胎儿窘迫新生儿窒息课件.pptx

1、This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee1 1This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,t

2、he Town party committee 掌握胎儿窘迫的临床表现及诊断掌握胎儿窘迫的临床表现及诊断 熟悉处理方法熟悉处理方法2 2This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee 胎儿在宫内因急性或慢性缺氧危及其健康和生命的综合症状胎儿在宫内因急性或慢性缺氧危及其健康和生命的综合症状 急性常发生在分娩期急性常发生在分娩期

3、 慢性发生在妊娠晚期，可延续至分娩期并加重慢性发生在妊娠晚期，可延续至分娩期并加重3 3This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee 围产儿死亡首要的因素围产儿死亡首要的因素 儿童智力低下的主要原因儿童智力低下的主要原因先天性疾病遗传咨询中先天性疾病遗传咨询中6060为智力低下为智力低下智力低下中智力低下中9090为产前、

4、产时或产后缺氧为产前、产时或产后缺氧1010为遗传因素。为遗传因素。重度窒息中，重度窒息中，4.1%4.1%有智力异常有智力异常窒息窒息2020分钟后好转者，分钟后好转者，36.436.4智力异常智力异常4 4This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee母体母体循环循环绒毛绒毛间隙间隙胎儿胎儿循环循环O2CO25 5Thi

5、s year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee母体血液母体血液含氧量不足含氧量不足如：孕妇合并先天性心脏病或如：孕妇合并先天性心脏病或伴心功能不全等伴心功能不全等母胎间血氧母胎间血氧运输及交换障碍运输及交换障碍 如：宫缩过强、过频等如：宫缩过强、过频等 胎儿自身胎儿自身因素异常因素异常如：胎儿心肺功能及如：胎儿心肺功能及血红蛋白含

6、量异常血红蛋白含量异常6 6This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee 母胎间血氧运输及交换障碍母胎间血氧运输及交换障碍 脐带血循环障碍脐带血循环障碍五要素：胎盘五要素：胎盘 脐带脐带 休克休克 宫缩宫缩 药物药物7 7This year,my town construction work in the city,mun

7、icipal government,municipal construction Bureau of the direct leadership and support,the Town party committee8 8This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee 母体母体 胎盘胎盘 胎儿胎儿高血压、心肺、贫血高血压、

8、心肺、贫血PDH、GDM、老化、老化畸形、多胎、畸形、多胎、TTTS9 9This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee 胎儿生理储备超支或耗竭，影响重要器官功能至暂时或胎儿生理储备超支或耗竭，影响重要器官功能至暂时或永久损伤或死亡的病理变化正在发生或将要发生。永久损伤或死亡的病理变化正在发生或将要发生。轻、中度或一过性缺氧

9、轻、中度或一过性缺氧无严重后果无严重后果 长时间中、重度缺氧长时间中、重度缺氧严重并发症：严重并发症：胎儿生长受限、胎儿生长受限、胎死宫内、胎死宫内、缺血缺氧性脑病及脑瘫缺血缺氧性脑病及脑瘫1010This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committeeCO2呼吸性酸中毒呼吸性酸中毒交感交感N初期初期BP、心率、心率 迷走迷走N 血血

10、O2心率心率晚期晚期无氧糖酵解无氧糖酵解丙酮酸、乳酸丙酮酸、乳酸代谢性酸中毒代谢性酸中毒羊水粪染羊水粪染脑脑肾肾肠肠肺肺缺血缺氧脑病缺血缺氧脑病脑瘫脑瘫羊水减少羊水减少1111This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee胎心率异常胎心率异常重要征象重要征象羊水粪染：羊水粪染：胎动异常：胎动异常：酸中毒：酸中毒：急性胎儿窘迫

11、急性胎儿窘迫1212This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee急性胎儿窘迫急性胎儿窘迫胎心率胎心率宫缩压力宫缩压力1313This year,my town construction work in the city,municipal government,municipal construction Bureau o

12、f the direct leadership and support,the Town party committee加速加速心动过速心动过速急性胎儿窘迫急性胎儿窘迫心动过缓心动过缓1414This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee 早期减速早期减速 变异减速变异减速 晚期减速晚期减速急性胎儿窘迫急性胎儿窘迫减速减速1

13、515This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee早期减速早期减速急性胎儿窘迫急性胎儿窘迫1616This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct

14、leadership and support,the Town party committee变异减速变异减速急性胎儿窘迫急性胎儿窘迫1717This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee1818This year,my town construction work in the city,municipal governm

15、ent,municipal construction Bureau of the direct leadership and support,the Town party committee晚期减速晚期减速急性胎儿窘迫急性胎儿窘迫1919This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee正弦心律正弦心律变异消失变异消失2020T

