Hyaline membrane kab mob yog ib qho kev sib txuas nrog lub npe hu ua respiratory distress syndrome (RDSD). Qhov kev kuaj mob no yog tsim rau cov menyuam yug ntxov ntxov uas ua tsis taus pa thiab cov neeg uas muaj kev ua pa nyuaj thiab tachypnea, suav nrog.
Hauv cov menyuam mos, thaum nqus cua hauv chav, lub hauv siab thim rov qab thiab kev loj hlob ntawm cyanosis tau sau tseg, uas txuas ntxiv mus thiab nce ntxiv thaum thawj plaub caug yim mus rau cuaj caum-rau teev ntawm lub neej. Nyob rau hauv cov ntaub ntawv ntawm lub hauv siab x-ray, tus yam ntxwv sab nraud daim duab (reticular network nrog rau peripheral cua bronchogram) tshwm sim. Kev kho mob ntawm cov kab mob ntawm cov kab mob hyaline membrane ncaj qha nyob ntawm qhov hnyav ntawm tus menyuam, thiab ntxiv rau, ntawm qhov hnyav ntawm tus kab mob, kev ua haujlwm ntawm kev hloov pauv, muaj cov kab mob sib kis, qib ntawm cov ntshav hla dhau ntawm cov hlab ntsha qhib. duct thiab kev siv ntawm mechanical ventilation.
ua rau ntawm pathology
Hyaline membrane kab mobpom feem ntau hauv cov menyuam yug los rau cov niam uas raug kev txom nyem los ntawm ntshav qab zib, kab mob plawv thiab vascular, uterine los ntshav. Pab txhawb rau txoj kev loj hlob ntawm tus kab mob no muaj peev xwm ntawm intrauterine hypoxia nyob rau hauv ua ke nrog asphyxia thiab hypercapnia. Vim tag nrho cov no ua rau cov kab mob hyaline membrane, nws yuav ua rau lub ntsws txoj hlab ntsws cuam tshuam, tawm tsam cov alveolar septa ua impregnated nrog serous kua.
Microglobulin deficiency nrog rau kev txhim kho ntawm kev tshaj tawm nrog rau cov ntshav coagulation hauv zos muaj qee lub luag haujlwm hauv qhov tshwm sim ntawm tus kab mob raws li kev xav. Txhua tus poj niam cev xeeb tub nyob nruab nrab ntawm nees nkaum-ob thiab peb caug-plaub lub lis piam ntawm cev xeeb tub thaum muaj menyuam ntxov ntxov raug suav hais tias yog cov neeg mob uas xav tau kev tiv thaiv kev xeeb tub nrog glucocorticoids yam tsis tau poob. Qhov no pab txhawb rau kev loj hlob ntawm lub ntsws surfactant nyob rau hauv lub fetus npaj rau yug.
Symptoms
Kev kho mob tshwm sim nrog cov cim qhia ntawm ntxov ntxov ntxov muaj xws li nquag ua pa ua pa, uas tshwm sim tam sim lossis ob peb teev tom qab yug me nyuam, nrog o ntawm lub qhov ntswg tis thiab tshem tawm ntawm lub sternum. Yog tias atelectasis thiab ua pa tsis ua haujlwm, thiab cov tsos mob hnyav zuj zus, ces cyanosis tshwm sim ua ke nrog lethargy, ua pa tsis ua haujlwm thiab apnea. Cov tawv nqaij yog cyanotic.
Cov menyuam mos liab uas hnyav dua 1000 grams tuaj yeem muaj lub ntsws nruj heev uas lawv tsuas ua tsis tau patus me nyuam hauv chav tsev me nyuam. Raws li ib feem ntawm kev ntsuam xyuas, lub suab nrov thaum kev tshoov siab tsis muaj zog. Lub peripheral mem tes yog tsawg, edema tshwm sim, thiab tib lub sij hawm diuresis kuj txo.
