胎儿水肿.ppt
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Hydrops Fetalis : A Pathophysiologic Perspective
Dr. Raphi Pollack,Dept. of Obstetrics & Gynecology,Bikur Cholim Hospital,Jerusalem.
Hydrops Fetalis
? Etiology
? Physiologic principles
? The fetus - a unique model
? Experimental models of hydrops
? Clinical observations
? Conclusions
Hydrops Fetalis : Etiology
? Immune
? Nonimmune
- Congenital anomalies
- Fetal infections
- Fetal anemias
- Metabolic disorders
- Chromosomal abnormalities
- Placental causes
Hydrops Fetalis
"FinalCommonPathway"
Starling's Law
Jv = CFC ( ??P - ???????
Starling's Law
Pathogenesis of Hydrops
Severe anemia
Hepatic extramedullary hematopoeisis
Decreased prdtn of plasma proteins
Decreased plasma COP
Pathogenesis of Hydrops
Congestive heart failure
Increased central venous pressure
Increased capillary hydrostatic pressure
Pathogenesis of Hydrops
Severe tissue hypoxia
Endothelial cell damage
Capillary leak of fluid & protein
The Fetal Microcirculation
? Increased capillary permeability to plasma proteins.
? Fivefold increase in CFC wrt adult
? Increased compliance of interstitial space.
? ? capillary recruitment
The Fetal Microcirculation
Adult Sheep
1 l NS bolus IV
30% intravascular
at 30 min
FetalSheep
1 lNS bolus IV
6% intravascular
at 30 min
Fetal Lymphatic Flow
? Lymphatics must cope with increased interstitial fluid
? Fetal lymph flow5x greater than adult
? Flow is dependant on outflow pressure
? Slight increase in CVP result in dramatic decrease in lymph flow
Lymph-Flow Function Curve
Hydrops: Experimental Models
? Rapid atrial pacing
? Anemia
? CAML
? Thoracic ductligation
? Nephrectomy & Angiotensin I
Cardiac Output
CO =HRx SV
EDVxEJF
Experimental tachycardia
Decreased cardiac output
Tachyarrhythmia -induced Hydrops
Increased vasomotor Decreased cardiac
tone output
Increased venous pressure
Decreased lymphatic flow
Hydrops
Experimental Anemia
? Fetal sheep model (n=12)
? Partial exchange transfusion
?Hctfrom40% 30%
? Hydrops developed in 6 fetuses
Blair 1994
Experimental Anemia
Hydrops
?N = 6
?Increased UVp
?IncreasedCVp
?Anemia / 5.2 days
Non-hydropic
? N = 6
? Increased UVp
? Normal CVp
? Anemia / 8.3 days
ExperimentalCAML
? Fetal sheep model
? Inflatable tissue expander
? Up to 150cc NS in hemithorax
? Hydrops produced
? Increase in CVP 4 16 mmHg
Rice1994
Thoracic Duct Surgery
? N = 11
? Ductligation
? Hydrops in1 / 11
? Hct = 33%
? N = 5
? Duct excision
? Hydrops5 / 5
? Hct = 32%
Andres 1990
Nephrectomy & Angiotensin
? Fetal sheep model (N=9)
? Bilateral nephrectomy
? Infused with Angiotensin I
? Hydrops developed in 8 / 9
? arterial BP 37 81 mmHg
? CVP2.7 10.5mmHg
? Aldosterone, ANF active
Faber1994
ClinicalObservations
? 20 fetuses with NIHF
? UVpmeasured at cordocentesis
? 13 / 20 cases hadUVp
? Correlates well with CVP
? SuccessfullRx normalizedUvp
Weiner1993
Conclusions
? "Final common pathway"
?CVP
?Lymphatic fluid resorbtion
? Result of unique fetal lymphatics
? Rx implications :
-Rx heart failure (antiarrythmics)
-Rx anemia (transfusions)
-Drainage ofhydrothorax
Hydrops Fetalis : A Pathophysiologic Perspective
Dr. Raphi Pollack,Dept. of Obstetrics & Gynecology,Bikur Cholim Hospital,Jerusalem.
Hydrops Fetalis
? Etiology
? Physiologic principles
? The fetus - a unique model
? Experimental models of hydrops
? Clinical observations
? Conclusions
Hydrops Fetalis : Etiology
? Immune
? Nonimmune
- Congenital anomalies
- Fetal infections
- Fetal anemias
- Metabolic disorders
- Chromosomal abnormalities
- Placental causes
Hydrops Fetalis
"FinalCommonPathway"
Starling's Law
Jv = CFC ( ??P - ???????
