2020版新生儿复苏指南解读

2020版新生儿复苏指南解读
English Answer：
2020 Neonatal Resuscitation Program (NRP) Guidelines Interpretation.
Key Updates:
Emphasis on team-based resuscitation: Collaboration among healthcare providers is crucial for effective resuscitation.
New resuscitation algorithm: A simplified and streamlined algorithm enhances clarity and efficiency.
Increased use of capnography: Capnography provides real-time monitoring of ventilation and can guide resuscitation efforts.
Updated oxygen saturation targets: New targets during
resuscitation and after stabilization to prevent both hypoxemia and hyperoxia.
Focus on temperature management: Hypothermia and hyperthermia can worsen outcomes; optimal temperature should be maintained.
New guidelines for administering surfactant: Surfactant administration is recommended earlier in certain situations to improve lung function.
Resuscitation Algorithm:
Initial Steps:
Establish non-responsiveness and confirm term gestation: Check for breathing, movement, and cry.
Call for help: Activate the resuscitation team immediately.
Position and open airway: Position the infant with the
head slightly extended and the chin lifted.
Check for breathing: Observe chest rise and fall for 10 seconds.
If breathing is present: Continue monitoring and provide warmth and support as needed.
If breathing is absent: Begin positive-pressure ventilation (PPV) immediately.
PPV Considerations:
Initial settings: 20-30 breaths per minute, 20-25 cmH2O pressure, and 100% oxygen.
Capnography: Use capnography to confirm ventilation and adjust ventilation parameters.
Nasal versus oropharyngeal tubes: Both options are acceptable for PPV, depending on the provider's expertise.
Intermittent positive-pressure ventilation (IPPV) versus continuous positive-pressure ventilation (CPPV):
IPPV is usually preferred, but CPPV may be necessary in certain situations.
Medication Administration:
Epinephrine: Indicated for persistent bradycardia (<60 bpm) or asystole.
Sodium bicarbonate: May be considered for infants with severe metabolic acidosis (pH <7.00).
Surfactant: Administered intratracheally to improve lung function in specific situations.
Oxygen Management:
Initial oxygen concentration: 100%.
Oxygen saturation targets: 90-95% during resuscitation, 92-94% post-stabilization.
Oxygen delivery methods: Nasal cannula, face mask, or endotracheal tube, depending on the infant's condition.
Temperature Management:
Optimal temperature: 36.5-37.5°C (97.7-99.5°F).
Methods: Warm blankets, radiant warmer, or warm intravenous fluids.
Avoid hypothermia and hyperthermia: Both can have detrimental effects on the infant.
Additional Considerations:
Infection prevention: Follow strict infection control measures during resuscitation.
Post-resuscitation care: Monitor infants closely after resuscitation, provide appropriate support, and address underlying conditions.
Education and training: Healthcare providers should receive regular NRP training to ensure proficiency in resuscitation techniques.
Chinese Answer：
2020 年新生儿复苏指南解读。

关键更新：
强调团队复苏，医护人员之间的协作对有效的复苏至关重要。

新的复苏算法，简化和简化的算法提高了清晰度和效率。

增加使用呼末二氧化碳监测仪，呼末二氧化碳监测仪可实时
监测通气并可指导复苏工作。

更新的血氧饱和度目标，在复苏和稳定后的新目标，既防止
低氧血症又防止高氧血症。

关注温度管理，低温和高体温会恶化预后；应维持最佳温度。

使用表面活性剂的新指南，在某些情况下，建议更早使用表面活性剂以改善肺功能。

复苏算法：
初期步骤：
确定无反应并确认足月妊娠，检查呼吸、运动和哭声。

呼叫救助，立即启动复苏团队。

定位和开放气道，将婴儿的头稍微伸展，下巴抬起。

检查呼吸，观察胸部起落 10 秒钟。

如果出现呼吸，继续监测，并根据需要提供温暖和支持。

如果无呼吸，立即开始正压通气 (PPV)。

PPV 注意事项：
初始设置，每分钟 20-30 次呼吸，压力 20-25 cmH2O，氧气浓度 100%。

呼末二氧化碳监测仪，使用呼末二氧化碳监测仪确认通气并调整通气参数。

鼻管与口咽管，根据医生的专业知识，两种选择均可用于PPV。

间歇性正压通气 (IPPV) 与持续性正压通气 (CPPV)， IPPV 通常是首选，但在某些情况下可能需要 CPPV。

药物给药：
肾上腺素，适用于持续性心动过缓 (<60 bpm) 或心脏停搏。

碳酸氢钠，可考虑用于严重代谢性酸中毒（pH <7.00）的婴儿。

表面活性剂，在特定情况下经气管内给药以改善肺功能。

氧气管理：
初始氧气浓度， 100%。

氧饱和度目标，复苏期间 90-95%，稳定后 92-94%。

氧气输送方法，鼻导管、面罩或气管插管，取决于婴儿的状况。

体温管理：
最佳温度， 36.5-37.5°C (97.7-99.5°F)。

方法，保暖毯、辐射保温箱或温静脉注射液。

避免低温和高体温，两者都会对婴儿产生不利影响。

其他注意事项：
预防感染，在复苏过程中遵循严格的感染控制措施。

复苏后护理，复苏后密切监测婴儿，提供适当的支持并解决潜在状况。

教育和培训，医护人员应定期接受 NRP 培训，以确保掌握复苏技术。