Diagnosis
Nyob rau hauv cov txheej txheem ntawm kev kawm txog tus mob ntawm tus menyuam mos uas muaj cov tsos mob ua ntej, kev soj ntsuam kev soj ntsuam tau raug tshawb fawb, cov roj muaj pes tsawg leeg ntawm cov hlab ntsha tau kawm (peb tab tom tham txog hypoxemia thiab hypercapnia). Tsis tas li ntawd, cov kws kho mob ua x-ray hauv siab. Kev kuaj mob yog ua raws li cov tsos mob, suav nrog cov xwm txheej txaus ntshai. Chest x-ray qhia tau tias diffuse atelectasis.
Kev kuaj mob sib txawv yog tsom rau kev txiav txim siab tawm sepsis thiab mob ntsws vim yog kab mob streptococcal, ntuav tachypnea, pulmonary persistent hypertension, aspiration, thiab pulmonary edema vim congenital malformations. Cov me nyuam mos feem ntau xav tau cov kab lis kev cai ntshav thiab tej zaum yuav muaj lub tracheal aspirate. Nws yog qhov nyuaj heev rau kev kho mob sib txawv ntawm cov kab mob streptococcal pneumonia los ntawm cov kab mob hyaline membrane. Yog li, raws li kev xyaum qhia, cov tshuaj tua kab mob tau sau tseg txawm tias ua ntej kab lis kev cai tau txais.
Txoj Kev Tshawb Fawb
Hyaline membrane kab mob hauv cov menyuam yug tshiab tuaj yeem xav tias ua ntej yug menyuam los ntawm kev kuaj lub ntsws kom loj tuaj. Kev tsom xam yog nqa tawm siv cov kua amniotic tau los ntawm amniocentesis los yog sau los ntawm qhov chaw mos (nyob rau hauv cov ntaub ntawv ntawm rupture ntawm lub amniotic membrane). Qhov no pab txiav tximpom zoo hnub yug. Cov txheej txheem no tsim nyog rau kev xaiv ua haujlwm mus txog rau peb caug-cuaj lub lis piam, thaum lub plawv dhia hauv plab nrog rau theem ntawm tib neeg chorionic gonadotropin thiab ultrasound tsis tuaj yeem tsim muaj hnub nyoog gestational. Kev kuaj kua amniotic yuav suav nrog:
- Kev txiav txim siab ntawm qhov piv ntawm lecithin thiab sphingomyelin.
- Kev tsom xam ntawm cov npuas tsim kev ruaj ntseg index.
- Ratio ntawm surfactant rau albumin.
Qhov kev pheej hmoo ntawm cov kab mob hyaline membrane hauv cov menyuam mos yuav qis dua yog tias tus nqi ntawm lecithin thiab sphingomyelin tsawg dua 2, nrog rau qhov ua npuas ncauj ruaj khov ntawm 47. Surfactant thiab albumin yuav tsum ntau dua 55 milligrams ib gram.
Kev kho mob
Yog tus menyuam ntxov ntxov lub ntsws tsis tau qhib, kev kho mob suav nrog cov hauv qab no:
- Siv cov surfactant.
- Npaj oxygen ntxiv raws li xav tau.
- Ua tshuab cua tshuab.
Kev soj ntsuam nrog kev kho mob zoo, kev tuag hauv qhov no tsawg dua kaum feem pua. Nrog kev txhawb nqa ua pa kom zoo, kev tsim surfactant tshwm sim dhau sijhawm, thaum nws pib tsim, kab mob hyaline membrane hauv cov menyuam yug tshiab tau daws tsis pub dhau plaub lossis tsib hnub. Tab sis hypoxia hnyav tuaj yeem ua rau ntau lub cev tsis ua haujlwm thiab txawm tuag.
