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新生儿呼吸窘迫综合征(RDS)是新生儿最常见的呼吸系统疾病之一。70年代初期应用呼吸器作辅助呼吸以来,病死率明显降低,国外某些单位RDS存活率达90％左右,并认为RDS存活率与呼吸管理的水平密切有关。本文综合国外文献对RDS的呼吸管理作一简单介绍。病理生理婴儿肺脏缺乏肺泡表面活性物质,肺泡就萎陷,肺顺应性降低,仅及正常的25％,功能残余气量及肺容量减少,使呼吸功增加,但呼吸道阻力改变不大。由于换气面积减少,以及透明膜形成使肺泡隔增厚,造成氧的弥散障碍,通气-灌流比例失调,形成肺内分流,是RDS产生低氧血症的主要原因。由于通气不足,CO_2不能充分排出,产生呼吸性酸中毒。RDS的其他病理生理改变如代谢性酸中毒,持续胎儿循环和低血压等均继发于低氧血症。
Neonatal respiratory distress syndrome (RDS) is one of the most common respiratory diseases in newborns. Since the early 1970s, respirators have been used to assist respiration. The mortality rate has been significantly reduced. RDS survival rate in some foreign countries is about 90%. RDS survival rate is closely related to the level of respiratory management. In this paper, a comprehensive introduction of foreign literature on respiratory management of RDS. Pathophysiology The lack of alveolar surfactant in the lungs of the infant lungs resulted in collapsing of the alveoli and a reduction in lung compliance of only 25% of normal, with reduced residual capacity and lung capacity, resulting in an increase in respiratory work but with little change in respiratory resistance. As the ventilation area decreases, and the formation of transparent membrane alveolar septum thickening, causing oxygen diffusion barrier, ventilation - perfusion ratio imbalance, the formation of pulmonary shunt, is the main reason for RDS hypoxemia. Due to lack of ventilation, CO_2 can not be fully discharged, resulting in respiratory acidosis. Other pathophysiological changes in RDS, such as metabolic acidosis, persistent fetal circulation and hypotension are secondary to hypoxemia.