新生儿窒息.ppt

新生儿窒息AsphyxiaoftheNewborn,Dr.XiaopingLuoProfessorandChairmanDepartmentofPediatricsTongjiHospitalTongjiMedicalCollege,Thehighestmortalitythatbefallsthehumanraceinonedayoccursonthedayofbirth.Itissaidthatthemostimportantperiodofthelifeofahumanbeingisthetimespentinutero.Themosttryingordealahumanbeingsustainsistheordealofbirth.,AsphyxiaNeonatorum:CausationandTreatment,ProfessorofObstetrics,NorthwesternUniversityMedicalSchool,Jos.B.DeLee,PublishedinMedicine(Detroit)3:643-660,1897.,DefinitionofPerinatalAsphyxia,aconditionintheneonatewherethereisthefollowingcombination:Aneventorconditionduringtheperinatalperiodthatislikelytoseverelyreduceoxygendeliveryandleadtoacidosis;ANDAfailureoffunctionofatleasttwoorgansconsistentwiththeeffectsofacuteasphyxia.,Hypoxemia,Hypercapnia,Mixedacidosis,Organicfailure,RiskFactors-Maternal,Systemicdisease:diabetes,heartorrenaldiseases,anemia,infectiousdiseasesObstetricConditions:hypertensivediseaseofpregnancyorpre-eclampsia,placentalabruptionSubstanceabuse:drugaddiction,smokingMaternalage:35,or16,multiplepregnancy,RiskFactors-Fetal,Premature,SGA,macrosomiaCongenitalmalformation:noseandlaryngo-pharynxmalformation,lunghypoplasia,heartdiseaseAmnioticfluidormeconiumaspirationIntrauterineinfection:Torchsyndrome,RiskFactors-Intrapartum,Umbilicalcord:obstructionObstetricprocedures:forcepsdelivery,breechextraction,vacuumextractionMedication:analgesicandoxytocicmedicine,PathophysiologyofAsphysia,RespiratoryAlteration:primaryhyperpnea,primaryapnea,secondaryapneaHypoxic-ischemicChangesofMulti-organicsystem:“divingreflex”,inter-organshunting,organfailureBiochemicalandmetabolicConsequences:acidosis,hyper-orhypoglycemia,hypocalcemia,hyperbilirubinemia,hyperkalemia,hyponatremia,ClinicalManifestationofAsphysia,ApgarScoringSystem,ApgarScoringSystem,A,P,G,A,R,TheSignificanceofApgarScore,Apgar810,normal;47,mildasphyxia;03,severeasphyxiaAssignedat1,5,and10min,untilscoreof7ormore1scoreindicatetheseverityandguideforresuscitation5scoreandlaterismorepredictiveofprognosisPrematureinfantsintendtohavelowerscores,ClinicalManifestationofAsphyxia,MultiorganSystemDysfunctionRenalcompromise:oliguriaandelevatedcreatinineHypoxiccardiomyopathy(ECHOorECGabnormality)Hypoxicischemicencephalopathy(HIE)Pulmonarycomplications:respiratorydistress(RDS),persistentpulmonaryhypertension(PPHN)Disseminatedintravascularcoagulation(DIC)Hepaticfailure,hyperbilirubinemiaNecrotisingenterocolitis(NEC),stressulcerFluidoverload,hyperkalemia,hypoglycemia,andacidosis,AmericanHeartAssociation-AmericanAcademyofPediatricsApproachtoResuscitation,InfantwithanApgarScoreof7ormoregenerallydonotrequireresuscitationabriefperiodofoxygenblownoverthefaceoxygenincreasespulmonarybloodflowavoidexcessivesuctioningofclearfluidInfantwithanApgarScoreof4to6stimulationadministrationofoxygenbyfacemask,orbagemptythestomachwhenusingbagormaskventilation,AmericanHeartAssociation-AmericanAcademyofPediatricsApproachtoResuscitation,InfantwithanApgarScoreof1to3usuallyrequireintubationandexpansionofthelungbagandmaskventilationusuallyisadequatetosustainfurtherstepsdependontheresponsetoventilationInfantwithanApgarScoreof0noliveborninfantshouldbeassignedascoreof0resuscitationshouldproceedasforascoreof1cardiaccompression,ResuscitationtheABCDEProtocol,AirwayBreathingCirculationDrugsEvaluation&Enviroment,AdvancedLifeSupport(ALS),TheNeonatalResuscitationGuidelines,Pediatrics,2000,NeonatalResuscitationMedications,Post-resuscitationIssuesandMore,ContinuingCareoftheNewlyBornInfantsupportiveorongoingcaremonitoringappropriatediagnosticevaluati