tau kuaj xyuas thiab kho qhov ua rau ua pa tsis ua haujlwm.

Hnub nyoog pib

Lub hnub nyoog ntawm qhov pib yog neonatal: cov tsos mob thiab cov tsos mob ntawm kev ua pa nyuaj siab tshwm sim nyob rau hauv cov me nyuam mos tom qab yug me nyuam los yog ob peb feeb / teev tom qab yug me nyuam.

Me Nyuam Noj Qab Haus Huv: Kawm paub ntau ntxiv txog MEDICHILD los ntawm kev mus saib BOOTH ntawm EMERGENCY EXPO

Ua rau: surfactant deficiency

Tus menyuam mos uas muaj RDS raug kev txom nyem los ntawm kev tsis txaus surfactant.

Surfactant (los yog 'pulmonary surfactant') yog cov tshuaj lipoprotein uas tsim los ntawm hom II pneumocytes ntawm qib alveolar txij li peb caug-tsib lub lim tiam ntawm cev xeeb tub thiab nws lub luag haujlwm tseem ceeb yog txo qhov nro ntawm qhov chaw los ntawm kev lav alveolar nthuav dav thaum ua pa ua pa: nws tsis tuaj. yog li ntawd nrog los ntawm txo alveolar expansion thiab ib tug nyiam mus kaw nrog compromised gas exchanges, nrog rau qhov ua tsis taus pa ntawm ib txwm ua pa.

Thaum yug los, surfactant yuav tsum tau tsim kom muaj ntau txaus thiab zoo los tiv thaiv qhov kawg ntawm kev ploj tuag ntawm tus menyuam mos lub alveoli.

Lub luag haujlwm rau kev tsim cov khoom siv surfactant-active, uas yog ib qho tseem ceeb heev rau kev ua haujlwm ntawm lub ntsws tom qab yug me nyuam, yog qhov ua haujlwm tsis zoo ntawm alveolar hom II hlwb (hom II pneumocytes).

Tus me nyuam mos ntxov ntxov dua, qhov tsawg dua nws muaj txaus hom II pneumocyte hlwb thaum yug los thiab, yog li ntawd, nws yog ntxov ntxov, qhov ntau nws tsis muaj txaus surfactant ntau lawm.

Qhov xwm txheej ntawm tus me nyuam yug tshiab RDS yog, yog li ntawd, qhov sib npaug ntawm lub hnub nyoog gestational thiab txhua tus me nyuam mos ntxov ntxov (hnub nyoog gestational tsawg dua 38 lub lis piam) muaj kev pheej hmoo rau tus kab mob no.

Neonatal RDS muaj qhov tshwm sim ntau rau cov menyuam mos yug ntxov ntxov (hnub nyoog qis dua 29 lub lis piam) thiab cov menyuam mos yug me nyuam (tsawg dua 1,500 grams).

Deficiency lossis tsis muaj surfactant tuaj yeem tshwm sim los yog txaus siab, ntxiv rau qhov ntxov ntxov, los ntawm:

kev hloov pauv hauv ib lossis ntau cov noob coding rau surfactant proteins;
meconium aspiration syndrome;
mob sepsis.

Genetic ua rau neonatal respiratory distress syndrome

Tsis tshua muaj tshwm sim yog los ntawm noob caj noob ces thiab tshwm sim los ntawm kev hloov pauv hauv cov noob

ntawm cov protein surfactant (SP-B thiab SP-C);
ntawm adenosine triphosphate A3 (ABCA3) binding complex.

Ua rau: tsis paub qab hau parenchyma

Thaum xub thawj, nws tau xav tias tsuas yog qhov teeb meem ntawm tus kab mob no yog qhov txo qis ntawm surfactant los ntawm lub ntsws tsis paub qab hau ntawm tus me nyuam mos ntxov ntxov, qhov kev tshawb fawb tsis ntev los no tau pom tias qhov teeb meem yog qhov nyuaj dua.

Tseeb tiag, tus me nyuam mos ntxov ntxov tsis tau tsuas yog txo tus nqi ntawm surfactant, tab sis qhov uas tam sim no tseem tsis paub qab hau thiab yog li ntawd ua haujlwm tsis zoo.

