encephalopathy-viw2新生儿缺氧性脑病.pptVIP

Hypoxic-Ischemic Encephalopathy (HIE) 1 Introduction ⑴Hypoxia（低氧）: refers to an arterial concentration of oxygen that is less than normal. ⑵Ischemia (缺血）: refers to blood flow to cell and organ that is insufficient to maintain their normal function. refers to a hypoxic-ischemic insult during the process of labor and delivery(分娩),which include fetal acidosis (pH7.0), a 5-min Apgar score of 0-3, and other multiple organ system dysfunction. Neurologic manifestation result from asphyxia , which may result in neonatal death or which may be manifested later as cerebral palsy （脑瘫）or mental deficiency. Hypoxia 2. Etiology ----- Fetal hypoxia(1) ⑴Inadequate oxygenation of maternal blood: as a result of hypoventilation（肺换气不足） during anesthesia, cyanotic heart disease, respiratory failure. ⑵Low maternal pressure: as a result in hypotension that complicate spinal anesthesia or that may result from compression of the vena cava and aorta by the gravid uterus. 2. Etiology--- Fetal hypoxia(2) ⑶Premature separation of placental and dysfunction of placental ⑷Impedance to the circulation of blood through the umbilical cord as result of compression or knotting of the cord 2. Etiology: After birth ⑴Serious anemia : owing to severe hemorrhage（出血） or hemolytic（溶血） disease; ⑵Shock : overwhelming infection (endotoxin shock), massive blood loss（hemorrhage shock). 2. Etiology-----After birth ? ⑶A deficit in arterial oxygen saturation: failure to breathe adequately postnatally owing to cerebral defect, narcosis(（麻醉）, or injury in infant. 2. Etiology-----After birth ⑷Failure of oxygenation of an adequate amount of blood: severe forms of cyanotic congenital heart disease or pulmonary disease in infant 3. Pathophysiology Within the minutes of the onset of total fetal hypoxia, bradycardia, hypotension, decreased cardiac output and severe metabolic as well as respiratory acidosis occurs. 3. Pathophysiology The initial circulation response of a fetus is increased shunting thr