新版新生儿心肺复苏指南的进展与不同课件

新版新生儿心肺复苏指南的进展与不同温州医学院附属黄岩医院新生儿科黄勇新版新生儿心肺复苏指南的进展与不同温州医学院附属黄岩医院1background2010年10月，美国心脏协会（AHA）以及欧洲复苏委员会（ERC）和国际复苏联络（ILCOR）委员会定期发出5年后最后一个版本-新的新生儿的心肺复苏指南。TheAmericanHeartAssociation(AHA)theEuropeanResuscitationCouncil(ERC)theInternationalLiaisonCommitteeonResuscitation(ILCOR)background2010年10月，美国心脏协会（AHA）2sourceAmericanHeartAssoc-iation.2005AmericanHeartAssociation(A-HA)guidelinesforcar-diopulmonaryresusc-itation(CPR)andem-ergencycardiovascularcare(ECC)ofpediatricandneonatalpatients:pediatricbasiclifesup-port.Pediatrics.2006May;117(5):e989-1004.KattwinkelJ,PerlmanJM,AzizK,ColbyC,elal.

neonatalresuscitation:2010AmericanHeartAssociationGuidelinesforCardiopulmonaryResuscitationandEme-rgencyCardiovascularCare.Circulation.2010;122(suppl3):S909–S919.sourceAmericanHeartAssoc-iat3NewbornResuscitationAlgorithm.KattwinkelJetal.Circulation2010;122:S909-S919Copyright©AmericanHeartAssociationNewbornResuscitationAlgorith4⑴pulseoximetryApulseoximetercanprovideacontinuousassessmentofthepulsewithoutinterruptionofotherresuscitationmeasures,butthedevicetakes1to2minutestoapply,anditmaynotfunctionduringstatesofverypoorcardiacoutputorperfusion.脉搏氧饱和度监测在新生儿心肺复苏中是必需的其他复苏措施不必中断缺点：心输出量不足或灌注不足，效果不佳⑴pulseoximetryApulseoximete5(2)UseofO2inthedeliveryroomTwometa-analysesofseveralrandomizedcontrolledtrialscomparingneonatalresuscitationinitiatedwithroomairversus100%oxygenshowedincreasedsurvivalwhenresuscitationwasinitiatedwithair.足月儿或接近足月儿开始复苏可以用0.21空气各种供氧措施，如T-复合器予1.0纯氧复苏，无助于生存率提高(2)UseofO2inthedeliver6(3)skincolorOtherstudieshavesho-wnthatclinicalassessm-entofskincolorisaverypoorindicatorofoxyh-emoglobinsaturationdu-ringtheimmediateneon-atalperiodandthatlackofcyanosisappearstobeaverypoorindicatorofthestateofoxygenationofanuncompromisedbabyfollowingbirth.皮肤颜色：评价指标差生后存在发绀期宫外10分钟达正常水平(3)skincolorOtherstudiesha7⑷CO2Detectors

ThenumberofstudiesonCO2detectorsinneonatesremainsverysmallandmostreportscomefromretrospectivestudies.Untilmoresolidevidenceprovesthattheiruseimprovespatientoutcome,werefrainfromrecommendingCO2detectorsaspartoftheroutineDRmanagement.

大部分报告来自回顾性研究不建议CO2探测器的日常管理需要更坚实的证据证明他们的使用提高了病人复苏结果⑷CO2DetectorsThenumbero8⑸RespiratorysupportPositivepressureventilation(PPV)intheDRisbestadministeredbyapressurelimitedT-pieceresuscitatorassuchdevicesallowmorecontrolofthedeliveredpressureandtidalvolumes.在产房正压通气（PPV）是最好的管理压力有限的T型复苏器允许压力控制和潮气量⑸RespiratorysupportPositive9⑹MeconiumaspirationWesuggesttocontinuewiththecurrentpracticeofclearingtheairwaybeforePPVisstartedinanyinfant,inparticularthosebornfromthick,MSAF,untilfurtherevidencebecomesavailable。正压通气前呼吸道应清理特别是那些出生稠厚的胎粪污染患儿。胎粪污染吸引存在争议⑹MeconiumaspirationWesugges10⑺TemperaturecontrolWerecommendtheuseofplasticcoveronlyforinfantswithaGA<28weeks.Inanycircumstances,closemonitoringoftheinfant’stemperatureismandatory,becausebothhypothermiaandhyper-thermianegativelyaffectsneonataloutcome.胎龄＜28周，使用塑料纸覆盖强制执行体温过高与体温过低影响复苏结果⑺TemperaturecontrolWerecom11⑻InducedhypothermiaInducedhypothermiashouldbeofferedtoalltermornearterminfantswithevolvingHIE.胎龄＞36周中重度HIE亚低温治疗（33.5°-34.5°C间）窗口期—6小时治疗期—72小时降低死亡率和残疾率⑻InducedhypothermiaInducedh12⑼Drugsandfluids

