妇产科学课件胎儿窘迫.ppt

1、This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee胎儿窘迫胎儿窘迫Fetal distress复旦大学附属妇产科医院 李桂英副教授This year,my town construction work in the city,municipal government,municipal construction Bureau o

2、f the direct leadership and support,the Town party committee定义定义:胎儿在子宫内因急性或慢性缺氧危及其健康和生命者,称胎儿窘迫,主要表现为低氧血症、酸中毒、高碳酸血症、高乳酸血症等一系列征候群。This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee危害性：围生儿死亡的首要

3、原因。儿童智力低下的主要原因。l 先天性疾病遗传咨询中60%为智力低下；l 智力低下中90%为产前、产时或产后缺氧，10%为遗传因素；l 重度窒息中，4.1%有智力低下；l 新生儿窒息20分钟后好转者，36.4%智力低下。This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee胎儿获得充分气体交换的五个重要环节：母体血液中氧含量充足，

4、子宫胎盘血循环通畅，绒毛间隙气血交换正常，脐带血循环通畅，胎儿心肺功能和血红蛋白正常。This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee分类：急性胎儿窘迫：多发生在分娩期.原因:脐带脱垂、前置胎盘、胎盘早剥、产程延长、宫缩过强或不协调。慢性胎儿窘迫：常发生在妊娠晚期。原因：妊娠期高血压疾病、慢性肾炎、糖尿病、严重贫血、ICP、过

5、期妊娠。This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee病理生理和临床表现：胎动异常、胎心率异常、羊水粪染、羊水过少。胎 儿生长受限。This year,my town construction work in the city,municipal government,municipal construction Burea

6、u of the direct leadership and support,the Town party committee诊断：目前国内尚无统一的诊断标准。监测手段的利用很不平衡，各种现有的监测手段均存在假阴性和假阳性，医务人员在判断结果时存在很大的个体差异。诊断应根据下列监测方法的结果综合临床全面分析。This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town

7、party committee监测方法:胎动计数 胎儿电子监护:NST(non-stress test):无应激试验:OCT(oxytocin challenge test):催产素激惹试验:CST(contraction stress test)宫缩应激试验 3.胎儿生物物理评分(Biophysical profile scores BPPs)4.胎儿血气分析：诊断胎儿窘迫的黄金标准 5.羊水胎粪污染 This year,my town construction work in the city,municipal government,municipal construction Bure

8、au of the direct leadership and support,the Town party committee诊断依据 胎动减少或消失：胎儿电子监护异常：下列情况应考虑胎儿有缺氧可能 胎心率160bpm甚至180bpm持续10分钟，注意除外感染、药物及心脏缺陷。This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee

9、2)胎心率 600 U/L 间接胆红素升高 外周血涂片见碎裂红细胞 红细胞压积降低This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee2.肝酶升高：ALT、AST升高。但转氨酶并不是十分敏感的指标3.血小板减少：This year,my town construction work in the city,municipal go

10、vernment,municipal construction Bureau of the direct leadership and support,the Town party committeeHELLP综合征分类密西西比分类法 病程中血小板最低记录分类I级 PLT 50109,AST/ALT 70u/L,LDH 600u/LII级 PLT 50100109,AST/ALT 70u/L,LDH 600u/LIII级PLT100150109,AST/ALT 40u/L,LDH 600u/LThis year,my town construction work in the city,mun

11、icipal government,municipal construction Bureau of the direct leadership and support,the Town party committee田纳西分类法完全性 HELLP syndrome：部分性HELLP syndrome：ELLP、EL、HEL、LP incomplete complete预后：子痫前期 incomplete complete This year,my town construction work in the city,municipal government,municipal constru

12、ction Bureau of the direct leadership and support,the Town party committee鉴别诊断：血栓性血小板减少性紫癜：神经精神异常、血小板、溶血、发热、肾损害。1.2.溶血性尿毒症性综合征：产后一天至数周发生的病因未明、预后不良的微血管病性溶血性贫血及肾功衰竭之综合征。This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and suppo

13、rt,the Town party committee3.急性脂肪肝：孕晚期持续呕吐，上腹痛，黄疸进行性加深，ALT和SB，纤维蛋白原,低蛋白血症，血氨，低血糖，尿胆红素（），超声“明亮肝”。This 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：控制病情，防治并发症：-肾上腺皮质激素：-血小板：-血浆：产科处理：-终止妊娠时机：-终止妊娠方式：-麻醉：This year,my town construction work in the city,municipal government,municipal construction Bureau of the direct leadership and support,the Town party committee思考题1.如何早期诊断HELLP综合征？