Aspiracija mekonija

master's thesis

• Title (english): Meconium aspiration
• Author: Amadea Mjertan
• Mentor: Boris Filipović-Grčić (mentor)
• Committee member: Jurica Vuković (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Boris Filipović-Grčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Mekonij je čest nalaz u amnijskoj tekućini, posebno u terminskim i prenesenim trudnoćama. Najvažnija posljedica prisutnosti mekonija u plodnoj vodi (mekonijska plodna voda – MPV) mekonijski je aspiracijski sindrom (MAS) koji se razvija u otprilike 5% slučajeva MPV-a. MAS je životno ugrožavajuće stanje, unatoč napretku i liječenju mortalitet se i dalje kreće od 5% pa sve do 40% , uz moguće dugoročne posljedice na dišnom i živčanom sustavu. Glavnu ulogu u nastanku aspiracije mekonija ima asfiksija, koja djelovanjem hipoksije dovodi do relaksacije sfinktera, otpuštanja mekonija te aspiracije uzrokovane inspiracijskim pokretima. Upravo zbog toga ključ prevencije MAS-a krije se u prevenciji asfiksije, odnosno kvalitetnoj porodničkoj skrbi. MAS se odlikuje kompleksnom patofiziologijom. Aspirirani mekonij dovodi do mehaničke opstrukcije zračnih puteva, smanjenja sinteze surfaktanta, upale plućnog tkiva, izostanka preobrazbe fetalnog krvotoka. Liječenje MAS-a temelji se na davanju kisika, respiracijskoj potpori mehaničkom ventilacijom, primjeni surfaktanta, dušikovog oksida (NO), a u novije vrijeme i na izvantjelesnoj membranskoj oksigenaciji (ECMO) u teškim slučajevima MAS-a. Primjenjuju se i drugi lijekovi te metode koje nisu znanstveno dokazane korisnima ili su u fazi ispitivanja te ostavljaju mogućnost uporabe u budućnosti.

Abstract (english)

Meconium is frequently found in amniotic fluid, especially in full-term and post-term pregnancies. The most significant consequence of meconium-stained amniotic fluid (MSAF) is meconium aspiration syndrome (MAS) which occurs in approximately 5% of cases of MSAF. MAS is a life-threatening state – in spite of advancements in its treatment, the
mortality rate is still between 5 and 40%, and there are risks of long-term damages in the respiratory and nervous systems. The main cause of meconium aspiration is asphyxia, which due to hypoxia leads to a relaxation of the sphincter, release of meconium and aspiration caused by inspiration. Because of this, the key to the prevention of MAS is to prevent asphyxia and to have quality obstetric care. MAS is characterised by a complex pathophysiology. The aspirated meconium leads to a mechanical obstruction of the airways, a decrease in surfactant synthesis, an inflammation of the lung tissue and the absence of fetal bloodstream transformation. MAS treatment is based on oxygenating, respiratory support by mechanical ventilation, application of surfactants, nitric oxide (NO), and in recent years also extracorporeal membrane oxygenation (ECMO) in severe cases of MAS. Other drugs and methods that have not been scientifically proven as useful are being used or tested and could
be applied in the future.

• Keywords: asfiksija; mekonijska plodna voda (MPV); mekonijski aspiracijski sindrom (MAS); perzistentna plućna hipertenzija novorođenčadi (PPHN)
• Keywords (english): asphyxia; meconium-stained amniotic fluid (MSAF); meconium aspiration syndrome (MAS); persistent pulmonary hypertension of the newborn (PPHN)
• Language: croatian
• URN:NBN: urn:nbn:hr:105:477659
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-11-03 17:34:45