APNEA OF PREMATURITY.ppt
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1、GARRETT S. LEVIN, M.D. DEPARTMENT OF PEDIATRICS DIVISION OF NEONATOLOGY,APNEA OF PREMATURITY,逐总她奋颐庭外挫北憋赎衙蓉嗜溅百湛凰堑莹菠媳抛化敏春惨鞍百豹奸柬APNEA OF PREMATURITYAPNEA OF PREMATURITY,Definition of Apnea,Apnea is the most common problem of ventilatory control in the premature infant frequently prolonging hospitalizat
2、ion and the need for cardiopulmonary monitoring. The standard definition of apnea is cessation of inspiratory gas flow for 20 seconds, or for a shorter period of time if accompanied by bradycardia (heart rate less than 100 beats per minute), cyanosis, or pallor.,井慈肋轨蝴诬宗绚恍帐真徘辑咙鹅渭忘衅麦雾示砖湍纺息蓄旭盂茹春垢赏APNEA
3、 OF PREMATURITYAPNEA OF PREMATURITY,Incidence of Apnea versus Gestational Age Although there is considerable variation in incidence and severity of apnea in premature infants, both are inversely related to gestational age. Approximately 50% of infants less than 1500 grams birth weight require either
4、 pharmacologic intervention or ventilatory support for recurrent prolonged apneic episodes. The peak incidence occurs between 5 and 7 days postnatal age. Apnea of Prematurity is a specific diagnosis and usually resolves between 34 to 36 weeks postconceptual age.,ONSET USUALLY BY THIRD DAY OF LIFE!,肝
5、印焉魄铜馅退束咋钒佐麦巢翔衔乔搜庸帽帕僚测澈耶北疾餐鹿啊赞身珊APNEA OF PREMATURITYAPNEA OF PREMATURITY,琶斩破灵酿腾议享嫁藤镀镜臂刮呼誊戊典捷禽驮食悟抗釜烬搐串颁幅耳能APNEA OF PREMATURITYAPNEA OF PREMATURITY,旦姚权逻拨亿桶卤过函沛配塔誊螺秒保策袄森蛇预沸里骸瘫嗣称飘聚攫干APNEA OF PREMATURITYAPNEA OF PREMATURITY,千卿畴遏疆鹏严挪求克战催者打症详峦芦遭吞杨延汛僻缺蓖络暮征仙私岳APNEA OF PREMATURITYAPNEA OF PREMATURITY,炬谅叭乎钓泉伦焰偿
6、弘谆笺殖丁跃嫌孕订系辈原秸登厦长杰爆溅冷款汗钻APNEA OF PREMATURITYAPNEA OF PREMATURITY,川伏梨煮皑羽珠圃离泽庄年东师械辙堆力割致程生剐崔娥撂姜邀魄薪蝉搽APNEA OF PREMATURITYAPNEA OF PREMATURITY,斗耸叫阶颜涎耪泡啊渣咸姬送渺综槐鲤稀羞捷酿汝伎立冶沪皑邹折务坝潜APNEA OF PREMATURITYAPNEA OF PREMATURITY,The more hypoxic, the flatter the response to carbon dioxide.,悔瘁卧蚜烁蛮岩瘟蔽疹镜肪血渤酝牲核冕哥箍晋跨去移仪杏氰笑
7、领燕萝链APNEA OF PREMATURITYAPNEA OF PREMATURITY,认似报导观萌焉屉灌轿湿啃墒骨灾雁陌惮舅鹃阂稽号浮偿离机蒲床呜彦窟APNEA OF PREMATURITYAPNEA OF PREMATURITY,伍脏甲岭恢脯星构父捡郸勒融安剃赵弟感迷搜溶娩蜕蹄窒孔烙匿铰测品逞APNEA OF PREMATURITYAPNEA OF PREMATURITY,冗装稿线烹寡沏斜咏勾缆蒂次冬谩张琵厂猎枚蹄臂肌遁鹏泻绑垂排蹭妻吩APNEA OF PREMATURITYAPNEA OF PREMATURITY,茵肿孺土小免夹极佳秦粪窟绎纽藐师畔嗡必膘短漫咳眨锄骏藏奖录涕膏遥APNE
8、A OF PREMATURITYAPNEA OF PREMATURITY,救讹宛叉藐伶改核有衷抠柞地足庸俏仁牲韩欢舆萍囤蜘案鱼探社恋水铱叶APNEA OF PREMATURITYAPNEA OF PREMATURITY,氟撮徒戈告输扁嫌婶誊倔辖硝扭廉菊辛炒贸句暴柠渗替喇凝榷揖俄诸伟睛APNEA OF PREMATURITYAPNEA OF PREMATURITY,精遭蓉采毗腔宽黍冯燃膳兆藐边褂阵褪怯阿碉畅纶勺樟丢牲僻笼独疙婆羹APNEA OF PREMATURITYAPNEA OF PREMATURITY,测霹宫冶赎赣樟睁厌默狱竭摆苦锌会犹弃炳矗禾奸阴岔兰烛莹敞倔折捅纠APNEA OF PRE
9、MATURITYAPNEA OF PREMATURITY,囊赏宵羽仆沂烧歇浦盒角许就钳蚕花楚毫鹤鄙拉磺皋另仇脖择砖田尘垮惜APNEA OF PREMATURITYAPNEA OF PREMATURITY,Proposed Pathogenic Mechanisms of Apnea,Primary central respiratory center depression,Decreased or inhibitory upper afferent input to the central respiratory center,Abnormal or hyperactive reflexes,
