英新生儿窒息与新法复苏

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1、NeonatalAsphyxiaanditsNewConceptonResuscitationChongminXuDep.NewnatesUnionHospitalNewWordspregnantwomaninvalidApgarscoreumbilicalcordprimaryapneaasynersisHIE(hypoxic-ischemicencephalopathy)ICH(intracranialhemorrhage)MOD(multipleorgansfunctiondamage)hypercapnia

2、hypoxemiaNeonatalasphyxiaisakindofgasexchangedisorder,thatcouldcausehypoxemia,hypercapniaandmetabolismacidosis,whichisaccountedonthatnewbornhasnoautorespirationoronlyhasirregular,intermittentandfeeblerespirationatbirth,orpresentrespiratorydepressionafterbirth.

3、It’sincidenceisabout5%occupiedtheviablebirth,andcancause20%deathintoltalnewnataldeath.Thenatureofasphyxiaitselfishypoxia.UsuallyweadoptApgarscoretojudgethedegreeofasphyxiation.AsphyxiacouldcausenotonlyHIE,butalsoMOD,andistheoneoftheimportantcausesofdeath,dysno

4、esiaandinvalid(cerebralpalsy)innewbornsallovertheworld.Neonatalmortalityisabout19.0‰(2005)inourcountry.Thefirstthreedeathcausesareprematurebirth&lowbirthweight,asphyxiaandpneumonia.Thereare1millionnewborndeathcausedbyneonatalasphyxia(total4millionyearly-2005.W

5、HO),and>1millionneonatessufferfromdysnoesia,cerebralpalsyandotherdeformitycausedbyittoo.DeliveryfactorsPlacentafactorFetalfactorumbilicalcordfactorPregnantwomanAsphyxialetiopatho-genisistooolderoryoungRespiratorydiseasecardiacdiseasesevereanaemiaSmoking&drugge

6、stationalhypertensionPregnantwomanfactorpolycyesisdiabetesplacentapraeviaplacentalabruptioninfarctusageingPlacentafactorshortcordknotofumbilicalcordumbilicalhangdownumbilicalcordcircleneckUmbilicalfactor胎儿因素prematurelargefordateinfantintrauterineinfectionrespi

7、ratorytractobstructioncongenitalcardiopathycongenitalabnormalityfoetusfactorsuckingfetalheadforcepsaiddeliverbreechpresentationunsuitablyusedrugsinlaborlaborextension&precipitatelaborcephalopelvicdisproportiondeliverfactorPathophysiologySwitchofrespiration&cir

8、culationfromfetustonewbornareblockedBreathalterbiochemistry&metabolismalterinbloodfetalpulmonaryfluidisremovedfromlungs↓surfaceactivesubstance(SAS)secretes↓functionalresidualcapaci