16、his year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee 度浅绿色，常见胎儿慢性缺氧度浅绿色，常见胎儿慢性缺氧 度深绿色或黄绿色，提示胎儿急性缺氧度深绿色或黄绿色，提示胎儿急性缺氧 度呈棕黄色，稠厚，提示胎儿缺氧严重度呈棕黄色，稠厚，提示胎儿缺氧严重 急性胎儿窘迫急性胎儿窘迫2121This year,my town construct

17、ion work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee胎动计数：胎动计数：3030次次/12h/12h，1010次次/12h/12h频繁频繁 减少减少 消失消失急性胎儿窘迫急性胎儿窘迫2222This year,my town construction work in the city,municipal government,municipal construction Bureau

18、 of the direct leadership and support,the Town party committee胎儿头皮血胎儿头皮血 pH7.20，PO210mmHg,PCO260mmHg 急性胎儿窘迫急性胎儿窘迫2323This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee急性胎儿窘迫应尽快改善胎儿缺氧状态急性胎儿窘迫

19、应尽快改善胎儿缺氧状态 一般处理：一般处理：左侧卧位，吸氧等左侧卧位，吸氧等 病因治疗：病因治疗：针对五要素针对五要素 尽快终止妊娠尽快终止妊娠 急性胎儿窘迫急性胎儿窘迫2424This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee 宫口未开全：需立即剖宫产宫口未开全：需立即剖宫产 胎心率胎心率180bpm，伴羊水污染，伴羊水污染度

20、度 羊水污染羊水污染度，伴羊水过少度，伴羊水过少 胎儿电子监护胎儿电子监护CST或或OCT出现频繁晚期减速或重度变异减速出现频繁晚期减速或重度变异减速 胎儿头皮血胎儿头皮血pH7.20 急性胎儿窘迫急性胎儿窘迫2525This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee 宫口开全宫口开全骨盆各径线正常骨盆各径线正常胎头双顶径已达坐

21、骨棘平面以下者胎头双顶径已达坐骨棘平面以下者应尽快经阴道助娩应尽快经阴道助娩 无论阴道分娩或剖宫产均需做好新生儿窒息抢救准备无论阴道分娩或剖宫产均需做好新生儿窒息抢救准备 急性胎儿窘迫急性胎儿窘迫2626This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee 胎动减少或消失胎动减少或消失：胎儿电子监护异常：胎儿电子监护异常：胎儿生物

22、物理评分低：胎儿生物物理评分低：胎盘功能低下：胎盘功能低下：尿尿E3、雌激素、雌激素/肌酐、胎盘生乳素等肌酐、胎盘生乳素等 羊水粪染羊水粪染 胎儿生长受限胎儿生长受限慢性胎儿窘迫慢性胎儿窘迫2727This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee NSTNST无反应型无反应型 在无胎动与宫缩时，胎心率在无胎动与宫缩时，胎心率1

23、80bmp180bmp或或120bpm120bpm持续持续1010分钟以上分钟以上 基线变异频率基线变异频率5bpm5bpm OCTOCT可见频繁重度变异减速或晚期减速可见频繁重度变异减速或晚期减速慢性胎儿窘迫慢性胎儿窘迫2828This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee项目2分（正常）0分（异常）NST(20分钟)2次

24、胎动伴胎心加速15bpm，持续15秒2次胎动，胎心加速15bpm，持续15秒胎儿呼吸运动(30分钟)1次，持续30秒无，或持续30秒胎动(30分钟)3次躯干和肢体活动（连续出现计1次）2次躯干和肢体活动；无活动肢体完全展开肌张力1次躯干和肢体伸展复屈手指摊开合拢无活动；肢体完全伸展；伸展缓慢，部分复屈羊水量羊水暗区垂直直径2cm无；或最大暗区垂直直径2cm 2929This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct lea

25、dership and support,the Town party committee处理处理应针对病因，视孕周、胎儿成熟度及胎儿窘迫程度决定处理措施应针对病因，视孕周、胎儿成熟度及胎儿窘迫程度决定处理措施 一般处理：左侧卧位，定时吸氧一般处理：左侧卧位，定时吸氧 期待疗法期待疗法：孕周小，尽量保守治疗以期延长胎龄同时促胎肺：孕周小，尽量保守治疗以期延长胎龄同时促胎肺成熟成熟 终止妊娠终止妊娠慢性胎儿窘迫慢性胎儿窘迫3030This year,my town construction work in the city,municipal government,municipal constr

26、uction Bureau of the direct leadership and support,the Town party committee 妊娠近足月妊娠近足月 胎动减少胎动减少 OCTOCT出现频繁的晚期减速、重度变异减速出现频繁的晚期减速、重度变异减速 胎儿生物物理评分胎儿生物物理评分33分者分者 剖宫产剖宫产慢性胎儿窘迫慢性胎儿窘迫3131This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leaders

27、hip and support,the Town party committeeNeonatal asphyxia3232This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee胎儿娩出后胎儿娩出后1分钟，仅有心跳而无呼吸或未建立规律呼吸分钟，仅有心跳而无呼吸或未建立规律呼吸的缺氧状态。的缺氧状态。-是新生儿死亡及伤残的主要原因。是新