Nws tseem tsis tau paub meej tias tus me nyuam mos ntxov ntxov tuaj yeem siv tau cov surfactant uas twb muaj lawm.

Tus me nyuam mos nrog RDS kuj tseem muaj lub ntsws tsis paub qab hau nrog qhov txo qis alveolar roj pauv thaj chaw, nce alveolar-capillary membrane tuab, txo qis pulmonary tiv thaiv kab mob, lub hauv siab tsis paub qab hau thiab nce capillary permeability.

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Ib qho mob hnyav ntawm asphyxia lossis txo qis pulmonary perfusion muaj peev xwm cuam tshuam nrog kev tsim cov tshuaj surfactant, ua rau nws tsis txaus thiab yog li ua rau cov kab mob ntawm RDS lossis nce nws qhov hnyav.

Cov yam ntxwv txaus ntshai rau cov menyuam yug tshiab RDS yog:

thaum ntxov yug
gestational hnub nyoog ntawm 28 lub lis piam los yog tsawg dua;
Qhov hnyav thaum yug me nyuam (tsawg dua 1500 grams, piv txwv li 1.5 kg)
txiv neej pw;
haiv neeg Caucasian;
leej txiv mob ntshav qab zib;
niam mob ntshav qab zib;
niam malnourished default
niam nrog ntau cev xeeb tub;
leej niam siv cawv thiab/los yog siv tshuaj;
leej niam raug tus kab mob rubella;
caesarean seem yam tsis muaj kev ua haujlwm dhau los;
aspiration ntawm meconium (uas tshwm sim feem ntau nyob rau hauv lub sij hawm tom qab los yog tag nrho lub sij hawm yug los ntawm caesarean seem);
mob ntsws pulmonary hypertension;
ib ntus tachypnoea ntawm tus me nyuam mos (neonatal ntub ntsws syndrome);
broncho-pulmonary dysplasia;
cov kwv tij yug ntxov ntxov thiab/los yog muaj mob plawv.

Cov yam ntxwv uas txo qhov kev pheej hmoo rau menyuam yaus RDS (neonatal respiratory distress) yog:

fetal loj hlob retardation
pre-eclampsia;
eclampsia;
niam hypertension;
ntev rupture ntawm daim nyias nyias;
niam txiv siv corticosteroids.

Pathophysiology

Txhua tus menyuam mos yug tshiab ua lawv thawj txoj kev ua pa thaum lawv los rau hauv lub ntiaj teb.

Ua li no, cov me nyuam mos yuav tsum tau ua kom lub ntsws mob siab vim tias lub ntsws tau tawg tag thaum yug los.

Nyob rau hauv ib txwm muaj xwm txheej, lub xub ntiag ntawm surfactant tso cai rau saum npoo ntawm lub alveolus kom txo qis, ua rau nws muaj peev xwm tswj tau qhov seem ua haujlwm muaj peev xwm thiab yog li pib kev tshoov siab ntawm qib siab ntawm lub ntsws siab-ntim nkhaus: nrog rau txhua txoj cai, lub residual functional muaj peev xwm nce mus txog rau thaum nws mus txog qhov qub.

Qhov txawv txav tsis zoo thiab qhov ntau ntawm surfactant nyob rau hauv cov me nyuam muaj mob ua rau lub cev qhuav dej ntawm cov txheej txheem alveolar thiab qhov tsis sib xws ntawm qhov cua.

Raws li tus naj npawb ntawm kev sib tsoo alveoli nce, tus me nyuam mos raug yuam, txhawm rau kom ua pa kom txaus, siv cov txheej txheem them nyiaj dynamic txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau qhov kawg, yog li tiv thaiv lub alveoli los ntawm kev kaw:

tsub kom qhov tsis zoo ntawm intrapleural siab thaum kev tshoov siab;
ua kom cov leeg inspiratory tonically nquag nquag thaum exhalation, uas ua rau cov tav tawb ntau nruj;
tsub kom txoj kev ua pa los ntawm adducting lub suab qaum thaum exhalation;
nce qhov ua pa thiab txo lub sij hawm tas sij hawm.