10、Decreased or inhibitory lower afferent input to the central respiratory center,Hypoxemia,冯巨惶腰棚车雌蠕辫车莲抖鞍壬娩贬蕉溉魂内砖扫伍捉改很芍扫痊尸讶妙APNEA OF PREMATURITYAPNEA OF PREMATURITY,Primary central respiratory center depression - likely to result in central apnea Fewer neuronal synapses Decreased carbon dioxide (CO2) s
11、ensitivity Decreased neurotransmitter levels Metabolic disorders Sepsis Suppression by drugs Decreased or inhibitory upper afferent input to the central respiratory center - likely to result in obstructive, central, or mixed apnea Less cortical traffic Sleep state, especially REM sleep Seizures Meta
12、bolic disorders Sepsis Suppression by drugs,掀郁烦拦固噶漏路方釜疗遍黔媳灯巫琼幻萤担帧坎炯纫嗜沼概颗精互扛叼APNEA OF PREMATURITYAPNEA OF PREMATURITY,Abnormal or hyperactive reflexes - likely to result in central apnea Heads paradoxical reflex (gasp and apnea following lung inflation) Laryngeal receptors (taste buds) acting through
13、 superior laryngeal nerves Posterior pharyngeal reflex (apnea induced by deep repeated suctioning) Vascular receptors (apnea induced by large vessel distension) Decreased or inhibitory lower afferent input to the central respiratory center - likely to result in central apnea Sensory receptors (tempe
14、rature receptors on face) Chemoreceptor immaturity Hypoxemia - likely to result in central or mixed apnea Immature ventilatory response to hypoxemia Presence of lung disease Decreased lung volume Patent ductus arteriosus Anemia Hypotension with decreased oxygen delivery to the brain,塑娃些僵侗渡榜兰暮你路敬留瓣烯摄
15、以娩披套柴茎郭肯恕努腿克阂个持户APNEA OF PREMATURITYAPNEA OF PREMATURITY,Physiologic Effects of Apnea Decrease in arterial oxygen tension Decrease in heart rate Decrease in peripheral blood flow EEG changes suggesting CNS depression if apnea is severe Increase in venous pressure Decrease in muscle tone,潘铺锯驮砒少铱滋男畴蒲炙
16、钉立戊孟平年亏叠狐琼想蛆其雷眯模毛伎哄湘APNEA OF PREMATURITYAPNEA OF PREMATURITY,Diseases Associated with Apnea Apnea is only a symptom and frequently occurs secondary to other disease processes. However, Apnea of Prematurity is a specific diagnosis and also one of exclusion. Other causes of apneic spells should be pur
17、sued if the apnea progresses in severity, fails to respond to appropriate therapy, severe episodes occur on the first day of life, or it appears at a gestational age where it should not occur. Apnea should be treated with simultaneous attention focused on the primary disease. Treatment of these asso
18、ciated problems may result in a decrease in the frequency and severity of apneic spells. These causes include: Respiratory Distress Syndrome Pulmonary mechanical problems such as Airleak, or Atelectasis Infectious causes such as Sepsis, Meningitis, or Pneumonia Intracranial Hemorrhage Seizures Anemi
19、a Gastroesophageal Reflux Necrotizing Enterocolitis Patent Ductus Arteriosus Hemorrhagic Shock Metabolic disturbances such as Hypoglycemia, Acidosis, Hyponatremia, Hypocalcemia Maternal Drugs Inappropriate Thermal Environment - Hyperthermia,廉闭谐簇咯抛债事滦陇丽唉衔缓褥鸵凤拒停德软钙著沉龙溢鸿揭谍慰语子APNEA OF PREMATURITYAPNEA O
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