1、Resuscitation of Neonatal Asphyxia,Qiuji Tao 2011.7.29,学习目标,Neonatal Resuscitation Process 掌握新生儿窒息复苏流程Summary of Key Issues and Major Changes 了解窒息复苏新进展,overview,19% of the newborns die because of asphyxia over the world. Most (90%) of the Newborns are viable. A minority (fewer than 10%) of newlyborn
2、 infants require a little help to establish breath. Only 1% need further resuscitation to live.,Neonatal asphyxia recovery process,neonatal resuscitation can be divided into four steps (4 for 30 seconds), 2 minutesrapid assessment -30spositive pressure artificial respiration -30schest compressions -
3、30suse of epinephrine -30s,第一个30秒 (新生儿快速综合评估),第二个30S （建立呼吸）,快速评估 初步复苏,Summary of Key Issues and Major Changes,Neonatal cardiac arrest is predominantly asphyxial, so the A-B-C resuscitation sequence with a 3:1 compression-to-ventilation ratio has been maintained except when the etiology is clearly ca
4、rdiac.,胸外按压指征：30s正压人工呼吸后仍无心率或心率持续60次/min。按压深度为前后胸直径的1/3。,Assessment of Heart Rate, Respiratory Rate,and Oxygenation,2010 (New): Assessment of Heart Rate, Respiratory Rate,and Oxygenation 2005（旧）：在 2005 版本中，根据心率、呼吸速率和肤色评估结果进行评估。 Why: Assessment of color is subjective. There are now data regarding nor
5、mal trends in oxyhemoglobin saturation monitored by pulse oximeter.,Supplementary Oxygen,2010 (New): For babies born at term, it is best to begin resuscitation with air rather than 100% oxygen. 2005 (Old): If cyanosis, bradycardia, or other signs of distress are noted in a breathing newborn during s
6、tabilization, administration of 100% oxygen is indicated.,Supplementary Oxygen,Why: Evidence is now strong that healthy babies born at term start with an arterial oxyhemoglobin saturation of 90%. Hyperoxia can be toxic, particularly to the preterm baby,Recommendations for Monitoring Exhaled CO2,2010
7、 (New): Exhaled CO2 detectors are recommended to confirm endotracheal intubation. 2005（旧）：可使用呼出二氧化碳监护仪验证气管插管的位置。 Why: Further evidence is available regarding the efficacy of this monitoring device as an adjunct to confirming endotracheal intubation.,Compression-to-Ventilation Ratio,2010 (New): The r
8、ecommended compression-to-ventilation ratio remains 3:1. If the arrest is known to be of cardiac etiology, a higher ratio (15:2) should be considered。 2005（旧）：按压通气比率应为 3:1，即 90 次对应 30 次人工呼吸，实现每分钟大约 120 次操作。,Suctioning,2010 (New): There is insufficient evidence to recommend a change in the current practice of performing endotracheal suctioning of nonvigorous babies with meconium-stained amniotic fluid.,Suctioning,Why:尚无证据证明气道抽吸对健壮婴儿有好处，即使有胎粪也是如此，有证据证明此类抽吸存在风险。现有证据不足以支持或反对为出生时吸入胎粪污染羊水而导致呼吸窘迫的婴儿常规性地执行气管插管内抽吸。,DRUGS,麻醉剂拮抗剂纳络酮从复苏常规用药中除去而放至特殊用药章。纳络酮对无呼吸的新生儿不应当是首选治疗方法，应先给正压人工呼吸。,谢 谢 ！,
