新生儿窒息(英文)PPT课件.ppt

新生儿窒息AsphyxiaoftheNewborn,Dr.XiaopingLuoProfessorandChairmanDepartmentofPediatricsTongjiHospitalTongjiMedicalCollege,1,Thehighestmortalitythatbefallsthehumanraceinonedayoccursonthedayofbirth.Itissaidthatthemostimportantperiodofthelifeofahumanbeingisthetimespentinutero.Themosttryingordealahumanbeingsustainsistheordealofbirth.,AsphyxiaNeonatorum:CausationandTreatment,ProfessorofObstetrics,NorthwesternUniversityMedicalSchool,Jos.B.DeLee,PublishedinMedicine(Detroit)3:643-660,1897.,2,DefinitionofPerinatalAsphyxia,aconditionintheneonatewherethereisthefollowingcombination:Aneventorconditionduringtheperinatalperiodthatislikelytoseverelyreduceoxygendeliveryandleadtoacidosis;ANDAfailureoffunctionofatleasttwoorgansconsistentwiththeeffectsofacuteasphyxia.,Hypoxemia,Hypercapnia,Mixedacidosis,Organicfailure,3,RiskFactors-Maternal,Systemicdisease:diabetes,heartorrenaldiseases,anemia,infectiousdiseasesObstetricConditions:hypertensivediseaseofpregnancyorpre-eclampsia,placentalabruptionSubstanceabuse:drugaddiction,smokingMaternalage:35,or16,multiplepregnancy,4,RiskFactors-Fetal,Premature,SGA,macrosomiaCongenitalmalformation:noseandlaryngo-pharynxmalformation,lunghypoplasia,heartdiseaseAmnioticfluidormeconiumaspirationIntrauterineinfection:Torchsyndrome,5,RiskFactors-Intrapartum,Umbilicalcord:obstructionObstetricprocedures:forcepsdelivery,breechextraction,vacuumextractionMedication:analgesicandoxytocicmedicine,6,PathophysiologyofAsphysia,RespiratoryAlteration:primaryhyperpnea,primaryapnea,secondaryapneaHypoxic-ischemicChangesofMulti-organicsystem:“divingreflex”,inter-organshunting,organfailureBiochemicalandmetabolicConsequences:acidosis,hyper-orhypoglycemia,hypocalcemia,hyperbilirubinemia,hyperkalemia,hyponatremia,7,ClinicalManifestationofAsphysia,ApgarScoringSystem,8,ApgarScoringSystem,A,P,G,A,R,9,TheSignificanceofApgarScore,Apgar810,normal;47,mildasphyxia;03,severeasphyxiaAssignedat1,5,and10min,untilscoreof7ormore1scoreindicatetheseverityandguideforresuscitation5scoreandlaterismorepredictiveofprognosisPrematureinfantsintendtohavelowerscores,10,ClinicalManifestationofAsphyxia,MultiorganSystemDysfunctionRenalcompromise:oliguriaandelevatedcreatinineHypoxiccardiomyopathy(ECHOorECGabnormality)Hypoxicischemicencephalopathy(HIE)Pulmonarycomplications:respiratorydistress(RDS),persistentpulmonaryhypertension(PPHN)Disseminatedintravascularcoagulation(DIC)Hepaticfailure,hyperbilirubinemiaNecrotisingenterocolitis(NEC),stressulcerFluidoverload,hyperkalemia,hypoglycemia,andacidosis,11,AmericanHeartAssociation-AmericanAcademyofPediatricsApproachtoResuscitation,InfantwithanApgarScoreof7ormoregenerallydonotrequireresuscitationabriefperiodofoxygenblownoverthefaceoxygenincreasespulmonarybloodflowavoidexcessivesuctioningofclearfluidInfantwithanApgarScoreof4to6stimulationadministrationofoxygenbyfacemask,orbagemptythestomachwhenusingbagormaskventilation,12,AmericanHeartAssociation-AmericanAcademyofPediatricsApproachtoResuscitation,InfantwithanApgarScoreof1to3usuallyrequireintubationandexpansionofthelungbagandmaskventilationusuallyisadequatetosustainfurtherstepsdependontheresponsetoventilationInfantwithanApgarScoreof0noliveborninfantshouldbeassignedascoreof0resuscitationshouldproceedasforascoreof1cardiaccompression,13,ResuscitationtheABCDEProtocol,AirwayBreathingCirculationDrugsEvaluation&Enviroment,14,AdvancedLifeSupport(ALS),TheNeonatalResuscitationGuidelines,Pediatrics,2000,15,NeonatalResuscitationMedications,16,Post-resuscitationIssuesandMore,ContinuingCareoftheNewlyBornInfantsupportiveorongoingcaremonitoringappropriatediagnosticevaluationDocumentationofRe