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新生儿窒息AsphyxiaoftheNewbornDr.XiaopingLuoProfessorandChairmanDepartmentofPediatricsTongjiHospitalTongjiMedicalCollegeThehighestmortalitythatbefallsthehumanraceinonedayoccursonthedayofbirth...….……Itissaidthatthemostimportantperiodofthelifeofahumanbeingisthetimespentinutero.Themosttryingordealahumanbeingsustainsistheordealofbirth.AsphyxiaNeonatorum:CausationandTreatmentProfessorofObstetrics,NorthwesternUniversityMedicalSchoolJos.B.DeLeePublishedinMedicine(Detroit)3:643-660,1897.DefinitionofPerinatalAsphyxiaaconditionintheneonatewherethereisthefolaconditionintheneonatewherethereisthefollowingcombination:lowingcombination:AneventorconditionduringtheperinatalperiodthatislikAneventorconditionduringtheperinatalperiodthatislikelytoseverelyreduceoxygendeliveryandleadtoacidosis;elytoseverelyreduceoxygendeliveryandleadtoacidosis;ANDANDAfailureoffunctionofatleasttwoorgansconsistentwithtAfailureoffunctionofatleasttwoorgansconsistentwiththeeffectsofacuteasphyxia.heeffectsofacuteasphyxia.Hypoxemia,Hypercapnia,Mixedacidosis,OrganicfailureRiskFactors-MaternalSystemicdisease:Systemicdisease:diabetes,heartorrenaldiseasediabetes,heartorrenaldiseases,anemia,infectiousdiseasess,anemia,infectiousdiseasesObstetricConditions:ObstetricConditions:hypertensivediseaseofprehypertensivediseaseofpregnancyorpre-eclampsia,placentalabruptiongnancyorpre-eclampsia,placentalabruptionSubstanceabuse:Substanceabuse:drugaddiction,smokingdrugaddiction,smokingMaternalage:Maternalage:>35,or<16,multiplepregnancy>35,or<16,multiplepregnancyRiskFactors-FetalPremature,SGA,macrosomiaPremature,SGA,macrosomiaCongenitalmalformation:Congenitalmalformation:noseandlnoseandlaryngo-pharynxmalformation,lunghypoplasia,heartdiseaseAmnioticfluidormeconiumaspirationIntrauterineinfection:Intrauterineinfection:TorchsyndromeTorchsyndromeRiskFactors-IntrapartumUmbilicalcord:Umbilicalcord:obstructionobstructionObstetricprocedures:Obstetricprocedures:forcepsdelivery,forcepsdelivery,breechextraction,vacuumextractionMedication:Medication:analgesicandoxytocicmedicinePathophysiologyofAsphysiaRespiratoryAlteration:RespiratoryAlteration:primaryhyperpnea,primaryapnea,secondaryapneaprimaryhyperpnea,primaryapnea,secondaryapneaHypoxic-ischemicChangesofMulti-organicsystem:Hypoxic-ischemicChangesofMulti-organicsystem:““divingreflex”,inter-organshunting,organfailuredivingreflex”,inter-organshunting,organfailureBiochemicalandmetabolicConsequences:BiochemicalandmetabolicConsequences:acidosis,hyper-orhypoglycemia,hypocalcemia,acidosis,hyper-orhypoglycemia,hypocalcemia,hyperbilirubinemia,hyperkalemia,hyponatremiahyperbilirubinemia,hyperkalemia,hyponatremiaClinicalManifestationofAsphysiaApgarScoringSystemApgarScoringSystemApgarScoringSystemApgarScoringSystemSign0Points1Point2PointsActivity(muscletone)absentarmsandlegsflexedactivemovementPulse(heartrate)absentbelow100bpmabove100bpmGrimace(reflexirritability)noresponsegrimacesneeze,cough,pullsawayAppearance(skincolor)blue-gray,paleallovernormal,/-extremitiesnormaloverentirebodyRespirationabsentslow,irregulargood,cryingAPGARTheSignificanceofApgarScoreTheSignificanceofApgarScoreApgar8~10,normal;4~7,mildasphyxia;0~3,severeasphyxiaAssignedat1,5,and10min,untilscoreof7ormore1’scoreindicatetheseverityandguideforresuscitation5’scoreandlaterismorepredictiveofprogn...