兒科學

1、Pulmonary hemorrhage: What do we know? What do we need to learn?,2,Pulmonary hemorrhage and PDAPulmonary hemorrhage and exogenous surfactant (PS)Management of Pulmonary hemorrhage (PH)Surfactant use for Pulmonary hem

2、orrhage beyond RDS,3,Pulmonary hemorrhage and PDA,Currently, PH complicates the hospital course of 3-5% of preterm infants with RDS. The cause of PH is thought to be due to a rapid lowering of intrapulmonary pressure, w

3、hich facilitates L→R shunting across a PDA and an increase in pulmonary blood flow.Hemorrhagic edema fluid rather than whole blood,4,Pulmonary hemorrhage and exogenous surfactant,The surfactant itself has no effect on d

4、uctal contractility Rapid decline in pulmonary vascular resistance favoring an earlier clinical presentation of the ductus in preterm infants and in experimental animal models,5,Pulmonary hemorrhage and exogenou

5、s surfactant,Whether PS therapy increases the risk of PH? (controversial) The meta-analysis supports an increase in the risk of PDA and PH associated with prophylactic synthetic surfactant administration Cochr

6、ane Database Syst Rev. 2000;(2):CD001079.Natural surfactant extract for prevention and treatment of RDS No differences are reported in the risk of PDA Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007836.,6,Ma

7、nagement of Pulmonary hemorrhage,Pathogenesis of this disorder is not well understoodTherapy remains nonspecific and supportiveNo published trials are available in prevention or treatment of PH,7,Management of Pulmona

8、ry hemorrhage,Allow adequate ventilationMechanical ventilation PEEP: 6-8cmH2O ↓efflux of hemorrhagic fluid → alveolar space ↓ L→R ductal shunting HFV vs CMV (effective?),8,Management of Pulmonary hemorr

9、hage,Treat the metabolic acidosisMaintain adequate tissue perfusion Fluid (blood, NS, or albumin), pressorsPharmacologic closure of PDA Ibuprofen versus indomethacinAggressive correction of coagulopathy (FFP,

10、 cryoprecipitate),9,Surfactant use for Pulmonary hemorrhage,Retrospective case reports and one prospective uncontrolled study that used surfactant for PH in neonates have shown promising results in treating PH. Pulmona

11、ry haemorrhage, which some consider a complication of PS therapy, has also been effectively managed using surfactant instillation. The Hb and RBC lipids may act to inhibit natural surfactant and treatment with PS has be

12、en shown to improve outcome for infants with PH.,10,Surfactant use for Pulmonary hemorrhage,Surfactant has also been used to treat massive pulmonary haemorrhage, the rationale being that blood is known to inhibit surfact

13、ant function. The evidence for benefit of this strategy mainly comes from observational studies as randomised controlled trials are difficult to perform because of the unpredictable nature of the problem. Aziz A. S