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1、新生儿窒息AsphyxiaoftheNewbornDr.XiaopingLuoProfessorandChairmanDepartmentofPediatricsTongjiHospitalTongjiMedicalCollegeThehighestmortalitythatbefallsthehumanraceinonedayoccursonthedayofbirth...….……Itissaidthatthemostimportantperiodofthelifeofahumanbeingisthetimespentinutero.Themosttryingordealah
2、umanbeingsustainsistheordealofbirth.AsphyxiaNeonatorum:CausationandTreatmentProfessorofObstetrics,NorthwesternUniversityMedicalSchoolJos.B.DeLeePublishedinMedicine(Detroit)3:643-660,1897.DefinitionofPerinatalAsphyxiaaconditionintheneonatewherethereisthefollowingcombination:Aneventorcondition
3、duringtheperinatalperiodthatislikelytoseverelyreduceoxygendeliveryandleadtoacidosis;ANDAfailureoffunctionofatleasttwoorgansconsistentwiththeeffectsofacuteasphyxia.Hypoxemia,Hypercapnia,Mixedacidosis,OrganicfailureRiskFactors-MaternalSystemicdisease:diabetes,heartorrenaldiseases,anemia,infect
4、iousdiseasesObstetricConditions:hypertensivediseaseofpregnancyorpre-eclampsia,placentalabruptionSubstanceabuse:drugaddiction,smokingMaternalage:>35,or<16,multiplepregnancyRiskFactors-FetalPremature,SGA,macrosomiaCongenitalmalformation:noseandlaryngo-pharynxmalformation,lunghypoplasia,heartdi
5、seaseAmnioticfluidormeconiumaspirationIntrauterineinfection:TorchsyndromeRiskFactors-IntrapartumUmbilicalcord:obstructionObstetricprocedures:forcepsdelivery,breechextraction,vacuumextractionMedication:analgesicandoxytocicmedicinePathophysiologyofAsphysiaRespiratoryAlteration:primaryhyperpnea
6、,primaryapnea,secondaryapneaHypoxic-ischemicChangesofMulti-organicsystem:“divingreflex”,inter-organshunting,organfailureBiochemicalandmetabolicConsequences:acidosis,hyper-orhypoglycemia,hypocalcemia,hyperbilirubinemia,hyperkalemia,hyponatremiaClinicalManifestationofAsphysiaApgarScoringSystem
7、ApgarScoringSystemSign0Points1Point2PointsActivity(muscletone)absentarmsandlegsflexedactivemovementPulse(heartrate)absentbelow100bpmabove100bpmGrimace(reflexirritability)noresponsegrimacesneeze,cough,pullsawayAppearance(skincolor)blue-gray,paleallo
