湘雅儿科精品课件-Hypoxic-Ischemic

第七章第六节
新生儿缺氧缺血性脑病 HypoxicHypoxic-Ischemic Encephalopathy(HIE)
Department of pediatrics 陈平洋
中南大学儿科学教研室
Purpose
To be familiar with etiology, Mechanism and prevention To master clinical manifestation, diagnosis and treatment To understand the prognosis
furosemide(速尿): every time 1mg/Kg (速尿)
Treatment
3,Supportive therapy(支持疗法) , (支持疗法) ① Support cardiorespiratory(循环呼吸)status: (循环呼吸) prevent hypoventilation(通气不足), hypercapnia(高碳酸血症), hypoxemia(低氧血症) 低氧血症) ② Maintain adequate blood pressure(血压). (血压) ③ Maintain adequate blood glucose(血糖) (血糖) level, acid-base and electrolyte balance(水, ( 电解质,酸碱平衡) 电解质,酸碱平衡) ④ Fluid restriction(限制液体) < 60~80ml/kg/d (限制液体)
Summary
HIE(缺氧缺血性脑病)is caused by ( perinatal asphyxia(围生期的窒息) 围生期的窒息) HIE is a disease primarily of the term infant
Hypoxia(低氧血症) (低氧血症)
diminished cerebral perfusion blood capillary 脑灌注) (脑灌注) ↓ Permeability (毛细血管通 ischemia ↓ 透性) cerebral necrosis 透性)↑ (脑梗死) 脑梗死) cerebral edema Intracranial pressure( pressure(颅内压 )↑ Intracranial hemorrhage 颅内出血) (颅内出血)
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Treatment
1,Control convulsions (控制惊厥) , )
luminal(鲁米那) loading dose : 20mg/kg aequum (维持量): every time 5mg/kg 维持量
2,Control cerebral edema (控制脑水肿) , ) manicol(甘露醇): every time 0.25 ~ (甘露醇) 0.5g/kg
Clinical Diagnosis and Grades of Severity
Mild 1consciousness Irritability 意识) (意识) (易激惹) 2muscle tone(肌张力) (肌张力) Normal 3primitive reflexes Hyperactive 4convulsion(惊厥) (惊厥) None 5respiratoryfailure None 6pupils(瞳孔) (瞳孔) Normal 7anteriorfontanelle Normal 8duration(病程) <24 hr 病程) 病程 9prognosis(预后) Good (预后) Moderate Severe Coma(昏迷) (昏迷) lethargic(昏睡) ( Flaccid(弛缓) ( Hypotonic(增高) (增高) Absent Weak Commonly seen Commonly seen Commonly seen None or mild Normal or miosis Unequal, poor light reflex 缩小) (缩小) Tension(紧张) (紧张) Full(饱满) (饱满) Days to weeks 24hr to 14days Death or severe Variable sequela(后遗症) (后遗症)
cerebral metabolism (脑代谢)disorder acidemia . ATP Na .Ca pump function ↓ cellular Ca.Na ↑ cerebral edema 水肿) (脑 水肿) ↓ ↓
Etiology and Mechanism(病因与发病机制) (病因与发病机制)
Who is risk baby?
1. Fetal distress in uterus(胎儿宫内窘迫 胎儿宫内窘迫) 胎儿宫内窘迫 2. Infants who are asphyxiated(窒息) 窒息) 窒息 3. Infants who develop postnatal(产后) 产后) 产后 asphyxiacted insults: severe pulmonary disease, apnea(呼吸暂 呼吸暂 停), congenital heart disease(先天性心 ( 脏病) 脏病)
Selective vulnerabilities(选择易损性) vulnerabilities(选择易损性)
Occur in selected areas of the brain stem, 脑干) 丘脑) (脑干)thalamencephalon(丘脑)and cerebellum(小脑) where metabolism is 小脑) vigorous and which are most sensitive to hypoxicischemic(缺氧缺血性) injury hypoxicischemic(缺氧缺血性) injur 损伤) (损伤).
Diagnosis
1,History , Perinatal asphyxia(围生期窒息) 围生期窒息) 2,Clinical manifestation , Brain injury(脑水肿) (脑水肿) Some degree of systemic organ injury 3,Ultrasound examinations (超声检查) 超声检查) , 4,CT scan of the brain or MRI , 5, EEG , 6, Ck-BB(肌酸磷酸激酶) , (肌酸磷酸激酶)