1.epinephrineIntheabsenceofasuffcientIVaccess,anintra-osseousaccessmayalsobeused.肾上腺素心率持续＜60次／分肾上腺素1:10000溶液（0.1毫克/毫升）0.1-0.3毫升/公斤静脉不可用时，骨内给药⑼Drugsandfluids

1.epineph13⑼-2.SodiumbicarbonateDuetolackofevidence,sodiumbicarbonatemayonlybeconsideredduringprolongedcardiacarrestsunresponsivetoothertherapyandonacompassionateusebasis,andonacase-by-casebasisinthepostresus-citationcareofnewlyborninfants证据缺乏指证：心跳停止，抢救无反应⑼-2.SodiumbicarbonateDuet14⑼-3.NaloxoneNaloxoneshouldnotbeusedduringresuscitationorthepost-resuscitationcareofdepressednewlyborninfants.不应使用⑼-3.NaloxoneNaloxoneshould15⑼-4.VolumeexpansionIsotoniccrystalloidsolutionorblood(10mL/kgIV)shouldbeusedfortheinitialIVvolumeexpansioninadepressednew-borninfantintheDRwithahistoryorclinicalsignsofsignificanthypovo-lemia,butrarelyonanempiricbasis.应该是等渗晶体溶液或血（10毫升/公斤IV）用于产时血容量明显减少，无循证医学证据早产儿易引起颅内出血⑼-4.VolumeexpansionIsotoni16⑼-5.GlucoseIVinfusionWesuggesttostartbygivinga10%glucose(dextrose)IVsolu-tionintheDRasearlyaspossible,andindepend-entlyfromresuscitationstatus(i.e.startinfusionduringresuscitation).产房，建议早期给予10％葡萄糖溶液独立于复苏状态（即在复苏开始输液时）⑼-5.GlucoseIVinfusionWe17⑽Delayedcordclamping

Forterminfants,cordclampingmaybedelayedfor1–2min.

Delayedcordclampingmaybeofbenefittoterminfantsbornincountrieswithpoormaternalnutritionalstateand/orinsuffici-entpostnatalfollow-up.对于足月儿，钳夹脐带最好推迟1-2分钟主要针对营养状况不佳的孕产妇⑽DelayedcordclampingForte18(11)EthicalconsiderationsWhenextremelypretermdeliveryorresuscitationisanticipated,theparentalwishesshouldbeobtainedafterunbiasedcounselingandtheiropinionsshouldberespected.胎龄＜23周，体重＜400克征询父母意见(11)EthicalconsiderationsWh19谢谢你的兴趣谢谢你的兴趣20新版新生儿心肺复苏指南的进展与不同温州医学院附属黄岩医院新生儿科黄勇新版新生儿心肺复苏指南的进展与不同温州医学院附属黄岩医院21background2010年10月，美国心脏协会（AHA）以及欧洲复苏委员会（ERC）和国际复苏联络（ILCOR）委员会定期发出5年后最后一个版本-新的新生儿的心肺复苏指南。TheAmericanHeartAssociation(AHA)theEuropeanResuscitationCouncil(ERC)theInternationalLiaisonCommitteeonResuscitation(ILCOR)background2010年10月，美国心脏协会（AHA）22sourceAmericanHeartAssoc-iation.2005AmericanHeartAssociation(A-HA)guidelinesforcar-diopulmonaryresusc-itation(CPR)andem-ergencycardiovascularcare(ECC)ofpediatricandneonatalpatients:pediatricbasiclifesup-port.Pediatrics.2006May;117(5):e989-1004.KattwinkelJ,PerlmanJM,AzizK,ColbyC,elal.