Kev kho tshwj xeeb rau cov kab mob hyaline membrane suav nrog cov tshuaj intracheal surfactantkev kho mob. Nws yuav tsum tau tracheal intubation, uas tej zaum yuav tsim nyog kom ua tiav qhov cua thiab oxygenation. Cov menyuam mos ntxov ntxov uas hnyav dua li ib kilogram thiab cov menyuam mos uas xav tau cov pa oxygen qis dua plaub caug feem pua tuaj yeem teb tau zoo rau O 2, nrog rau kev kho qhov ntswg qhov ntswg. Lub tswv yim ntawm kev kho mob surfactant thaum ntxov ua ntej txiav txim siab qhov txo qis hauv lub sijhawm ntawm kev tso pa tawm thiab txo qis hauv qhov tshwm sim ntawm bronchopulmonary dysplasia.
Surfactant accelerates rov qab thiab txo qhov kev pheej hmoo ntawm pneumothorax, intraventricular hemorrhage, interstitial emphysema, pulmonary dysplasia thiab tuag hauv ib xyoos. Tab sis hmoov tsis, cov me nyuam mos uas tau txais kev kho mob zoo sib xws rau tus mob no muaj kev pheej hmoo ntawm apnea ntawm prematurity.
Tshuaj qhib ntsws rau cov menyuam mos ntxov ntxov
Kev hloov pauv surfactant ntxiv suav nrog Beractant, nrog rau Poractant Alfa, Calfactant thiab Lucinactant.
Tshuaj "Beractant" yog ib qho lipid extract ntawm bovine ntsws, uas yog ntxiv nrog cov protein "C", "B", ntxiv rau colfosceryl palmitate, tripalmitin thiab palmitic acid. Qhov ntau npaum li cas yog 100 milligrams ib kilo ntawm lub cev qhov hnyav txhua 6 teev raws li xav tau txog li plaub koob.
"Poractant" yog ib qho kev hloov pauv tau los ntawm lub ntsws porcine. Cov tshuaj muaj phospholipids ua ke nrog nruab nrab lipids, fatty acids thiabsurfactant-associated proteins B thiab C. Cov koob tshuaj muaj raws li hauv qab no: 200 milligrams ib kilo, ua raws li ob koob tshuaj 100 milligrams ib kilogram ntawm lub cev qhov hnyav txhua kaum ob teev raws li xav tau.
"Calfactant" ua haujlwm ua lub ntsws calfactant muaj phospholipids nrog rau nruab nrab lipids, fatty acids, thiab surfactant-related proteins B thiab C. Cov koob tshuaj yog 105 milligrams ib kilogram ntawm lub cev qhov hnyav txhua txhua kaum ob teev mus txog peb. koob tshuaj raws li xav tau.
"Lucinactant" yog cov khoom siv hluavtaws uas suav nrog synapultide peptide, phospholipids thiab fatty acids. Kev noj tshuaj yog 175 milligrams ib kilogram ntawm lub cev qhov hnyav txhua 6 teev rau txog plaub zaug.
Nws tsim nyog sau cia tias kev ua raws li lub ntsws dav dav hauv tus menyuam mos tuaj yeem txhim kho sai tom qab kev kho mob no. Lub tshuab ua pa siab yuav tsum tau txo kom sai kom txo tau qhov kev pheej hmoo ntawm huab cua to.
Kev Tiv Thaiv
Txhawm rau tiv thaiv qhov sib txawv xws li kab mob hyaline membrane, cov tshuaj tshwj xeeb tau muab rau cov poj niam cev xeeb tub. Thaum lub fetus mus txog ntawm nees nkaum-tsib thiab peb caug-plaub lub lis piam, leej niam xav tau ob koob tshuaj Betamethasone, 12 milligrams txhua, muab intramuscularly raws nraim ib hnub sib nrug.
Los yog siv "Dexamethasone" 6 milligrams intramuscularly txhua kaum ob teev rau tsawg kawg ob hnub ua ntej xa khoom. Qhov no txo qhov kev pheej hmoo ntawm kev tsim tus kab mob hauv nqe lus nug.los yog txo qhov hnyav. Qhov kev tiv thaiv no txo qis qhov kev pheej hmoo ntawm cov menyuam mos tuag los ntawm kev ua pa ntawm lub ntsws hauv cov menyuam yug tshiab, nrog rau qee hom kab mob ntsws (xws li pneumothorax).
