兒科學(xué)10新生兒缺血性腦病

Encephalopathy,HIEMainClinicalEtiology/HighriskPathogenesisandClinicalmanifestationsanddiagnosticClinicalClinicalBraindamageinFetusandneonatescausedbyhypoxicand/ordecreasingorabruptionofbloodflowtobrainduringperinatalperiod.AlmostallthefactorscausingasphyxiaresultingHIE,andcentaandumbilicusSubstantialpulmonary,cardiacandCNSdiseaseofthefetusandneonatesProngedMedicationduringHighriskProlongedfetalRepeatedlateLowApgarscoresat5minutesorLowfetalscalporcordRequirementforprolongedresuscitationwithpositive-pressureventilationPathogenesisandChangeofcerebralbloodnormaltermstableCBF:50-CBF＜20ml/min/100g,brainPathogenesisandChangeofcerebralIncreaseinanaerobicNa+,Ca2+pumpfunctionintracellularATPexhaustedNa+,Ca2+endosmosisIrritabilityaminoblockingoxidativephosphorylationinbloodstreamreperfusionoxygenradicalPathogenesisandChangeofTermbaby:cortexinfarctiongraymatterinpartesprofundawhitematterinjuryCerebralinfl IL-1,TNF-,CKsCellularapoptosisClinicalexcitation/Apparentat24NonormalClinicalConvulsion,withdisorderofApparentat24-48Deterioration:intensityofanteriorClinicallightcomaorcomaatIrregularrespirationandConvulsionwith12PoormuscleIntensityofanteriorMostdiein1Survivorswithsevere 至55分；或出生時(shí)臍動脈血?dú)鈖H7.00 中華醫(yī)學(xué)會兒科學(xué)會新生兒學(xué)組2004年11 可在HIE(72小時(shí)內(nèi))開始檢查 injuryinHypothalamusandBasalgangliainjuryinHypothalamusandBasalganglia

injuryinAreaadjacenttothesagittalMRCerebralarteryInfarctionintermsCerebralInfarctionin MRPVLinPVLinPunctateencephalonSeverityand中華醫(yī)學(xué)會兒科學(xué)會新生兒學(xué)組2004年11月修訂–Irritability,normal–Moro’s:;Sucking:–normalrespiration，no–Oppressed，muscletone，Moro’sandSucking–convulsion。>7-10d,mayhave–irregularrespirationorapnea.respirationfailure.veryhighdeathrate–SurvivorsusuallyhaveMildandRecovered<5d,goodMiddle>7d,orSevereworseClinicalForanasphyxiatedimmediatemaintenanceofventilationandcontrolofmaintenanceofmetabolichomeostasis,especiallybloodglucoselevelstoavoidadditionalcerebralinsultClinicalMaintenanceofadequateAvoidanceofhypoxemiaandToavoidsystemiccerebralPreventionoffluidcurrentdatainhumannewbornsdonotprovideconvincingevidencethatsupportstheuseofantiedematherapyMaintenanceofClinicalControlbeginwithaloadingdoseof(20mg/kg)followedbyadditional5-mg/kg,totaldose40mg/kgForrefractorylorazepambyIVmaybeRecentmendationsbriefdurationoftreatment;possibledeleteriouseffectsofanticonvulsantsonthedevelo nervoussystem.ClinicalCoolCap(SelectiveHeadHypothermiaMulti-centerUS,Canada,UKandNewZealand:Sample:Apgar<=6/5min+CordarterialphclinicalHIE+EEGaEEGsevere:(n=46)：notaEEGModerate:(n=172);showedGluckmanPD,CoolCaptrialgroup.LancetClinicalCoolCap(SelectiveHeadHypothermiaaEEGModerate:(n=172);showedDeathsevereneromotiondisabled48%vs66%–MDI:85vs– 90vsGluckmanPD,CoolCaptrialgroup.LancetClinicalWholebodyNIHNeonatal–Death:24%(H)vs36%middleorsevere45%(H)vs62%(N) (OR:0.72,95%CI0.55-0.93)Shankaranetal：NationalInstituteofChildHealthandHumanDevelopmentNeonatalResearchNetwork.Whole-bodyhypothermiaforneonateswithhypoxic-ischemicencephalopathy.HIEisthemajorcauseoftheneonatalAsphyxiaandischemiahypoxemiainperinatalresultinginHI