neonatalresuscitation:2010AmericanHeartAssociationGuidelinesforCardiopulmonaryResuscitationandEme-rgencyCardiovascularCare.Circulation.2010;122(suppl3):S909–S919.sourceAmericanHeartAssoc-iat23NewbornResuscitationAlgorithm.KattwinkelJetal.Circulation2010;122:S909-S919Copyright©AmericanHeartAssociationNewbornResuscitationAlgorith24⑴pulseoximetryApulseoximetercanprovideacontinuousassessmentofthepulsewithoutinterruptionofotherresuscitationmeasures,butthedevicetakes1to2minutestoapply,anditmaynotfunctionduringstatesofverypoorcardiacoutputorperfusion.脉搏氧饱和度监测在新生儿心肺复苏中是必需的其他复苏措施不必中断缺点：心输出量不足或灌注不足，效果不佳⑴pulseoximetryApulseoximete25(2)UseofO2inthedeliveryroomTwometa-analysesofseveralrandomizedcontrolledtrialscomparingneonatalresuscitationinitiatedwithroomairversus100%oxygenshowedincreasedsurvivalwhenresuscitationwasinitiatedwithair.足月儿或接近足月儿开始复苏可以用0.21空气各种供氧措施，如T-复合器予1.0纯氧复苏，无助于生存率提高(2)UseofO2inthedeliver26(3)skincolorOtherstudieshavesho-wnthatclinicalassessm-entofskincolorisaverypoorindicatorofoxyh-emoglobinsaturationdu-ringtheimmediateneon-atalperiodandthatlackofcyanosisappearstobeaverypoorindicatorofthestateofoxygenationofanuncompromisedbabyfollowingbirth.皮肤颜色：评价指标差生后存在发绀期宫外10分钟达正常水平(3)skincolorOtherstudiesha27⑷CO2Detectors

ThenumberofstudiesonCO2detectorsinneonatesremainsverysmallandmostreportscomefromretrospectivestudies.Untilmoresolidevidenceprovesthattheiruseimprovespatientoutcome,werefrainfromrecommendingCO2detectorsaspartoftheroutineDRmanagement.

大部分报告来自回顾性研究不建议CO2探测器的日常管理需要更坚实的证据证明他们的使用提高了病人复苏结果⑷CO2DetectorsThenumbero28⑸RespiratorysupportPositivepressureventilation(PPV)intheDRisbestadministeredbyapressurelimitedT-pieceresuscitatorassuchdevicesallowmorecontrolofthedeliveredpressureandtidalvolumes.在产房正压通气（PPV）是最好的管理压力有限的T型复苏器允许压力控制和潮气量⑸RespiratorysupportPositive29⑹MeconiumaspirationWesuggesttocontinuewiththecurrentpracticeofclearingtheairwaybeforePPVisstartedinanyinfant,inparticularthosebornfromthick,MSAF,untilfurtherevidencebecomesavailable。正压通气前呼吸道应清理特别是那些出生稠厚的胎粪污染患儿。胎粪污染吸引存在争议⑹MeconiumaspirationWesugges30⑺TemperaturecontrolWerecommendtheuseofplasticcoveronlyforinfantswithaGA<28weeks.Inanycircumstances,closemonitoringoftheinfant’stemperatureismandatory,becausebothhypothermiaandhyper-thermianegativelyaffectsneonataloutcome.胎龄＜28周，使用塑料纸覆盖强制执行体温过高与体温过低影响复苏结果⑺TemperaturecontrolWerecom31⑻InducedhypothermiaInducedhypothermiashouldbeofferedtoalltermornearterminfantswithevolvingHIE.胎龄＞36周中重度HIE亚低温治疗（33.5°-34.5°C间）窗口期—6小时治疗期—72小时降低死亡率和残疾率⑻InducedhypothermiaInducedh32⑼Drugsandfluids

1.epinephrineIntheabsenceofasuffcientIVaccess,anintra-osseousaccessmayalsobeused.肾上腺素心率持续＜60次／分肾上腺素1:10000溶液（0.1毫克/毫升）0.1-0.3毫升/公斤静脉不可用时，骨内给药⑼Drugsandfluids

1.epineph33⑼-2.SodiumbicarbonateDuetolackofevidence,sodiumbicarbonatemayonlybeconsideredduringprolongedcardiacarrestsunresponsivetoothertherapyandonacompassionateusebasis,andonacase-by-casebasisinthepostresus-citationcareofnewlyborninfants证据缺乏指证：心跳停止，抢救无反应⑼-2.SodiumbicarbonateDuet34⑼-3.NaloxoneNaloxoneshouldnotbeusedduringresuscitationorthepost-resuscitationcareofdepressednewlyborninfants.不应使用⑼-3.NaloxoneNaloxoneshould35⑼-4.VolumeexpansionIsotoniccrystalloidsolutionorblood(10mL/kgIV)shouldbeusedfortheinitialIVvolumeexpansion