新生儿内科教学（重庆医科大学）2新生儿缺氧缺血性脑病.pptVIP

Hypoxic-ischemic encephalopathy (HIE) 新生儿缺氧缺血性脑病 Children’s Hospital of Chongqing Medical University Prof. Jialin Yu 余加林 教授 Outline Neonatal asphyxia→oxygen-poor →ischemia→brain injured in perinatal period Currently birth trauma↓，O2 deficiency asphyxia↑ Severe consequence ：neonatal death or children disablement, one of reason of cerebral palsy in childhood. Common in full term bb, also in premature causes mothers fetus antepartum intrapartum postpartum 20％ 35％ 35％ 10％ hypoxia Placenta umbilical cord Ante- intrapartum Causes of HIE also causes of asphyxia: Maternal factors： illnesses， obstetric deseases，smoking or drug addiction, teenage pregnancies, older than 35 years Intrapartum factors：umbilical core，malposition, placental insufficiency, placental abruption Fetal factors：congenital anomalies, IUGR， hydrops fetalis Infant factors： apnea, HMD, MAS, PPHN, shock. Etiopathogenesis of HIE Cerebral blood flow (CBF)： 1. fail in compensation： 2 steps of redistribution Diving reflex The first time --- Secondary redistribution Anterior cerebral artery, ACA middle cerebral artery,MCA Posterior cerebral artery,PCA Branch of ACA Branch of MCA Branch of PCA term infant：parasagittal damage in cortex 皮层矢状旁区受损 preterm infant：periventricular leukomalacia (PVL) 脑室周围的白质软化 Consequence of secondary redistribution 脑室旁白质软化 periventricular leukomalacia, PVL Suddenly completely asphyxia 2. Non-compensation：ganglion- brainstem damage Cerebral blood flow (CBF)： 3. autoregulation ↓→Pressure-passive cerebral circulation (PPCC) Cerebral blood flow (CBF)： Change of brain metabolism: 1.oxygen free radicals→rupture of cell membrane destroy BBB (1) over production： cytochrome-oxydase↓； repe