新版新生儿心肺复苏指南的进展与不同.ppt

新版新生儿心肺复苏指南的进展与不同,温州医学院附属黄岩医院 新生儿科 黄 勇,background,2010年10月，美国心脏协会（AHA）以及欧洲复苏委员会（ERC）和国际复苏联络（ILCOR）委员会定期发出5年后最后一个版本-新的新生儿的心肺复苏指南。 The American Heart Association (AHA) the European Resuscitation Council (ERC) the International Liaison Committee on Resuscitation (ILCOR),source,American Heart Assoc-iation.2005 American Heart Association (A-HA) guidelines for car-diopulmonary resusc-itation (CPR) and em-ergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life sup-port.Pediatrics.2006 May;117(5):e989-1004.,Kattwinkel J, Perlman JM, Aziz K, Colby C, el al. neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Eme-rgency Cardiovascular Care.Circulation.2010;122(suppl 3):S909S919.,Newborn Resuscitation Algorithm.,Kattwinkel J et al. Circulation 2010;122:S909-S919,Copyright American Heart Association,pulse oximetry,A pulse oximeter can provide a continuous assessment of the pulse without interruption of other resuscitation measures, but the device takes 1 to 2 minutes to apply, and it may not function during states of very poor cardiac output or perfusion.,脉搏氧饱和度监测在新生儿心肺复苏中是必需的 其他复苏措施不必中断 缺点：心输出量不足或灌注不足，效果不佳,(2) Use of O 2 in the delivery room,Two meta-analyses of several randomized controlled trials comparing neonatal resuscitation initiated with room air versus 100% oxygen showed increased survival when resuscitation was initiated with air.,足月儿或接近足月儿开始复苏可以用0.21空气 各种供氧措施，如T-复合器予1. 0纯氧复苏，无助于生存率提高,(3) skin color,Other studies have sho-wn that clinical assessm-ent of skin color is a very poor indicator of oxyh-emoglobin saturation du-ring the immediate neon-atal period and that lack of cyanosis appears to be a very poor indicator of the state of oxygenation of an uncompromised baby following birth.,皮肤颜色：评价指标差 生后存在发绀期 宫外10分钟达正常水平,CO 2 Detectors,The number of studies on CO 2 detectors in neonates remains very small and most reports come from retrospective studies.Until more solid evidence proves that their use improves patient outcome, we refrain from recommending CO 2 detectors as part of the routine DR management.,大部分报告来自回顾性研究 不建议CO2探测器的日常管理 需要更坚实的证据证明他们的使用提高了病人复苏结果, Respiratory support,Positive pressure ventilation (PPV) in the DR is best administered by a pressure limited T-piece resuscitator as such devices allow more control of the delivered pressure and tidal volumes.,在产房正压通气（PPV）是最好的管理 压力有限的T型复苏器允许压力控制和潮气量,Meconium aspiration,We suggest to continue with the current practice of clearing the airway before PPV is started in any infant, in particular those born from thick, MSAF, until further evidence becomes available。,正压通气前呼吸道应清理 特别是那些出生稠厚的胎粪污染患儿。 胎粪污染吸引存在争议,Temperature control,We recommend the use of plastic cover only for infants with a GA 28 weeks. In any circumstances, close monitoring of the infant s temperature is mandatory, because both hypothermia and hyper- thermia negatively affects neonatal outcome.,胎龄28周，使用塑料纸覆盖 强制执行 体温过高与体温过低影响复苏结果,Induced hypothermia,Induced hypothermia should be offered to all term or near term infants with evolving HIE.,胎龄36周 中重度HIE 亚低温治疗（33.5 - 34.5C间） 窗口期 6小时 治疗期72小时 降低死亡率和残疾率,Drugs and fluids 1.epinephrine,In the absence of a suffcient IV access, an intra-osseous access may also be used.,肾上腺素 心率持续60次分 肾上腺素1:10 000溶液（0.1毫克/毫升）0.1 - 0.3毫升/公斤 静脉不可用时，骨内给药, -2.Sodium bicarbonate,Due to lack of evidence, sodium bicarbonate may only be considered during prolonged cardiac arrests unresponsive to other therapy and on a compassionate use basis, and on a case-by-case basis in the postresus-citation care of newly born infants,证据缺乏 指证：心跳停止，抢救无反应, -3.Naloxone,Naloxone should not be used during resuscitation or the post-resuscitation care of depressed newly born infants.,不应使用, -4.Volume expansion,Isotonic crystalloid solution or blood (10 mL / kg IV) should be used for the initial IV volume expansion in a depressed new-born infant in the DR with a history or clinical signs of significant hypovo-lemia, but rarely on an empiric basis.,应该是等渗晶体溶液或血（10毫升/公斤IV） 用于产时血容量明显减少，无循证医学证据 早产儿易引起颅内出血, -5.Glucose IV infusion,We suggest to start by giving a 10% glucose (dextrose) IV solu- tion in the DR as early as possible, and independ-ently from resuscitation status (i.e. start infusion during resuscitation).,产房，建议早期给予10葡萄糖溶液 独立于复苏状态（即在复苏开始输液时）,Delayed cord clamping,For term infants, cord clamping may be delayed for 1 2 min. Delayed cord clamping may be of benefi t to term infants born in countries with poor maternal nutritional state and / or insuffici- ent postnatal follow-up.,对于足月儿，钳夹脐带最好推迟1 - 2分钟