英新生儿窒息与新法复苏PPT学习教案

1、会计学1第1页/共56页New Wordspregnant woman invalidApgar score umbilical cordprimary apnea asynersisHIE ( hypoxic-ischemic encephalopathy) ICH (intracranial hemorrhage) MOD (multiple organs function damage)hypercapnia hypoxemia第2页/共56页 Neonatal asphyxia is a kind of gas exchange disorder, that could cause h

2、ypoxemia, hypercapnia and metabolism acidosis, which is accounted on that newborn has no auto respiration or only has irregular, intermittent and feeble respiration at birth, or present respiratory depression after birth. Its incidence is about 5% occupied the viable birth,and can cause 20% death in

3、 toltal newnatal death. The nature of asphyxia itself is hypoxia. Usually we adopt Apgar score to judge the degree of asphyxiation. 第3页/共56页 Asphyxia could cause not only HIE, but also MOD, and is the one of the important causes of death, dysnoesia and invalid (cerebral palsy) in newborns all over t

4、he world .Neonatal mortality is about 19.0 (2005) in our country. The first three death causes are premature birth & low birth weight, asphyxia and pneumonia. There are 1 million newborn death caused by neonatal asphyxia (total 4 million yearly-2005. WHO), and 1 million neonates suffer from dysn

5、oesia, cerebral palsy and other deformity caused by it too. 第4页/共56页Delivery factorsPlacenta factorFetal factorumbilical cord factorPregnant woman Asphyxial etiopatho-genisis第5页/共56页 too older or youngRespiratory diseasecardiac diseaseanaemiagestational hypertensionPregnant woman factorpolycyesisdia

6、betes第6页/共56页placenta praeviaplacental abruptioninfarctusageing Placenta factorfactor第7页/共56页short cordknot of umbilical cordumbilical hang downumbilical cord circle neckUmbilical factor第8页/共56页胎儿因素胎儿因素prematurelarge for date infantintrauterine infectionrespiratory tract obstructioncongenital cardio

7、pathy congenital abnormalityfoetus factor第9页/共56页sucking fetal head forceps aid deliver breech presentation unsuitably use drugs in labor labor extension & precipitate laborcephalopelvic disproportiondeliver factor第10页/共56页第11页/共56页fetal pulmonary fluid is removed from lungs surface active subst

8、ance(SAS) secretes functional residual capacity of alveolus set up pulmonary circulation resistancegenetal circulation resistance arterial duct & ovale foramen shut functionalityNormal fetus transform to neonate in respiration & circulation 第12页/共56页Blocked switch of respiration & circul

9、ation from fetus to newborn Asphyxia Respiration ceases or inhibit alveolar ectasia Hypoxia, acidosisactivitypulmonary fluid removes Fetal circulationConstitution hypoxia, ischemia and Inconvertible pulmonary vascular resistance第13页/共56页第14页/共56页 Breath alterBreath alter 1 1Primary apnea When hypoxi

10、a, the baby may breath deeply and quickly at first l-2 mins, if no management in time, it may occur breath inhibition and reflective heart rate decreasing in a short time. 2Secondary apnea If the hypoxia persistence, the baby m ay occur gasping respiration, heart rate continue step dow n, the BP beg

11、in to descend, m uscular tension lost, the baby is pale and respiratory m ovem ent asynersis, he m ay occur a deep gasp at last and then e n t e r t h e s e c o n d a r y a p n e a . (need positive pressure )第15页/共56页第16页/共56页blood gas PaCO2，PH & PaO2mixed acidosis Glucose metabolic disordercate

12、cholamine & & glucagon release earlyblood sugar normal or then then glycogen depletion, blood sugarHyperbilirubinemia Bilirubin combine with albumin、the vigor of liver enzymeunconjugated bilirubin Hyponatremiaatrial natriuretic peptide, ADH is parasecretiondiluted hyponatremiaHypocalcemiacal

13、cium channel open、calcium pump dysfunction calcium influx Blood biochemistry and metabolism alteration第17页/共56页三三 Clinical situation (一一) intrauterine asphyxia 1. early stage the fetal heart rate and fetal movement increase; 2. advanced stage fetal movement decrease or disappear, fetal heart rate sl

14、ow down, amniotic fluid was polluted by meconium. (二二) Apgar score A simple clinical evaluation way to determine the degree of asphyxia in baby just borned. 0-3 score is severe asphyxia, while 4-7 scores , mild asphyxia. 1 min score after birth can judge degree of asphyxia, 5 mins score is helpful r

15、o judge the baby prognosis. 第18页/共56页physical signScore denomscore0121 min.5&10 min.Skin colorcyanose/paleBody red, limbs cyanoseRed all over03 severe asphyxia47 mild asphyxia810 normalJudge PrognosisH.R.(time/min)no100Reaction after stimulate sole or intubatenoSome actioneg.frownCry, sneezemusc

