英新生儿窒息与新法复苏.ppt

,NeonatalAsphyxiaanditsNewConceptonResuscitation,ChongminXuDep.NewnatesUnionHospital,.,NewWordspregnantwomaninvalidApgarscoreumbilicalcordprimaryapneaasynersisHIE(hypoxic-ischemicencephalopathy)ICH(intracranialhemorrhage)MOD(multipleorgansfunctiondamage)hypercapniahypoxemia,Neonatalasphyxiaisakindofgasexchangedisorder,thatcouldcausehypoxemia,hypercapniaandmetabolismacidosis,whichisaccountedonthatnewbornhasnoautorespirationoronlyhasirregular,intermittentandfeeblerespirationatbirth,orpresentrespiratorydepressionafterbirth.Itsincidenceisabout5%occupiedtheviablebirth,andcancause20%deathintoltalnewnataldeath.Thenatureofasphyxiaitselfishypoxia.UsuallyweadoptApgarscoretojudgethedegreeofasphyxiation.,AsphyxiacouldcausenotonlyHIE,butalsoMOD,andistheoneoftheimportantcausesofdeath,dysnoesiaandinvalid(cerebralpalsy)innewbornsallovertheworld.Neonatalmortalityisabout19.0(2005)inourcountry.Thefirstthreedeathcausesareprematurebirth2.advancedstagefetalmovementdecreaseordisappear,fetalheartrateslowdown,amnioticfluidwaspollutedbymeconium.(二)ApgarscoreAsimpleclinicalevaluationwaytodeterminethedegreeofasphyxiainbabyjustborned.0-3scoreissevereasphyxia,while4-7scores,mildasphyxia.1minscoreafterbirthcanjudgedegreeofasphyxia,5minsscoreishelpfulrojudgethebabyprognosis.,AsphyxiadiagnosticcodeAAP(美国儿科学会)severecasepresencecardiacshock(CS),heartfailureandpersistentfetalcirculation.2.respiratorysystem(RS)Aspirationofamnioticfluidormeconiumsyndrome,pneumorrhagiaandpersistentpulmonaryhypertension,LBWImaypresencehyalinemembranediseaseandapneaetc.,3.Kidneyacuterenalfailure(ARF,oliguria,proteinuria,Bloodureanitrogenandcreatinineincrease);thrombosisofrenalvein(grosshematuria).4.centralnervoussystem(C.N.S)HIE(hypoxic-ischemicencephalopathy)andICH(intracranialhemorrhage)5.Metabolismacidosis,hypoglycemiaandelectrolytedisturbances；6.gastrointestinaltract(GIT)stressulcerNEC(necrotizingenterocolitis),jaundiceaggratate.,SystemsdamagedbyAsphyxiainperinatalperioddamagecentralnervoussystemhypoxic-ischemicencephalopathy,intracranialhemorrhage,encephaledemaurinarysystemglomerularfiltrationrateand/ortubularreabsorptionfunctiondamage,renaltubularnecrosis,renalfailurecardiovascularsystemmitralinsufficiency,myocardiolysis,cardiafailure，shockrespiratorysystempulmonaryhypertension,meconiumaspiratedpneumonia,alveolussurfaceactivesubstancedecreasemetabolismacidosis,hypoglycemia,hypocalcemia,ADHsecreteincreasedigestivesystemstressulcer，NEC(necrotizingenterocolitis),liverfunctionallesionskinsubcutaneousfatnecrosishematologicalsystemDIC(disseminatedintravascularcoagulation),四laboratoryexamination1.takebloodoutofintrauterineapneababysscalpbyamnioscopeorfetusouteropofcervixuteritomeasureitspH-howtorescuethebaby.2.afterbirth,bloodgas,bloodsugar,electrolyte,bloodureanitrogenandcreatinine,type-BultrasonicorCTscandevelopmently,五Treatment1.theresuscitationshouldbecarriedoutbypediatricianco-operatedwithobstetrician2.shouldbefamiliaritywiththebabysdeliveryhistory,anddothefullprepareforskillandoperation,apparatusanddevicebeforehand;,(一)ABCDEresuscitationprogramA(airway)：B(breathing)C(Circulation)D(drug)E(evaluation)ABCisthemostimportant,andAisbasic,Bisthekeypoint.,(二)resuscitationprocedure1Thefirstresuscitationstepkeepbodywarmextremeinfra-redraytable;usewarmanddrytoweltomopthebaby;arrangeposturepadtheshoulderfor2-3cmsuckthemucosaoutofthebabysmouth,noseandpharyng(2mins,shouldinsertagastrictube,pressingheartoutchestthelowerl/3ofthebreastbone,120pem,everypressing3times,shouldsupplypressurizeoxygenonce.Pressaboutl一2cmdept,thefingershouldntleftthepressinglocation；,oraltracheacannulaintubationandsusctiononceshouldbefinishedwithin20secondsifthebabyhasoneofthefollowsmeconiumropinessorthereisgranulesofmeconiumhypolarynxthebabysufferfromsevereasphyxiaandneedartificialventilatingforalongtime;theresultispoorusingresuscitaing;thebabyheartrateis80-100pemanddoesntincreasetofollows；suspectdiagnosisofdiaphragmatichernia.,anatomiclandmarkforputinlaryngoscope,trachealintubation,4.medicineassistingresuscitationalkalitherapyadrenalintherapyvasoactiveagenttherapydopamine3-5ug/kg.minHeparinetherapy20-30u/kg.d,H,tidnaloxoneanti-morphinumandinhibitionofHIE.,5Observeandmonitorpostresuscitationbodytemperature,breath,heartrate.Bloodpressure,urinaryvolume,skincolor,andsymptomofnervoussystem;noticeacid-baseimbalance,electrolytedisturbances,abnormityofurinationanddefecation,infectionandfeedingetc.,出生,是否足月？是否羊水清？是否有呼吸和哭声？是否肌张力好？,保温摆正体位，通畅气道擦干,刺激,重新摆正体位,评价心率、呼吸和肤色,常压给氧,常规护理保温必要时通畅气道擦干,观察护理,是,正常呼吸心率100及肤色红润,否,紫绀,肤色红润,2006NRP流程图,HarrisAPetal.JPediatr1986;109:117ReddyVKetal.ClinPediatr1999;38:87TothBetal.ArchGynObst2002;266:105,正压人工呼吸,正压人工呼吸胸外按压,给肾上腺素和/或扩容,复苏后护理,呼吸暂停HR100及皮肤红润,HR60,HR60,*在某些步骤可考虑气管插管,AnnouncementsSeizeeveryminuteandsecond，obstetricsandpediatricoperatetogetherExcutetheABCDEprocedurestrictlyRespiratoryheartrateandskincolourarethetreebigphysicalsigntojudgetheasphyxiaandresusitation,循环往复，至完成复苏,遵循,六、preventing1、antepartumbodycheckperiodicly,avoidprematureandoperationdelivery.2、waitingfordeliveryfetalheartmonitoranddiscoveryearlyintrauterinedistress.3、intrapartumsuckthemucosaoutofthebabysmouth,noseandpharyng(10seconds)rightaf