儿内2hie新生儿缺氧缺血性脑病.pptxVIP

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;causes mothers fetus antepartum intrapartum postpartum 20％ 35％ 35％ 10％;Risk factors of HIE ;Pathogenesis of HIE;Diving reflex;Secondary redistribution;Branch of ACA;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;;3. autoregulation ↓→Pressure-passive cerebral circulation (PPCC);Change of brain metabolism: 1. oxygen free rsadical→rupture of cell membrane destroy BBB (1) over production： cytochrome-oxydase↓； reperfusion：xanthine oxidase↑ hypoxanthine----------------→ urea +oxyradicals (2) remove not enough：超氧化物歧化酶 （SOD）↓;Change of brain metabolism: 2. imbalance of Na Ca： anaerobic glycolysis→lactic acid↑,ATP↓→ pump out of order → Ca++ inflow→chaos of signal →Na++ inflow→intra-cellular edema 3. excitable neurotransmitter: glutamic acid； β- opioid peptide;Ca++;;neuropathology： 脑细胞水肿(edema ) 脑细胞坏死(necrosis of brain cells ) 脑细胞凋亡(apoptosis ）;after damage duo to hypoxia;Clinical manifestation ;Attention: 部分患儿在宫内已发生HIE, 出生时Apgar评分正常,多脏器受损不明显 但生后数周或数月逐渐出现神经系统受 损表现 ???;investigations;Investigations: Imaging assessment;Investigations ; diagnose：;Criteria of HIE --- only for term bb;Criteria of Sarnat grades for HIE; objective 1.增强代偿性生长 2.建立新的神经网络 3.纠正错误的传导与支配;发育中脑的可塑性 Plasticity during growth of brain 树突增 长、增多 Dendrons grow in length and number 轴突延伸 Axons elongation 突触增加 Increase synapse 建立新的神经传导回路 Rebuild loops of nerve conduction ——代偿 性生长 pensation growth;Hypoxic-ischemia necrosis neurons