新生兒缺氧缺血性腦病Hypoxic-IschemicEncephalopathyHIE

1、新生兒缺氧缺血性腦病Hypoxic-Ischemic Encephalopathy(HIE)Department of pediatrics1 PurposeTo be familiar with etiology, Mechanism and preventionTo master clinical manifestation, diagnosis and treatmentTo understand the prognosis2 SummaryHIE（缺氧缺血性腦病）is caused by perinatal asphyxia（圍生期的窒息） HIE is a disease prima

2、rily of the term infant3Hypoxia（低氧血癥） cerebral metabolism （腦代謝）disorder acidemia . ATPNa .Ca pump function cellular Ca.Na cerebral edema（腦 水腫）diminished cerebral perfusion（腦灌注） ischemia cerebral necrosis （腦梗死）cerebral edema Intracranial pressure（顱內(nèi)壓 ) blood capillaryPermeability（毛細(xì)血管通透性）Intracranial

3、 hemorrhage（顱內(nèi)出血）4Etiology and Mechanism（病因與發(fā)病機(jī)制）Selective vulnerabilities（選擇易損性） Occur in selected areas of the brain stem, （腦干）thalamencephalon（丘腦）and cerebellum（小腦） where metabolism is vigorous and which are most sensitive to hypoxicischemic（缺氧缺血性） injury（損傷）.5 Who is risk baby?1. Fetal distress

4、in uterus(胎兒宮內(nèi)窘迫)2. Infants who are asphyxiated(窒息） 3. Infants who develop postnatal(產(chǎn)后） asphyxiacted insults: severe pulmonary disease, apnea(呼吸暫 停), congenital heart disease（先天性心 臟?。?Clinical Diagnosis and Grades of Severity1consciousness（意識(shí)）2muscle tone（肌張力）3primitive reflexes4convulsion（驚厥）5resp

5、iratoryfailure6pupils（瞳孔）7anteriorfontanelle 8duration(病程）9prognosis（預(yù)后）Irritability（易激惹） Normal Hyperactive None None Normal Normal 24 hr Goodlethargic（昏睡）Hypotonic（增高） WeakCommonly seen None or mildNormal or miosis（縮?。〧ull（飽滿）24hr to 14daysVariable SevereComa（昏迷)Flaccid（弛緩）AbsentCommonly seenCommo

6、nly seenUnequal, poor light reflexTension（緊張） Days to weeksDeath or severe sequela（后遺癥） Moderate Mild7 Diagnosis 1、History Perinatal asphyxia（圍生期窒息） 2、Clinical manifestation Brain injury（腦水腫） Some degree of systemic organ injury 3、Ultrasound examinations （超聲檢查） 4、CT scan of the brain or MRI 5、 EEG 6

7、、 Ck-BB（肌酸磷酸激酶）8 Treatment1、Control convulsions （控制驚厥） luminal（魯米那） loading dose : 20mg/kg aequum (維持量）: every time 5mg/kg2、Control cerebral edema （控制腦水腫） manicol（甘露醇）: every time 0.25 0.5g/kg furosemide（速尿）: every time 1mg/Kg9 Treatment3、Supportive therapy（支持療法） Support cardiorespiratory（循環(huán)呼吸）status: prevent hypoventilation（通氣不足）, hypercapnia（高碳酸血癥）, hypoxemia（低氧血癥） Maintain adequate blood pressure（血壓）. Maintain adeq