28、生儿死亡及伤残的主要原因。-出生后常见的一种紧急情况。出生后常见的一种紧急情况。定义定义3333This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee新生儿新生儿窒息窒息3434This year,my town construction work in the city,municipal government,municipal

29、 construction Bureau of the direct leadership and support,the Town party committee1、胎儿窘迫：、胎儿窘迫：延续延续2、呼吸中枢受到抑制或损害、呼吸中枢受到抑制或损害胎儿颅内出血及脑部长时间缺氧胎儿颅内出血及脑部长时间缺氧药物影响：麻醉剂、镇静剂药物影响：麻醉剂、镇静剂呼吸道阻塞呼吸道阻塞:吸入羊水、粘液吸入羊水、粘液 3、其它、其它:先天性心脏畸形、先天性膈疝、先天性肺发育不良先天性心脏畸形、先天性膈疝、先天性肺发育不良病因病因3535This year,my town construction work in

30、 the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee按出生后按出生后15分钟的分钟的Apgar评分判断、评分判断、根据缺氧程度不同分为根据缺氧程度不同分为2类：类：轻度轻度 重度重度3636全身红润躯干红，四肢紫唇青紫，全身苍白皮肤颜色咳嗽、恶心有，不强无喉反射四肢活动四肢稍屈曲无,松弛肌张力佳,哭声响亮浅、慢、不规则0呼吸1001000心率(次/分)210Apgar评分法评分法This year,my

31、town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee轻度窒息（青紫窒息轻度窒息（青紫窒息blue a.）Apgar评分评分47分分皮肤青紫色，呼吸表浅或不规则，心跳规则，心率常减慢皮肤青紫色，呼吸表浅或不规则，心跳规则，心率常减慢（80 120次次/分），肌张力好，喉反射存在。分），肌张力好，喉反射存在。若处理不及时，可能转为重度窒息若处理不及时，可能转为

32、重度窒息3838This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee重度窒息（苍白窒息重度窒息（苍白窒息pale a.）Apgar评分评分03分分皮肤苍白，口唇暗紫，呼吸无皮肤苍白，口唇暗紫，呼吸无/微弱，心跳不规律且弱（微弱，心跳不规律且弱（80次次/分），肌张力松弛，喉反射（分），肌张力松弛，喉反射（）。）。若不及时抢救可致死

33、亡若不及时抢救可致死亡出生后、分钟出生后、分钟Apgar评分有助于诊断和判断预后评分有助于诊断和判断预后3939This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee预防预防v提高产前检查质量提高产前检查质量v严密观察产程，及时处理胎儿窘迫严密观察产程，及时处理胎儿窘迫v慎用镇静剂、麻醉剂慎用镇静剂、麻醉剂v严格掌握手术指征，避免新

34、生儿颅内损伤严格掌握手术指征，避免新生儿颅内损伤4040This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee处理（处理（新生儿窒息复苏）新生儿窒息复苏）1、复苏前准备、复苏前准备 掌握复苏技术的熟练人员掌握复苏技术的熟练人员 药品和器械准备药品和器械准备药品：葡萄糖液、维生素药品：葡萄糖液、维生素c、肾上腺素等、肾上腺素等器械：器

35、械：保暖箱、氧气、咽喉镜、气管导管等保暖箱、氧气、咽喉镜、气管导管等4141This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee2 2、复苏方案、复苏方案A (airway):清理呼吸道清理呼吸道B (breath)：吸氧和人工呼吸：吸氧和人工呼吸吸氧：喷氧、鼻内插管、气管插管吸氧：喷氧、鼻内插管、气管插管人工呼吸：口对口人工呼吸

36、、人工呼吸器人工呼吸：口对口人工呼吸、人工呼吸器C (circulation):建立正常循环建立正常循环胸外心脏按压胸外心脏按压100-120次分次分4242This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee4343This year,my town construction work in the city,municipal

37、 government,municipal construction Bureau of the direct leadership and support,the Town party committee4444This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee(drug)：药物：药物 0.01%肾上腺素肾上腺素 气管内给药气

38、管内给药碳酸氢钠碳酸氢钠3-5ml/kg+等量等量5%GS脐静脉给药脐静脉给药E(evaluation):新生儿评价、监护贯穿抢救全过程新生儿评价、监护贯穿抢救全过程 最关键最关键 是根本是根本4545This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee复苏后护理复苏后护理 重点监护重点监护,注意保暖，保持呼吸道通畅注意保暖，保持呼吸道通畅 给氧给氧 延迟哺乳延迟哺乳 预防感染预防感染 预防新生儿颅内出血预防新生儿颅内出血 维生素维生素100mg im qd3天天 维生素维生素k1 10mg im qd3天天4646This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee4747