胎儿窘迫及新生儿窒息的护理andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies概念胎儿在宫内有缺氧征象，危及胎儿健康生命者，称为胎儿窘迫。andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies病因1、母体因素:高血压、慢性肾炎、妊娠高血压症、贫血、心脏病、肺心病、高热吸烟、创伤药物使用不当、长期仰卧位。2、胎儿因素：胎儿畸形、心血管系统功能障碍、溶血、贫血、感染。3脐带、胎盘因素：脐带长度异常、血肿、狭窄、胎盘植入异样、形状异常、发育障碍、循环障碍。andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies病理生理胎儿窘迫的基本病生理变化是缺血缺氧引起的一系列变化andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies临床表现胎儿窘迫的主要表现为胎心音改变，胎动异常及羊水胎粪污染或羊水过少，严重者胎动消失。1、急性胎儿窘迫多发生在分娩期主要表现在：胎心率异常，CST或OCT出现频繁的晚期减速或可变减速，羊水胎粪污染和胎儿头皮PH值下降。2、慢性胎儿窘迫发生在末期，主要表现为胎动减少或消失，NST基线平直，胎儿发育受限，胎盘功能减退，羊水胎粪污染等。羊水胎粪污染可以分为三度：一度为浅绿色二度为黄绿色并浑浊三度为棕黄色，稠厚andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies处理原则积极寻找原因，给予纠正1.情况不严重着，给予吸氧，嘱产妇左侧卧位2.胎先露达坐骨棘平面以下3厘米者，应尽快助产经阴道娩出胎儿。3、慢性胎儿窘迫者，根据孕周、胎儿成熟度和窘迫程度决定处理方案。andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies可能的护理诊断气体交换受损（胎儿）：与------有关焦虑：与------有关预期性悲哀：与------有关andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies护理措施1、孕妇左侧卧位，间断吸氧，严密观察胎心2、为手术者做好术前准备3、做好新生儿抢救和复苏的准备4、心理护理andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies概念–新生儿窒息：是指胎儿娩出后一分钟，仅有心跳而无呼吸或未建立规律呼吸的缺氧状态，为新生儿死亡及伤残的主要原因之一。andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies病因1、胎儿窘迫，胎儿吸入羊水、黏液致呼吸道阻塞2、呼吸中枢受损害3、药物抑制呼吸中枢、早产、肺发育不良、呼吸道畸形andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies临床表现根据窒息程度分轻度窒息和重度窒息Apgar评分为其指标1、轻度窒息Apgar评分4~7分2、重度窒息Apgar评分0~3分1分钟Apgar评分反映宫内的情况，在出生后5分钟Apgar对评估预后很有意义andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies处理原则预防为主，一旦发生及时抢救。如果发生窒息要及时按ABCDE步骤进行复苏andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstetricEmergencies可能的护理诊断1、新生儿气体交换受损：与------有关有受伤的危险：与------有关2、母亲功能障碍性悲伤：与------有关恐惧：与------有关andHyperthermiaAssociatedwithPoisoningorandNeonatalRespiratoryCareEmbryologicDevelopmentBirthsObstet...
