英新生兒窒息與新法復蘇-全文預覽
【正文】 istance ↑ Hypoxiaischemia alter in difference ans as asphyxia 缺 O2 PH PaO2 PaCO2 潛水反射 血液再分配 無氧酵解 低血糖 兒茶酚胺 血鈣 心納素 抗利尿激素 細胞膜 鈉泵 鈣泵 鈣離子內(nèi)流 高血糖 腸 血鈉 NEC 腎 腎 V血栓 腎功能衰竭 腎上腺 腦 缺 O2 加重 壓力被動 性腦血流 體循環(huán)壓 體循環(huán)壓 顱內(nèi)出血 HIE 腦血流灌注 大腦半 球血流 矢狀旁 區(qū)及其 下白質(zhì) 受損 PVL 心臟 肺 A壓 心功能受損 心衰 休克 PFC 缺 O2 加重 ↓ ↓ ↓ 血液高凝 DIC Breath alter 1． Primary apnea When hypoxia, the baby may breath deeply and quickly at first l2 mins, if no management in time, it may occur breath inhibition and reflective heart rate decreasing in a short time. ． 2． Secondary apnea If the hypoxia persistence, the baby may occur gasping respiration, heart rate continue step down, the BP begin to descend, muscular tension lost, the baby is pale and respiratory movement asynersis, he may occur a deep gasp at last and then enter the secondary apnea. (need positive pressure ) ? blood gas PaCO2↑， PH amp。 circulation from fetus to newborn are blocked ? Breath alter ? biochemistry amp。 Neonatal Asphyxia and its New Concept on Resuscitation Chongmin Xu Union Hospital New Words pregnant woman invalid Apgar score umbilical cord primary apnea asynersis HIE ( hypoxicischemic encephalopathy) ICH (intracranial hemorrhage) MOD (multiple ans function damage) hypercapnia hypoxemia ? Neonatal asphyxia is a kind of gas exchange disorder, that could cause hypoxemia, 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. ? It’s incidence is about 5% occupied the viable birth,and can cause 20% death in toltal newnatal death. ? The nature of asphyxia itself is hypoxia. ? Usually we adopt Apgar score to judge the degree of asphyxiation. ? 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 the world .Neonatal mortality is about ‰ (2022) in our country. The first three death causes are premature birth amp。 precipitate labor cephalopelvic disproportion deliver factor Pathophysiology ? Switch of respiration amp。 circulation Blocked switch of respiration amp。 2. advanced stage fetal movement decrease or disappear, fetal heart rate slow down, amniotic fluid was polluted by meconium. (二 ) Apgar score A simple clinical evaluation way to determine the degree of asphyxia in baby just borned. 03 score is severe asphyxia, while 47 scores , mild asphyxia. 1 min score after birth can judge degree of asphyxi
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