新生儿颅内出血

Subdural hemorrhage SDH硬膜 SDH硬膜 下出血
• Birth trauma产伤 trauma产伤 • Clinical signs of SDH related to the site of
the bleeding and the severity of hemorrhage. 临床症状与出血的部位和出血的量相关
Nursing management
Reduce the risk of increased ICP include avoiding interventions that cause crying 制动 Some nursing procedures increase ICP. care includes ICP. evaluating manipulations to reduce discomfort. 护理操 discomfort. 作集中 Some medicine , supporting ,correcting acidosis 纠酸 Avoiding cause fluctuations in cerebral blood flow. flow.
Classification
• There are three major types
PeriventricularPeriventricular-intraventricular hemorrhage (PVH(PVH-IVH)脑室和脑室周围出血 Subdural hemorrhage (SDH) 硬膜下出血 Subarachnoid hemorrhage (SAH)蛛网膜下腔出血 Intracerebellar hemorrhage小脑出血
Subarachnoid hemorrhage (SAH) 蛛网膜下腔出血
• occurs in full term infants as result of the
trauma 产伤 • in preterm infants as result of the same type of events that cause IVH • Small hemorrhage are the most common 少量出血
Capillary in brain rupture bleeding 脑内 毛细血管破裂出血
Common Clinical Signs/Symptoms of ICH
Change of consciousness意识改变 consciousness意识改变 Irregular respiratory pattern or apnea Abnormal eyes signs/movement Pupils signs瞳孔改变 signs瞳孔改变 Change of muscle tone Others: Others: jaundice, anemia, etc intracranial hypertension 颅内高压
Intracranial Hemorrhage of the Newborn ( ICH ) 新生儿颅内出血
Contents mastered :
The main causes of neonatal ICH 颅内出血 Classification and manifestation Nursing diagnosis and nursing management of neonatal ICH Prevention of neonatal ICH
有呼吸受损的危险 Risk for asphyxia 有窒息的危险 Risk for nutrition disorder Risk for infection Temperature adjust is ineffective 体温调节无效
Nursing management
Routine observation, management, nursing care is directed toward prevention of fluctations in cerebral BP 颅内血压稳定 ICP is decreased when the head is in a midline position and elevated 30 degrees 体位 Environment is calm, temperature and humidity is comfortable 环境 Maintain temperature stability 温度
Definition
• Neonatal intracranial hemorrhage is cranial
injure颅内损伤 injure颅内损伤 of newborns due to perinatal hypoxia or birth trauma 围生期的窒息 产伤 • The incidence is more higher in premature 早产儿 • A severe disease in neonate
Etiology and Epidemiology of ICH
Trauma (epidural, subdural, or subarachnoid) 产伤 硬膜外的，硬膜下的， 硬膜外的，硬膜下的，蛛网膜下的 Term infants
• fetal head is too large compared with the size of the pelvic outlet 骨盆出口 • prolonged labor/breech臀 or precipitant deliveries急产 labor/breech臀 deliveries急产 • Delivery with mechanical assistance 机械性的辅助
Pressure passivity blood flow 压力被动性血流 Cerebral vessels expand 脑血管 扩张
动脉压 动脉压
Capillary in brain ischemic injure 脑内毛细血管 缺血性损伤
血管内压
Vena encephali vessels rupture bleeding 脑静脉血管 破裂出血
Periventricular/ intraventricular hemorrhage (P/IVH) 脑室周围/ 脑室周围/脑室出血
• It is the most common type of intracranial • • • •
hemorrhage in the neonatal period 最常见 Preterm infants 早产儿 Serious neurologic disorder of preterm infant Signs appear in 24hours, or 2-3days later 2CSF indicate hemorrhage
Intracranial hemorrhage
胎头吸引
precipitant deliveries急产
mechanical injury 产钳助产
breech deliveries 臀牵引 天幕、大脑镰撕裂、脑表浅静脉破裂 天幕、大脑镰撕裂、 Intracranial hemorrhage
Primary hemorrhagic disturbance 最初的出血障碍
laboratory
Cranial ultrasonography (real-time)超声波 (real-time)超声波 Computed tomography (CT) Magnetic resonance imaging (MRI)
Nursing diagnosis
• Potential complication • Risk for respiratory injury • • • •
Nursing management
maintain temperature Oxygen using Health education
Asphyxia/HypoxicAsphyxia/Hypoxic-ischemic encephalopathy 窒息 Premature
Intracranial hemorrhage
胎儿头部 过分受压
Malpresentation 胎位不正
prolonged labor 产程延长
fetal head is too large
Congenital vascular anormality 先天性的血管异常 Iatrogenic hemorrhage 医源性的出血 ng)
pathogenesis 发病机制
Hypoxic缺氧 asphysia窒息 Hypoxic缺氧, asphysia窒息 缺氧, Hypoxemia低氧血症、hypercapnia高碳酸血症
• DIC • Thrombocytopenia血小板减少 Thrombocytopenia血小板减少 • neonatal vitamin K deficiency 维生素K 缺乏 维生素K (maternal phenobarbital苯巴比妥 or phenytoin苯妥英钠) phenobarbital苯巴比妥 phenytoin苯妥英钠 苯妥英钠)
Nursing management
Rapid volume expansion following hypotension and administration of hyperosmolar 高 渗 solution such as NaHCO3 NaHCO3 should be avoided. avoided. Monitoring serum blood glucose levels and preventing hypoglycemia is also an important factor in keeping the infant neurologically intact. 监测血糖水平 intact.