Lub distensibility ntawm lub hauv siab phab ntsa, uas yog ib qho zoo dua thaum lub sij hawm tus me nyuam, thaum lub fetus yuav tsum dhau los ntawm lub utero-qhov chaw mos kwj dej, yuav ua tau ib tug tsis zoo thaum tus me nyuam mos RDS inhales thiab sim nthuav lub ntsws uas tsis yog-distensible, qhov tseeb, raws li ib tug tshwm sim. intra-pleural siab negativity generated nyob rau hauv lub sim mus nthuav lub ntsws tsis-distensible nce, muaj ib tug traction mus rau sab hauv ntawm lub tav tawb thiab qhov tshwm sim no txwv lub ntsws expansion.

Kev loj hlob ntawm lub ntsws atelectasis kuj ua rau txo qis hauv cov khoom seem seem, uas ua rau hloov pauv roj ntsws ntxiv.

Yog li ntawd, hyaline daim nyias nyias yog tsim, tsim los ntawm cov khoom muaj protein ntau uas ua los ntawm lub ntsws puas, uas ntxiv kom txo tau lub ntsws distensibility; Lub xub ntiag ntawm cov qauv no, yog li ntawd, ua rau daim duab pathological no hu ua 'hyaline membrane kab mob', ib qho kev qhia siv yav dhau los los xaiv tus mob no.

Cov kua protein exuding los ntawm puas alveoli ua rau inactivation ntawm scarce surfactant tam sim no.

Lub xub ntiag ntawm cov kua dej no thiab ua rau hypoxemia ua rau muaj qhov loj ntawm thaj chaw intrapulmonary shunt uas ntxiv inhibit surfactant kev ua si.

Ib tug ntshai vicious vajvoog yog li generated, yam ntxwv los ntawm ib tug nruam succession ntawm

txo surfactant ntau lawm
atelectasis;
txo lub ntsws distensibility;
hloov qhov cua / perfusion (V / P) piv;
hypoxemia;
ntxiv txo nyob rau hauv surfactant ntau lawm
ua phem rau atelectasis

Pathological lub cev

Macroscopically, lub ntsws zoo li ib txwm loj, tab sis muaj ntau dua compact, atelectatic thiab muaj xim liab-liab ntau dua li lub siab. Lawv kuj hnyav dua li qub, ntau heev kom lawv tog thaum raus hauv dej.

Microscopically, lub alveoli tsis zoo tsim thiab feem ntau vau.

Nyob rau hauv cov ntaub ntawv ntawm kev tuag ntxov ntawm tus me nyuam mos, ib tug pom muaj nyob rau hauv lub bronchioles thiab alveolar ducts ntawm cellular khib nyiab tshwm sim los ntawm lub necrosis ntawm lub alveolar pneumocytes, uas, nyob rau hauv cov ntaub ntawv ntawm kev ciaj sia taus, yog encased nyob rau hauv pinkish hyaline daim nyias nyias.

Cov daim nyias nyias no npog cov pa bronchioles, alveolar ducts thiab, tsawg zaus, cov alveoli thiab muaj fibrinogen thiab fibrin (nrog rau cov khib nyiab necrotic tau piav saum toj no).

Lub xub ntiag ntawm cov tshuaj tiv thaiv tsis muaj zog tuaj yeem raug sau tseg.

Lub xub ntiag ntawm hyaline daim nyias nyias yog cov ntsiab lus ntawm pulmonary hyaline membrane kab mob, tab sis lawv tsis tshwm sim hauv cov me nyuam yug los yog cov me nyuam mos uas muaj sia nyob tsuas yog ob peb teev.

Yog hais tias tus me nyuam muaj sia nyob ntev dua 48 teev, qhov tshwm sim rov qab pib tshwm sim: kev loj hlob ntawm alveolar epithelium thiab desquamation ntawm daim nyias nyias, cov khoom tawg mus rau hauv cov hlab ntsha uas lawv tau zom los yog phagocytosed los ntawm cov ntaub so ntswg macrophages.