儿科12级-12级儿科课件-05 HIE.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, also in premature causes mothers fetus antepartum intrapartum postpartum 20％ 35％ 35％ 10％ hypoxia Placenta umbilical cord Ante- intrapartum Risk factors of HIE also causes of asphyxia: Maternal factors： illnesses， obstetric diseases，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. infections: 生后8日龄大鼠 0.3 mg/kg LPS 缺氧缺血前4h腹腔注射 缺氧缺血20 min (7.7% O2, 36°C) Eklind et al, Eur J Neurosci. 2001 Mar;13(6):1101-6 脂多糖 (LPS) 使未成熟鼠脑对缺氧缺血敏感 6 神经病理学评分 总评分 子宫内注射LPS 加重早产新生鼠缺氧缺血性脑损伤 Wang et al, J Neuropathol Exp Neurol, 2007, in press Pathogenesis 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) 脑室周围的白质区受损 Consequence of secondary redistribution Suddenly completely asphyxia 2. Non-compensation： ganglion-brainstem damage Cerebral blood flow (CBF)： 3. autoregulation ↓→Pressure-passive cerebral circulation (PPCC) Cerebra