Ntse ntawm pathology
Cov kab mob no yog tshwm sim los ntawm qhov tsis muaj pulmonary surfactant, uas, raws li txoj cai, tau pom tshwj xeeb rau cov menyuam mos uas yug ua ntej peb caug-xya lub lim tiam ntawm cev xeeb tub. Kev tsis txaus feem ntau zuj zus ntxiv thaum ntxov ntxov nce.
Vim vim qhov tsis txaus ntawm surfactant, alveoli tuaj yeem kaw, uas ua rau muaj kev cuam tshuam atelectasis hauv lub ntsws, uas ua rau mob thiab o ntawm lub cev. Ntxiv rau qhov ua rau ua pa tsis ua haujlwm, muaj kev pheej hmoo ntawm hemorrhage, bronchopulmonary dysplasia, nro pneumothorax, sepsis, thiab ntxiv rau, kev tuag.
Yog tias tus poj niam hauv kev ua haujlwm yuav tsum muaj kev daws teeb meem ntxov ntawm lub nra, ces nws yuav tsum tau ntsuas qhov kev loj hlob ntawm lub ntsws los ntawm kev tshuaj xyuas cov kua amniotic rau qhov piv ntawm sphingomyelin, lecithin, thiab surfactant. thiab albumin. Nyob rau hauv cov ntaub ntawv ntawm pathology, intracheal surfactants thiab muab kev pab ua pa raws li xav tau.
Tus niam uas xav tau ntau koob tshuaj corticosteroids (peb tab tom tham txog Betamethasone thiab Dexamethasone) yog tias nws yuav yug los ntawm nees nkaum plaub thiab peb caug plaub lub lis piam. Corticosteroids ua rau kev tsim cov tshuaj surfactantnyob rau hauv ib tug fetus nrog ib tug tej yam degree ntawm prematurity thiab kev pheej hmoo ntawm hyaline membrane kab mob yog txo.
Txhais tau
Raws li qhov teeb meem, tus neeg mob yuav muaj kev pheej hmoo ntawm ductus arteriosus, interstitial emphysema, tsis tshua muaj pulmonary hemorrhage thiab mob ntsws. Cov tsos mob ntawm tus mob bronchopulmonary dysplasia, lobar emphysema, rov tshwm sim ntawm cov kab mob ua pa thiab cicatricial stenosis ntawm lub larynx raws li qhov tshwm sim ntawm intubation tsis suav nrog.
Dab tsi ua rau muaj kev pheej hmoo
Qhov kev pheej hmoo ntawm kev tsim tus kab mob hauv nqe lus nug nce ntxiv nrog rau qib prematurity. Raws li qhov kev ntsuas no, lub ntsws ntawm tus me nyuam mos tej zaum yuav yog ib feem los yog tag nrho tsis paub tab thiab yog li tsis muaj peev xwm muab kev ua pa kom txaus vim qhov tsis muaj lossis tsis txaus ntawm cov khoom siv surfactant. Hauv cov xwm txheej zoo li no, cov menyuam mos yug tshiab tau pom tias ua kev kho mob uas hloov cov tshuaj no.
"Dexamethasone" - cov tshuaj no yog dab tsi?
Ntau tus neeg xav paub yog vim li cas Dexamethasone tau sau rau hauv kev txhaj tshuaj. Cov tshuaj tam sim no tau nthuav dav hauv kev thov hauv cov tshuaj thiab yog ib qho hluavtaws glucocorticosteroid, uas muaj zog tiv thaiv kab mob thiab tiv thaiv kab mob. Tsis tas li ntawd, nws muaj peev xwm nkag mus rau hauv lub paj hlwb zoo. Ua tsaug rau cov peev txheej no, cov tshuaj no tuaj yeem siv rau hauv kev kho mob ntawm cov neeg mob uas muaj cerebral edema thiab txhua yam kab mob ntawm lub qhov muag. Ntawm no rauDab tsi yog qhov tshuaj txhaj "Dexamethasone".
