围生期过渡医学课件.ppt

Perinatal Transition围生期过渡;From intrauterine to extra-uterine environment从宫内到子宫外环境;Common Cardiorespiratory Disorders of Perinatal Transition围产期过渡期常见的心肺障碍:;Physiologic Transition 生理过渡;Physiologic Transition;Fetal Circulation 胎儿循环;The Fetal Lung;Perinatal Events:;33% during labor, with increased catecholamine release, there is increased blood flow to the fetal lung with concomitant increased PaO2 which increases gene expression of eNaC 33% at birth and short thereafter, initial effective breaths generate high transpulmonary pressures: up to -50 cmH2O during inspiration. The negative hydrostatic pressure drives alveolar fluid from the air spaces into the interstitium ;Perinatal Events:;9、 人的价值，在招收诱惑的一瞬间被决定。*** 10、低头要有勇气，抬头要有低气。**** 11、人总是珍惜为得到。***** 12、人乱于心，不宽余请。**** 13、生气是拿别人做错的事来惩罚自己。***** 14、抱最大的希望，作最大的努力。**** 15、一个人炫耀什么，说明他内心缺少什么。。***** 16、业余生活要有意义，不要越轨。*** 17、一个人即使已登上顶峰，也仍要自强不息。****;Variation in PVR and SVR;Relationship between PAP and SAP;Critical signals for drop in PVR: Mechanical distension of the lung, decreased PaCO2 and increased PaO2 The fetus in late gestation increases pulmonary expression of nitric oxide synthase (NOS) and soluble guanylate cyclase The prostacyclin pathway is also potentially important: COX-1 is upregulated during late gestation, leading to increase production of prostacyclin ;Beginning of transition…;Successful transition;Pathophysiology of PPHN;Types:;There will be a quiz at the end;Lung diseases associated with PPHN in 299 neonates enrolled in the early iNO study in FT and late Preterm newborns 2004 data.;Etiology of PPHN (Steurer et al, Pediatrics 2017;Idiopathic PPHN (?);Other causes of PH;Management;Vasopressin ;Respiratory Management:;Oxygen and Ventilation;Medications: iNO;NO signaling pathway;Sildenafil;Sildenafil;Sildenafil in PPHN;Prostanoids: Epoprosterol;Prostanoids:;Prostacyclin signaling pathway;Prostanoids: Iloprost;Endothelin-1;Endothelin-1 Receptors: ETA and ETB;(?), Hypoxia, shear stress, decreased blood flow, adren