16、ular tensionlaxitasLimbs flex a littleLimbs activerespirationnoslow,irregularnormal,cry loudly第19页/共56页Blood in arteria umbillicalis metabolism or mixed acidosis, score is persistence timeNervous system manifestation, convulsioncoma or muscular tension low etc.第20页/共56页 MOD 1. cardiovascular system

17、(CVS) mild case may presence conducting system and cardiac muscle damaged; severe case presence cardiac shock (CS), heart failure and persistent fetal circulation. 2. respiratory system (RS) Aspiration of amniotic fluid or meconium syndrome, pneumorrhagia and persistent pulmonary hypertension, LBWI

18、may presence hyaline membrane disease and apnea etc. 第21页/共56页3. Kidney acute renal failure (ARF, oliguria, proteinuria, Blood urea nitrogen and creatinine increase); thrombosis of renal vein (gross hematuria).4. central nervous system (C.N.S) HIE ( hypoxic-ischemic encephalopathy) and ICH (intracra

19、nial hemorrhage)5. Metabolism acidosis, hypoglycemia and electrolyte disturbances；6. gastrointestinal tract (GIT) stress ulcer NEC (necrotizing enterocolitis), jaundice aggratate. 第22页/共56页 Systems damaged by Asphyxia in perinatal period damagecentral nervous system hypoxic-ischemic encephalopathy,

20、intracranial hemorrhage, encephaledema urinary system glomerular filtration rate and/or tubular reabsorption function damage, renal tubular necrosis, renal failurecardiovascular system mitral insufficiency, myocardiolysis, cardia failure，shockrespiratory system pulmonary hypertension, meconium aspir

21、ated pneumonia, alveolus surface active substance decreasemetabolism acidosis, hypoglycemia, hypocalcemia, ADH secrete increasedigestive system stress ulcer，NEC (necrotizing enterocolitis), liver functional lesionskin subcutaneous fat necrosishematological system DIC (disseminated intravascular coag

22、ulation)第23页/共56页四四 laboratory examination 1. take blood out of intrauterine apnea babys scalp by amnioscope or fetus outerop of cervix uteri to measure its pH-how to rescue the baby. 2. after birth, blood gas, blood sugar, electrolyte, blood urea nitrogen and creatinine, type-B ultrasonic or CT sca

23、n developmently, 第24页/共56页五五 Treatment 1. the resuscitation should be carried out by pediatrician co-operated with obstetrician 2. should be familiarity with the babys delivery history, and do the full prepare for skill and operation, apparatus and device beforehand; 第25页/共56页(一一)ABCDE resuscitation

24、 program A (air way) ： B (breathing) C (Circulation) D (drug) E (evaluation) ABC is the most important, and A is basic, B is the key point. 第26页/共56页(二二) resuscitation procedure 1The first resuscitation step keep body warm extreme infra-red ray table; use warm and dry towel to mop the baby; arrange

25、posture pad the shoulder for 2-3 cm suck the mucosa out of the babys mouth, nose and pharyng (2 mins, should insert a gastric tube, pressing heart out chest the lower l/3 of the breast bone, 120 pem, every pressing 3 times, should supply pressurize oxygen once. Press about l一2 cm dept, the finger sh

26、ouldnt left the pressing location；第31页/共56页The way of thumbs第32页/共56页 oral trachea cannula intubation and susction once should be finished within 20 seconds if the baby has one of the follows meconium ropiness or there is granules of meconium hypolarynx the baby suffer from severe asphyxia and need

27、artificial ventilating for a long time; the result is poor using resuscitaing; the baby heart rate is 80-100 pem and doesnt increase to follows； suspect diagnosis of diaphragmatic hernia.第33页/共56页anatomic landmark for put in laryngoscopetracheal intubation第34页/共56页 4 . m e d i c i n e a s s i s t i

28、n g resuscitation alkali therapy adrenalin therapy vasoactive agent therapy dopamine 3-5ug/kg.min Heparine therapy 20-30u/kg.d, H, tid naloxone anti-morphinum and inhibition of HIE.第35页/共56页5Observe and monitor post resuscitation body temperature, breath, heart rate. Blood pressure, urinary volume,

29、skin color, and symptom of nervous system; notice acid-base imbalance, electrolyte disturbances, abnormity of urination and defecation, infection and feeding etc. 第36页/共56页出生出生是否足月？是否足月？是否羊水清？是否羊水清？是否有呼吸和哭声？是否有呼吸和哭声？是否肌张力好？是否肌张力好？保温保温 摆正体位，摆正体位， 通畅气道通畅气道 擦干擦干,刺激刺激, 重新摆正体位重新摆正体位评价心率、呼吸和肤色评价心率、呼吸和肤色常压给氧常压给氧常规护理常规护理 保温保温 必要时通畅气道必要时通畅气道 擦干擦干观察护理观察护理是是正常呼吸正常呼吸心率心率 100 及及 肤色红润肤色红润否否紫绀紫绀肤色红润肤色红润Harris AP et al. J Pediatr