Starling's Law
Pathogenesis of Hydrops
Severe anemia
Hepatic extramedullary hematopoeisis
Decreased prdtn of plasma proteins
Decreased plasma COP
Pathogenesis of Hydrops
Congestive heart failure
Increased central venous pressure
Increased capillary hydrostatic pressure
Pathogenesis of Hydrops
Severe tissue hypoxia
Endothelial cell damage
Capillary leak of fluid & protein
The Fetal Microcirculation
? Increased capillary permeability to plasma proteins.
? Fivefold increase in CFC wrt adult
? Increased compliance of interstitial space.
? ? capillary recruitment
The Fetal Microcirculation
Adult Sheep
1 l NS bolus IV
30% intravascular
at 30 min
FetalSheep
1 lNS bolus IV
6% intravascular
at 30 min
Fetal Lymphatic Flow
? Lymphatics must cope with increased interstitial fluid
? Fetal lymph flow5x greater than adult
? Flow is dependant on outflow pressure
? Slight increase in CVP result in dramatic decrease in lymph flow
Lymph-Flow Function Curve
Hydrops: Experimental Models
? Rapid atrial pacing
? Anemia
? CAML
? Thoracic ductligation
? Nephrectomy & Angiotensin I
Cardiac Output
CO =HRx SV
EDVxEJF
Experimental tachycardia
Decreased cardiac output
Tachyarrhythmia -induced Hydrops
Increased vasomotor Decreased cardiac
tone output
Increased venous pressure
Decreased lymphatic flow
Hydrops
Experimental Anemia
? Fetal sheep model (n=12)
? Partial exchange transfusion
?Hctfrom40% 30%
? Hydrops developed in 6 fetuses
Blair 1994
Experimental Anemia
Hydrops
?N = 6
?Increased UVp
?IncreasedCVp
?Anemia / 5.2 days
Non-hydropic
? N = 6
? Increased UVp
? Normal CVp
? Anemia / 8.3 days
ExperimentalCAML
? Fetal sheep model
? Inflatable tissue expander
? Up to 150cc NS in hemithorax
? Hydrops produced
? Increase in CVP 4 16 mmHg
Rice1994
Thoracic Duct Surgery
? N = 11
? Ductligation
? Hydrops in1 / 11
? Hct = 33%
? N = 5
? Duct excision
? Hydrops5 / 5
? Hct = 32%
Andres 1990
Nephrectomy & Angiotensin
? Fetal sheep model (N=9)
? Bilateral nephrectomy
? Infused with Angiotensin I
? Hydrops developed in 8 / 9
? arterial BP 37 81 mmHg
? CVP2.7 10.5mmHg
? Aldosterone, ANF active
Faber1994
ClinicalObservations
? 20 fetuses with NIHF
? UVpmeasured at cordocentesis
? 13 / 20 cases hadUVp
? Correlates well with CVP
? SuccessfullRx normalizedUvp
Weiner1993
Conclusions
? "Final common pathway"
?CVP
?Lymphatic fluid resorbtion
? Result of unique fetal lymphatics
? Rx implications :
-Rx heart failure (antiarrythmics)
-Rx anemia (transfusions)
-Drainage ofhydrothorax
附件资料：
相关资料1：
- 古今名医临证金鉴·水肿关格卷（上）.pdf
- 水肿：老中医李玉泽医疗经验选编.扫描版.pdf
- 《古今名医临证金鉴·水肿关格卷（上）》.单书健.扫描版.pdf
- 古今名医临证金鉴--水肿关格卷（下）.pdf
- 《古今名医临证金鉴·水肿关格卷（下）》.单书健.扫描版.pdf
- 《水肿：老中医李玉泽医疗经验选编》.佚名.扫描版.pdf
- [水肿].李楚杰.扫描版.pdf
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- 《水肿》.李楚杰.扫描版.pdf
- 冠状动脉造影时造影剂过敏导致喉头痉挛、水肿二例.pdf
- 急性心源性肺水肿机械通气治疗效果及对血流动力学的影响.pdf
- [水肿：老中医李玉泽医疗经验选编].佚名.扫描版.pdf
- 加强对急性心源性肺水肿的临床研究.pdf
- 尼莫地平对高血压脑出血血肿体积和周围水肿带的影响.pdf
- 古今名医临证金鉴·水肿关格卷（下）.pdf