Chapter 1987 【1987】Unexpected

Where is the fear of atelectasis?

The alveoli do not open, and there is no gas exchange, indicating that the patient is severely hypoxic, and even died of suffocation. Such symptoms of hypoxia and asphyxia are called respiratory distress syndrome, or RDS in English. In adult patients, it is called adult RDS, referred to as ARDS, plus an A. Neonatal respiratory distress syndrome is NRDS, add an N. Why should the two be separated, because the causes of respiratory distress syndrome in adults and newborns are not the same.

Adult ARDS, like SARS, which left a deep impression on us, is mainly caused by severe infection. In the lungs of patients with severe infection, the virus inactivates a large amount of alveolar surfactant called PS, and the alveoli collapse.

At the same time, a large amount of mucus can be produced to block the bronchi, resulting in bronchial mechanical obstruction that cannot be ruled out, eventually leading to the death of the patient due to severe hypoxia.

The treatment plan must be anti-infection first. The effect of anti-infection can only be greatly reduced if there is no specific drug against a certain virus. The only remaining methods for doctors are bronchoscopy and physical solutions such as back slapping and coughing up sputum. These remaining life-saving methods become especially important in the rescue of such patients. So this kind of ward needs a lot of nurses to assist in the rescue. For the rest, the patient's own immune system can only rely on the patient's own immune system to fight the infection. But relying on the patient's own immune system to fight infection has another fatal point, which is the immune storm we can hear doctors say, and it is also one of the important causes of death for such patients.

It can be seen that for patients with adult respiratory distress syndrome, the current medical methods are limited, which has always made clinicians very afraid. When encountering a new respiratory virus infection like SARS, we can only adopt more distant and ancient methods such as isolation. There is no way, there is no cure.

In addition to infection, adult respiratory distress syndrome can have factors such as trauma and foreign body inhalation. The process is also more dangerous and the fatality rate is high.

In contrast, NRDS, Neonatal Respiratory Distress Syndrome, occurs mainly in preterm infants. The etiology of this kind of children is relatively simple in retrospect, and it seems to be relatively easy to treat.

To understand the source of neonatal respiratory distress syndrome, we must first understand the mechanism of normal babies leaving the mother's body. First, the lungs are atelectatic and the alveoli are not inflated when the fetus is not self-breathing in the mother's womb. After birth, the baby needs to rely on the alveolar surfactant given by the mother to make the baby's lungs inflate automatically. Premature infants lack this substance due to leaving the mother's body early and cannot get the gift from the mother. The alveoli cannot be inflated and opened, resulting in difficulty in breathing.

Going back to the lung-promoting acupuncture mentioned by Dr. Hu at the beginning of the discussion, the most commonly used drugs in clinical practice are hormonal drugs such as dexamethasone, which use this mechanism of action to induce fetal lung type 2 cells to produce alveolar surfactant PS, ultimately avoid white lung to avoid respiratory distress.

The current situation is an emergency, and the doctor failed to give the mother a lung-promoting acupuncture in advance. As a result, the baby who was born early has symptoms of respiratory distress, as Dr. Hu said, which is expected by the medical staff. up.

Now that we know that the baby is short of this thing and causes respiratory distress, can we directly give the baby alveolar surfactant? sure. The question is, where is there such a thing in the small health center?

This medicine is expensive. General hospitals that do not have a neonatology department will not have such specialized expensive medicines.