湘雅儿科课件-新生儿缺氧缺血性脑病（可编辑）

湘雅儿科课件新生儿缺氧缺血性脑病新生儿缺氧缺血性脑病HYPOXICISCHEMICENCEPHALOPATHYHIEDEPARTMENTOFPEDIATRICS陈平洋第七章第六节中南大学儿科学教研室PURPOSETOBEFAMILIARWITHETIOLOGY,MECHANISMANDPREVENTIONTOMASTERCLINICALMANIFESTATION,DIAGNOSISANDTREATMENTTOUNDERSTANDTHEPROGNOSISSUMMARYHIE缺氧缺血性脑病ISCAUSEDBYPERINATALASPHYXIA围生期的窒息HIEISADISEASEPRIMARILYOFTHETERMINFANTHYPOXIA低氧血症CEREBRALMETABOLISM脑代谢DISORDERACIDEMIAATPNACAPUMPFUNCTIONCELLULARCANACEREBRALEDEMA脑水肿DIMINISHEDCEREBRALPERFUSION脑灌注ISCHEMIACEREBRALNECROSIS脑梗死CEREBRALEDEMAINTRACRANIALPRESSURE颅内压BLOODCAPILLARYPERMEABILITY毛细血管通透性INTRACRANIALHEMORRHAGE颅内出血ETIOLOGYANDMECHANISM病因与发病机制SELECTIVEVULNERABILITIES选择易损性OCCURINSELECTEDAREASOFTHEBRAINSTEM,脑干THALAMENCEPHALON丘脑ANDCEREBELLUM小脑WHEREMETABOLISMISVIGOROUSANDWHICHAREMOSTSENSITIVETOHYPOXICISCHEMIC缺氧缺血性INJURY损伤WHOISRISKBABY1FETALDISTRESSINUTERUS胎儿宫内窘迫2INFANTSWHOAREASPHYXIATED窒息3INFANTSWHODEVELOPPOSTNATAL产后ASPHYXIACTEDINSULTSSEVEREPULMONARYDISEASE,APNEA呼吸暂停,CONGENITALHEARTDISEASE先天性心脏病CLINICALDIAGNOSISANDGRADESOFSEVERITY1CONSCIOUSNESS意识2MUSCLETONE肌张力3PRIMITIVEREFLEXES4CONVULSION惊厥5RESPIRATORYFAILURE6PUPILS瞳孔7ANTERIORFONTANELLE8DURATION病程9PROGNOSIS预后IRRITABILITY易激惹NORMALHYPERACTIVENONENONENORMALNORMAL24HRGOODLETHARGIC昏睡HYPOTONIC增高WEAKCOMMONLYSEENNONEORMILDNORMALORMIOSIS缩小FULL饱满24HRTO14DAYSVARIABLESEVERECOMA昏迷FLACCID弛缓ABSENTCOMMONLYSEENCOMMONLYSEENUNEQUAL,POORLIGHTREFLEXTENSION紧张DAYSTOWEEKSDEATHORSEVERESEQUELA后遗症MODERATEMILDDIAGNOSIS1、HISTORYPERINATALASPHYXIA围生期窒息2、CLINICALMANIFESTATIONBRAININJURY脑水肿SOMEDEGREEOFSYSTEMICORGANINJURY3、ULTRASOUNDEXAMINATIONS超声检查4、CTSCANOFTHEBRAINORMRI5、EEG6、CKBB肌酸磷酸激酶TREATMENT1、CONTROLCONVULSIONS控制惊厥LUMINAL鲁米那LOADINGDOSE20MG/KGAEQUUM维持量EVERYTIME5MG/KG2、CONTROLCEREBRALEDEMA控制脑水肿MANICOL甘露醇EVERYTIME02505G/KGFUROSEMIDE速尿EVERYTIME1MG/KGTREATMENT3、SUPPORTIVETHERAPY支持疗法SUPPORTCARDIORESPIRATORY循环呼吸STATUSPREVENTHYPOVENTILATION通气不足,HYPERCAPNIA高碳酸血症,HYPOXEMIA低氧血症MAINTAINADEQUATEBLOODPRESSURE血压MAINTAI