新生儿窒息复苏(英文)ppt(1)

NeonatalAsphyxiaandResuscitationThefirstaffiliatedhospitalofxinxiangmedicaluniversityNICUClinicalExampleYouareaskedtoattendanemergentcesareansectiondeliveryofa40weeks’gestationinfantwithnon-reassuringhearttones.Motherisa30-yearoldgravidaImarriedwomanwhowasadmittedinactivelaborfourhoursago.Membranesarerupturedatthetimeofdeliveryrevealingbloodyamnioticfiuidbutnomeconium.At30secondsoflife,heremainsapneicandcyanotic.Hisheartrateis30beatsperminute.Youadministerpositivepressureventilationwith100%FiO2,andnotegoodchestwallrisewitheachpositivepressurebreath.Theinfantcontinuestobeapneicandbradycardicwithaheartrateof40bpm.Chestcompressionsarebegunandpositivepressureventilationiscontinued.Following30secondsofcoordinatedventilationandchestcompressions,hisheartrateisstill40bpm.Youintubatetheinfantwhilethenursedrawsupepinephrinetobegivenviatheendotrachealtube.Thereisnoimprovementinhisheartratefollowingadministrationofepinephrine.Theinfantremainsbradycardic.reassessPositivepressureventilationandchestcompressionsarecontinuedasyoutheinfant.Goodbreathsoundsareheardbilaterally,buthisskinremainspaleandmottledandpulsesaredifficulttopalate.DefinitionPathophysiologyEvaluationoftheNewlyBornInfantResuscitationResuscitationProgramalgorithmStudyHighlightsDefinitionNeonatalasphyxiaismainlyduetofailureofthenewborntobreatheafterbirth,oritsheartfailstopumpenoughbloodtothelungsforgasexchange,orithaslowhaemoglobinlevels(anaemia)soitcannotdeliverenoughoxygenaroundthebody.Thebabywhocannotbreathecannotestablishindependentlifeoutsidethemother.Therefore,thepurposeofneonatalresuscitationistohelpthenewborntoestablishspontaneousbreathingandfacilitateoxygendeliverytoitsorgansandtissues–particularlythebrain,whichisveryquicklydamagedbyoxygenshortage.Youmayalsoneedtoresuscitateanybabythatisseverelyanaemicduetobloodlossduringlabouranddelivery,orthatcontinuestobecyanoticdespiteestablishedbreathing.PathophysiologyDuringlabor,thefetusexperiencesbriefperiodsofischemiaandhypoxemiabecausewitheachuterinecontraction,flowtotheplacenta(胎盘)decreasestransiently,impairingplacentalgasexchange.However,thefetusisabletorecoverbetweeneachcontractionandbloodgasesperformedintheumbilicalcord(脐带)immediatelyafterbirtharewithinanormal”range.Overstimulationoftheuteruswithoxytocin(催产素)mayleadtoexcessivelyfrequentcontractionswithlimitedrecoverytimeandtherebycompromisefetalwell-being.PathophysiologyToachievesuccessfultransitiontoextrauterinelife,theinfantmustaccomplishdramaticcardiorespiratorychanges.Inthefirstminutesaftercordclamping,withtheinitiationofbreathing,lungsmustbeexpandedandfluidinsidethealveoliandairwaysmustberapidlyabsorbed.Pulmonarybloodflowmustincreasedramatically,andintracardiacandextracardiacshuntsinitiallyreversedirectionandsubsequentlyclose.Thefirstbreathsofanormal-termneonateexertnegativepressuresthatmayreachpressuresashighas80cmH2O.EvaluationoftheNewlyBornInfantTheassessmentofthenewbornspostnataladaptationinthedeliveryroomisusuallydoneusingtheApgarscore,whichevaluatesfiveclinicalsigns:heartrate,respiratoryeffort,color,tone,andresponsetostimuliat1and5min.EvaluationoftheNewlyBornInfantSign012HeartrateAbsent100bpm100bpmRespiratoryeffortAbsentSlow,irregularGood,cryingMuscletoneFlaccidSomeflexionextremitiesActivemotionReflexirritabilityNorespondGrimaceVigorouscryColorPaleCyanoticcompletelypinkTheApgarscoreforevaluationofadaptationofthenewborninfantafterbirthThehigherthescore,thebetterthebabyisdoingafterbirth.Ascoreof7,8,or9isnormalandisasignthatthenewbornisingoodhealth.Ascoreof10isveryunusual,sincealmostallnewbornslose1pointforbluehandsandfeet,whichisnormalforafterbirth.Anyscorelowerthan7isasignthatthebabyneedsmedicalattention.Thelowerthescore,themorehelpthebabyneedstoadjustoutsidethemother’swomb.EvaluationoftheNewlyBornInfantAnapneicinfantshouldscore“0”,eveniftheinfantisventilated.Inadequaterespiratoryeffortsshouldscore“1”,alsoiftheinfantisventilated.Theprematureinfantthatishypotonicscores“1formuscletone.Heartrate(HR)isthemostrelevantclinicalsignindicatingadequatepostnataladaptationand/orresponsetoresuscitation.Inaddition,HRinthefirstminutesoflifehasprognosticvalueregardingmortalityintheearlyneonatalperiod.Assessmentofthecoloralsoshowshighinterobservervariability,especiallyinpreterminfants.Thiscanbeavoidedwiththeuseofpulseoximetry(脉搏血氧仪).Itisimportanttounderstandthathealthy-termnewbornsdonotreachpreductal(导管前)oxygensaturations(血氧饱和度)greaterthan85-90%until5minandpreterminfantsnotuntil10-15minafterbirth.EvaluationoftheNewlyBornInfantNewbornsmovingtheirextremitiessoonafterbirthdonotrequireanyassistance.However,iftheseresponsesareabsentorweak,stimulationbyrubbingthebackwithadrysofttowelshouldsuffice.Othermethodssuchasslapping,footflicking,shaking,spanking,orholdingthebabyupsidedownarepotentiallydangerousandshouldnotbeused.Iftheinfantdoesnotrespondpromptly,PPVshouldbestarted.Aninfantwithgoodtoneisunlikelytobeseverelycompromised,whereasafloppyinfantislikelytoneedactiveresuscitation.However,asindicatedabove,specialattentionshouldbepaidespeciallyveryprematurei