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1、新生兒呼吸困難浙江大學(xué)醫(yī)學(xué)院附屬兒童醫(yī)院孫眉月病因分三類肺部疾病RDS、TTN、MAS、肺氣漏、肺炎、肺出血、肺發(fā)育不良、慢性肺部疾病氣道及肺阻塞性疾病氣道阻塞（喉氣管軟化）、肺受壓（膈疝）非肺部疾病先心、心功能不全、貧血、多血、低體溫、窒息后病史注意點(diǎn)妊娠周齡母親情況糖尿病產(chǎn)前大出血宮內(nèi)生長(zhǎng)遲緩多胎妊娠感染史（羊膜早破、母親發(fā)熱）以往RDS史胎兒窘迫、臍血pH、復(fù)蘇情況體檢注意點(diǎn)胎齡評(píng)估,紫紺情況,呼吸困難嚴(yán)重度,呼吸節(jié)律、呼吸次數(shù),全身情況（灌注,心功中樞）治療原則氧療CPAP及機(jī)械通氣Fio
2、2>0.5才能維持PaO250mmHg開放氣道及氣道物理治療置于中性環(huán)境溫度，維持正常體溫容量及心功能維持液體需24小時(shí)勻速輸入抗菌素治療病因?qū)W診斷胸部X光片、血細(xì)胞計(jì)數(shù)、血?dú)庋囵B(yǎng)、透光試驗(yàn)PulmonarycausesoftachypneaMechanical(restrictive)Ribcageanomalies(asphyxiatingthoracicdystrophy)PneumothoraxPneumomediastinumPleuraleffusionChylothoraxSeve
3、reabdominaldistensionPulmonarycausesoftachypneaDevelopmentalabnormalityTEFCCAMCDHSequestrationPulmonaryhypoplasiaLobaremphysemaLungcystPulmonarycausesoftachypneaAirwayanomaliesChoanalstenosis,atresiaLaryngealwebLaryngotracheomalaciaBronchomalciaSubglo
4、tticstenosisPulmonarycausesoftachypneaParenchymalTTN,HMDPulmonaryedemaDelayedmaturationofepithelialsodiumchannel(ENaC)Aspirationsyndromes-meconium,mucus,milk,bloodPneumoniaPneumatocelePulmonaryhemorrhageInterstitialpneumonitisPPHNNonpulmonarycausesoft
5、achypneaCardiacLeft-to-rightshunt–pulmonarybloodflowCongestivecardiacfailurePDATruncusCoarctation/interruptedaorticarchAtrioventricular(AV)canalAVmalformationwithhighoutputfailureNonpulmonarycausesoftachypneaNeurologicPostasphyxialstateSubarachnoidhem
6、orrhageInfections—meningitisMetabolicMetabolicacidosisHypoglycemiaHypocalcemiaSepsisNonpulmonarycausesoftachypneaMiscellaneousHyperthermiaHypothermiaNarcoticwithdrawalPainHirschsprung’sLargeforgestationalage-infantofdiabeticmother(LGA-IDM)Trisomy-21Cl
7、inicalhistoryanddiagnosisofcausesfortachypneaHistoryLikelydiagnosisMaternalhistoryDiabetesTTN,RDS,hypoglycemia,LGA,CHDAsthmaTTNDrugsNarcoticwithdrawalPregnancyinducedIntrauterinegrowthretardation(IUGR),hypertension(PIH)polycythemia,hypoglycemiaPolyhyd
8、ramniosTEFPrevioussiblingwithSPBdeficiency,GBSpneumoniarespiratorydistressOligohydramniosPulmonaryhypoplasiaClinicalhistoryanddiagnosisofcausesfortachypnea(cont’)HistoryLikelydiagnosisLaboranddeliveryProlongedruptureofSepsis,pneumoniamembranes
