《新生兒心肺復(fù)蘇指南》的解讀

2010國際新生兒復(fù)蘇指南的進(jìn)展CompanyLogo資源source：2010國際CPR指南AmericanHeartAssoc-iation.2005AmericanHeartAssociation(A-HA)guidelinesforcar-diopulmonaryresusc-itation(CPR)andem-ergencycardiovascularcare(ECC)ofpediatricandneonatalpatients:pediatricbasiclifesup-port.Pediatrics.2006May;117(5):e989-1004.KattwinkelJ,PerlmanJM,AzizK,ColbyC,elal.

neonatalresuscitation:2010AmericanHeartAssociationGuidelinesforCardiopulmonaryResuscitationandEme-rgencyCardiovascularCare.Circulation.2010;122(suppl3):S909–S919.

2010年10月，美國心臟協(xié)會（AHA）以及歐洲復(fù)蘇委員會（ERC）和國際復(fù)蘇聯(lián)絡(luò)（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(fù)蘇指南。CompanyLogoNewbornResuscitationAlgorithm.KattwinkelJetal.Circulation2010;122:S909-S919Copyright?AmericanHeartAssociation⑴脈博pulseoximetryApulseoximetercanprovideacontinuousassessmentofthepulsewithoutinterruptionofotherresuscitationmeasures,butthedevicetakes1to2minutestoapply,anditmaynotfunctionduringstatesofverypoorcardiacoutputorperfusion.脈搏氧飽和度監(jiān)測在新生兒心肺復(fù)蘇中是必需的其他復(fù)蘇措施不必中斷缺點：心輸出量不足或灌注不足，效果不佳CompanyLogo(2)分娩室內(nèi)氧療

UseofO2inthedeliveryroomTwometa-analysesofseveralrandomizedcontrolledtrialscomparingneonatalresuscitationinitiatedwithroomairversus100%oxygenshowedincreasedsurvivalwhenresuscitationwasinitiatedwithair.足月兒或接近足月兒開始復(fù)蘇可以用0.21空氣各種供氧措施，如T-復(fù)合器予1.0純氧復(fù)蘇，無助于生存率提高CompanyLogo(3)皮膚色澤skincolorOtherstudieshavesho-wnthatclinicalassessm-entofskincolorisaverypoorindicatorofoxyh-emoglobinsaturationdu-ringtheimmediateneon-atalperiodandthatlackofcyanosisappearstobeaverypoorindicatorofthestateofoxygenationofanuncompromisedbabyfollowingbirth.皮膚顏色：評價指標(biāo)差生后存在發(fā)紺期宮外10分鐘達(dá)正常水平CompanyLogo⑷CO2監(jiān)測CO2Detectors

ThenumberofstudiesonCO2detectorsinneonatesremainsverysmallandmostreportscomefromretrospectivestudies.Untilmoresolidevidenceprovesthattheiruseimprovespatientoutcome,werefrainfromrecommendingCO2detectorsaspartoftheroutineDRmanagement.

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(fù)蘇結(jié)果CompanyLogo⑸呼吸支持RespiratorysupportPositivepressureventilation(PPV)intheDRisbestadministeredbyapressurelimitedT-pieceresuscitatorassuchdevicesallowmorecontrolofthedeliveredpressureandtidalvolumes.在產(chǎn)房正壓通氣（PPV）是最好的管理壓力有限的T型復(fù)蘇器允許壓力控制和潮氣量CompanyLogo⑹胎糞誤吸MeconiumaspirationWesuggesttocontinuewiththecurrentpracticeofclearingtheairwaybeforePPVisstartedinanyinfant,inparticularthosebornfromthick,MSAF,untilfurtherevidencebecomesavailable。正壓通氣前呼吸道應(yīng)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CompanyLogo⑺體溫調(diào)控TemperaturecontrolWerecommendtheuseofplasticcoveronlyforinfantswithaGA<28weeks.Inanycircumstances,closemonitoringoftheinfant’stemperatureismandatory,becausebothhypothermiaandhyper-thermianegativelyaffectsneonataloutcome.胎齡＜28周，使用塑料紙覆蓋強(qiáng)制執(zhí)行體溫過高與體溫過低影響復(fù)蘇結(jié)果CompanyLogo⑻人工降溫InducedhypothermiaInducedhypothermiashouldbeofferedtoalltermornearterminfantswithevolvingHIE.胎齡＞36周中重度HIE亞低溫治療（33.5°-34.5°C間）窗口期—6小時治療期—72小時降低死亡率和殘疾率CompanyLogo⑼藥物和液體Drugsandfluids

1.腎上腺素epinephrineIntheabsenceofasuffcientIVaccess,anintra-osseousaccessmayalsobeused.腎上腺素心率持續(xù)＜60次／分腎上腺素1:10000溶液（0.1毫克/毫升）0.1-0.3毫升/公斤靜脈不可用時，骨內(nèi)給藥CompanyLogo⑼-2.碳酸氫鈉SodiumbicarbonateDuetolackofevidence,sodiumbicarbonatemayonlybeconsideredduringprolongedcardiacarrestsunresponsivetoothertherapyandonacompassionateusebasis,andonacase-by-casebasisinthepostresus-citationcareofnewlyborninfants證據(jù)缺乏指證：心跳停止，搶救無反應(yīng)CompanyLogo⑼-3.納洛酮NaloxoneNaloxoneshouldnotbeusedduringresuscitationorthepost-resuscitationcareofdepressednewlyborninfants.不應(yīng)使用CompanyLogo⑼-4.擴(kuò)容VolumeexpansionIsotoniccrystalloidsolutionorblood(10mL/kgIV)shouldbeusedfortheinitialIVvolumeexpansioninadepressednew-borninfantintheDRwithahistoryorclinicalsignsofsignificanthypovo-lemia,butrarelyonanempiricbasis.應(yīng)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(xué)證據(jù)早產(chǎn)兒易引起顱內(nèi)出血CompanyLogo⑼-5.輸注葡萄糖GlucoseIVinfusion

Wesuggesttostartbygivinga10%glucose(dextrose)IVsolu-tionintheDRasearlyaspossible,andindepend-entlyfromresuscitationstatus(i.e.startinfusionduringresuscitation).產(chǎn)房，建議早期給予10％葡萄糖溶液獨立于復(fù)蘇狀態(tài)（即在復(fù)蘇開始輸液時）CompanyLogo⑽推遲鉗夾臍帶Delayedcordclamping

Forterminfants,cordclampingmaybedelayedfor1–2min.Delayedcordclampingmaybeofbenefittoterminfantsbornincountrieswithpoormaternalnutritionalstateand/orinsuffici-entpostnatalfollow-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CompanyLogo(11)倫理學(xué)意見Et