新生兒心肺復蘇指南的解讀PPT課件

1、Company Logo資源source：2010國際CPR指南American Heart Assoc-iation.2005 American Heart Association (A-HA) guidelines for car-diopulmonary resusc-itation (CPR) and em-ergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life sup-port.Pediatrics.2006 May;117(5):e989-1004.Katt

2、winkel J, Perlman JM, Aziz K, Colby C, el al. neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Eme-rgency Cardiovascular Care.Circulation.2010;122(suppl 3):S909S919. 2010年10月，美國心臟協(xié)會（AHA）以及歐洲復蘇委員會（ERC）和國際復蘇聯(lián)絡（ILCOR）委員會定期發(fā)出5年后最后一個版本-新的新生兒的心肺復蘇指南。

3、第1頁/共19頁Company LogoNewborn Resuscitation Algorithm.Kattwinkel J et al. Circulation 2010;122:S909-S919Copyright American Heart Association新生兒窒息復蘇流程圖足月嗎？羊水清嗎？有呼吸或哭聲嗎？肌張力好嗎？中國衛(wèi)生部婦幼保健司與社區(qū)衛(wèi)生司中國疾病預防控制中心婦幼保健中心 大約耗時出生保持體溫擺正體位；清理氣道 （ 必要時）擦干全身，給予刺激，重 新擺正體位*評價呼吸、心率和膚色給氧進行正壓人工呼吸*進行正壓人工呼吸做胸外心臟按壓*使用腎上腺素*重新檢 查以下步

4、驟的有效性：考慮以 下可能性：正壓人工呼吸胸外按壓氣管插管給腎上腺素低血容量否紫紺持續(xù)紫紺呼吸暫?；蛐穆?100心率 60心率 60考慮：氣道畸形肺部問題，如：氣胸膈疝先天性心臟病 心率或持續(xù)紫紺或人工呼吸失敗 100紅潤復蘇后護理有效通氣心率并紅潤 100BCD* 在這些步驟中，可以考慮使用氣管插管！新生兒窒息復蘇最重要和最有效的措施為正壓人工呼吸考慮停止復蘇無心跳 10m i n30sec30sec30sec第2頁/共19頁Company Logo脈博pulse oximetry A pulse oximeter can provide a continuous assessment of

5、 the pulse without interruption of other resuscitation measures, but the device takes 1 to 2 minutes to apply, and it may not function during states of very poor cardiac output or perfusion. 脈搏氧飽和度監(jiān)測在新生兒心肺復蘇中是必需的 其他復蘇措施不必中斷 缺點：心輸出量不足或灌注不足，效果不佳第3頁/共19頁Company Logo(2)分娩室內氧療 Use of O 2 in the delivery

6、room Two meta-analyses of several randomized controlled trials comparing neonatal resuscitation initiated with room air versus 100% oxygen showed increased survival when resuscitation was initiated with air. 足月兒或接近足月兒開始復蘇可以用0.21空氣 各種供氧措施，如T-復合器予1. 0純氧復蘇，無助于生存率提高第4頁/共19頁Company Logo(3) 皮膚色澤skin color

7、 Other studies have sho-wn that clinical assessm-ent of skin color is a very poor indicator of oxyh-emoglobin saturation du-ring the immediate neon-atal period and that lack of cyanosis appears to be a very poor indicator of the state of oxygenation of an uncompromised baby following birth. 皮膚顏色：評價指

8、標差 生后存在發(fā)紺期 宮外10分鐘達正常水平第5頁/共19頁Company LogoCO2監(jiān)測CO2 Detectors The number of studies on CO 2 detectors in neonates remains very small and most reports come from retrospective studies.Until more solid evidence proves that their use improves patient outcome, we refrain from recommending CO 2 detectors a

9、s part of the routine DR management. 大部分報告來自回顧性研究 不建議CO2探測器的日常管理 需要更堅實的證據(jù)證明他們的使用提高了病人復蘇結果第6頁/共19頁Company Logo 呼吸支持Respiratory support Positive pressure ventilation (PPV) in the DR is best administered by a pressure limited T-piece resuscitator as such devices allow more control of the delivered pres

10、sure and tidal volumes. 在產(chǎn)房正壓通氣（PPV）是最好的管理 壓力有限的T型復蘇器允許壓力控制和潮氣量第7頁/共19頁Company Logo胎糞誤吸Meconium aspiration We suggest to continue with the current practice of clearing the airway before PPV is started in any infant, in particular those born from thick, MSAF, until further evidence becomes available。

11、 正壓通氣前呼吸道應清理 特別是那些出生稠厚的胎糞污染患兒。 胎糞污染吸引存在爭議第8頁/共19頁Company Logo體溫調控Temperature control We recommend the use of plastic cover only for infants with a GA 28 weeks. In any circumstances, close monitoring of the infant s temperature is mandatory, because both hypothermia and hyper- thermia negatively affe

12、cts neonatal outcome. 胎齡28周，使用塑料紙覆蓋強制執(zhí)行體溫過高與體溫過低影響復蘇結果第9頁/共19頁Company Logo人工降溫Induced hypothermia Induced hypothermia should be offered to all term or near term infants with evolving HIE. 胎齡36周 中重度HIE 亞低溫治療（33.5 - 34.5C間） 窗口期 6小時 治療期72小時 降低死亡率和殘疾率第10頁/共19頁Company Logo 藥物和液體Drugs and fluids 1.腎上腺素epi

13、nephrine In the absence of a suffcient IV access, an intra-osseous access may also be used. 腎上腺素 心率持續(xù)60次分 腎上腺素1:10 000溶液（0.1毫克/毫升）0.1 - 0.3毫升/公斤 靜脈不可用時，骨內給藥第11頁/共19頁Company Logo -2.碳酸氫鈉Sodium bicarbonate Due to lack of evidence, sodium bicarbonate may only be considered during prolonged cardiac arre

14、sts unresponsive to other therapy and on a compassionate use basis, and on a case-by-case basis in the postresus-citation care of newly born infants 證據(jù)缺乏 指證：心跳停止，搶救無反應第12頁/共19頁Company Logo -3.納洛酮Naloxone Naloxone should not be used during resuscitation or the post-resuscitation care of depressed new

15、ly born infants. 不應使用第13頁/共19頁Company Logo -4.擴容Volume expansion Isotonic crystalloid solution or blood (10 mL / kg IV) should be used for the initial IV volume expansion in a depressed new-born infant in the DR with a history or clinical signs of significant hypovo-lemia, but rarely on an empiric b

16、asis. 應該是等滲晶體溶液或血（10毫升/公斤IV） 用于產(chǎn)時血容量明顯減少，無循證醫(yī)學證據(jù) 早產(chǎn)兒易引起顱內出血第14頁/共19頁Company Logo -5.輸注葡萄糖Glucose IV infusion We suggest to start by giving a 10% glucose (dextrose) IV solu- tion in the DR as early as possible, and independ-ently from resuscitation status (i.e. start infusion during resuscitation). 產(chǎn)

17、房，建議早期給予10葡萄糖溶液 獨立于復蘇狀態(tài)（即在復蘇開始輸液時） 第15頁/共19頁Company Logo推遲鉗夾臍帶Delayed cord clamping For term infants, cord clamping may be delayed for 1 2 min. Delayed cord clamping may be of benefi t to term infants born in countries with poor maternal nutritional state and / or insuffici- ent postnatal follow-up. 對于足月兒，鉗夾臍帶最好推遲1 - 2分鐘 主要針對營養(yǎng)狀況不佳的孕產(chǎn)婦第16頁/共19頁Company Logo(11)倫