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- 新生兒持續性肺動脈高血壓之臨床觀察
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- 新生兒持續性肺動脈高血壓
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題名 | 新生兒持續性肺動脈高血壓之臨床觀察 |
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作者姓名(中文) | 楊鵬弘; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 27:1 民75.01-02 |
頁次 | 頁18-25 |
分類號 | 417.517 |
關鍵詞 | 肺; 持續性; 高血壓; 動脈; 新生兒; 臨床; 觀察; |
語文 | 中文(Chinese) |
中文摘要 | 自民國70年1月至73年12月底,本院小兒科共有7例診斷為新生兒持續性肺動高血壓,其中2例為本院出生7例男女之比為5:2,平均出生週數為40.9±0.7 週,平均出生體重為3, 303.6±7.1gm,4例自然生產,2例真空吸引娩出,1例因有胎兒窘迫現象剖腹產出。5例於出生時有第一哭聲遲緩,3例有輕至中度胎便染色。7例之平均發作年齡為24.1小時,皆於使用100%O2及呼吸器下無法維持理想動脈血氧分壓後,給予tolazoline (2mg/kg靜脈注射後,再以2mg/kg/hr表脈點滴注射),並視患者血壓情形而定,同時給予5~10μg/kg/min不等之dopamine以維持血壓。結果7例中5例死亡。存活之2例,1例現年4歲,有智能不足,腦部機能受損之現象,1例現年10個月,目前無明顯神經學上之缺陷,唯需進一步追踪觀察。新生兒持續性肺高血壓之死亡率頗高,診斷上難與發紺性先天性心臟病相區病。如果能夠:①儘早確立診斷,②維持病兒適當的體溫、液體、養分及電解質之平衡,③給予適當的呼吸器輔助,④必要時及時給予適當量的tolazoline並注意其副作用,將有助於增加病患生存之機會,並使腦部受損之程度降至最低。 |
英文摘要 | Seven cases of persistent pulmonary hypertension in neonates were observed in the Chang Gung Memorial Hospital from January 1, 1981 to December 31, 1984; two of the patients were born in this Hospital. Of the total, five were male and two, female. All had hypoxemia and cyanosis upon arrival at the pediatric intensive care unit. The mean gestational age was 40.9±0.7 weeks; mean birth weight was 3,303.6±7.1gm; 4 cases were spontaneous delivery, 2 cased were delivered with vacuum, and one was delivered by Ceasarean section because of fetal distress. Five cases had delayed initial crying three cased had mild to moderate meconium stain. The mean onset age was 24.1 hours old. Tolazoline intravenous injection (2mg/kg) followed by intravenous infusion (2 mg/kg/hr) was used when hypoxemia and cyanosis persisted under 100% O2 with ventilator. Dopamine (5-10μg/kg/min) was given as necessary. Five cases expired from respiratory failure. One of the two surviving patients had below-average IQ at age of four years. Another survival case, now four months old, has no evidence of neurological deficit. To distinguish between persistent pulmonary hypertension and cyanotic congenital heart disease is difficult. However, the hyperoxia hyperventilation test and echocardiography can assist differential diagnosis. When persistent pulmonary hypertension is suspected, body temperature, fluids, nutrients and electrolytes should be adequately maintained. The use of a ventilator and tolazoline will increase the survival rate of patients and may reduce the incidence of hypoxic encephalopathy. |
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