新版新生儿心肺复苏指南的进展与不同

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1、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background2010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)sourceAmericanHear

2、tAssoc-iation.2005AmericanHeartAssociation(A-HA)guidelinesforcar-diopulmonaryresusc-itation(CPR)andem-ergencycardiovascularcare(ECC)ofpediatricandneonatalpatients:pediatricbasiclifesup-port.Pediatrics.2006May;117(5):e989-1004.KattwinkelJ,PerlmanJM,AzizK,ColbyC,e

3、lal.neonatalresuscitation:2010AmericanHeartAssociationGuidelinesforCardiopulmonaryResuscitationandEme-rgencyCardiovascularCare.Circulation.2010;122(suppl3):S909–S919.NewbornResuscitationAlgorithm.KattwinkelJetal.Circulation2010;122:S909-S919Copyright©AmericanHea

4、rtAssociation⑴pulseoximetryApulseoximetercanprovideacontinuousassessmentofthepulsewithoutinterruptionofotherresuscitationmeasures,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

5、断缺点：心输出量不足或灌注不足，效果不佳(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.

6、0纯氧复苏，无助于生存率提高(3)skincolorOtherstudieshavesho-wnthatclinicalassessm-entofskincolorisaverypoorindicatorofoxyh-emoglobinsaturationdu-ringtheimmediateneon-atalperiodandthatlackofcyanosisappearstobeaverypoorindicatorofthestateofoxygenationofanuncompromisedbabyfollow

7、ingbirth.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⑷CO2DetectorsThenumberofstudiesonCO2detectorsinneonatesremainsverysmallandmostreportscomefromretrospectivestudies.Untilmoresolidevidenceprovesthattheiruseimprovespatientoutcome,werefrainfromrecommendingCO2detectorsaspartofthe

8、routineDRmanagement.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⑸RespiratorysupportPositivepressureventilation(PPV)intheDRisbestadministeredbyapressurelimitedT-