Tshuaj nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj thiab cov tshuaj rau txhaj tshuaj muaj nyob rau hauv daim ntawv teev cov tshuaj tseem ceeb. Nws muaj peev xwm stabilize cell membranes. Nce lawv tsis kam mus rau qhov kev txiav txim ntawm ntau yam kev puas tsuaj. Hauv qhov no, nws yog siv los qhib lub ntsws ntawm cov menyuam mos uas muaj kev hem thawj ntawm kev tsim kab mob hyaline membrane.
Feem ntau, tshwj tsis yog tus kws kho mob tau qhia lwm yam, cov tshuaj tau muab ntawm 6 milligrams intramuscularly txhua kaum ob teev rau ob hnub. Muab hais tias nyob rau hauv peb lub teb chaws Dexamethasone tau muab faib ua feem ntau nyob rau hauv ampoules ntawm 4 milligrams, cov kws kho mob pom zoo kom nws intramuscular txhaj ntawm cov tshuaj no peb zaug nyob rau hauv ob hnub.
Lub hauv siab rov qab los ntawm kev tshoov siab
Tawm tsam keeb kwm ntawm pathology ntawm hyaline daim nyias nyias, qhov anterior ntawm lub hauv siab phab ntsa retracts, uas ua rau symmetrical lossis asymmetric funnel-shaped deformity. Tawm tsam keeb kwm yav dhau los ntawm kev ua pa sib sib zog nqus, qhov tob ntawm qhov funnel yuav loj dua vim qhov ua pa tsis zoo, uas yog vim qhov tsis zoo ntawm qhov sternal feem ntawm lub diaphragm.
Cov cim qhia ntxov ntawm tus kab mob nyob rau hauv kev txiav txim siab, raws li txoj cai, suav nrog qhov ua tsis taus pa ntawm cov menyuam mos ntxov ntxov uas ua pa ntau dua rau caum zaug hauv ib feeb, uas tau pom hauv thawj feeb ntawm lub neej. Tawm tsam keeb kwm yav dhau los ntawm kev loj hlob ntawm pathology, cov tsos mob kuj nce ntxiv, piv txwv li, cyanosis nce, diffuse crepitus tuaj yeem tshwm sim, apnea tam sim no nrog rau foamy thiab ntshav tawm ntawm qhov ncauj. Raws li ib feem ntawm kev ntsuas qhov hnyav ntawm kev ua pa tsis zoo, cov kws kho mob siv cov nplaiDowns.
Kev ua pa tawm hauv cov kab mob no
Qhov mob hnyav ntawm cov kab mob hyaline tuaj yeem ua rau ua pa nres. Hauv qhov no, tshuaj kho lub ntsws ua pa (ALV) raug tshuaj. Qhov kev ntsuas no yog siv rau cov ntsuas hauv qab no:
- Arterial ntshav acidity tsawg dua 7.2.
- PaCO2 sib npaug 60 millimeters mercury thiab saum toj no.
- PaO2 yog 50 millimeters mercury thiab qis dua thaum cov pa oxygen concentration hauv cov pa nqus tau los ntawm xya caum mus rau ib puas feem pua.
Yog li, tus kab mob xav tau hauv cov menyuam yug tshiab yog vim qhov tsis muaj peev xwm ntawm lub ntsws ntawm qhov hu ua surfactant. Qhov no feem ntau tshwm sim ntawm cov menyuam mos yug ua ntej peb caug-xya lub lim tiam. Txawm li cas los xij, qhov kev pheej hmoo nce ntxiv nrog rau qib prematurity. Cov tsos mob feem ntau muaj xws li ua tsis taus pa nyuaj nrog rau cov leeg nqaij koom nrog thiab alar flaring uas tshwm sim sai tom qab yug me nyuam. Kev pheej hmoo ua ntej yug menyuam tuaj yeem ntsuas tau los ntawm kev ua qhov kev kuaj mob hauv plab hauv plab. Kev sib ntaus tawm tsam pathology yog nyob rau hauv kev kho mob surfactant thiab kev txhawb nqa.
