新生儿复苏的进展(双语).pptVIP

Neonatal Resuscitation 新生儿复苏 福建医大附属协和医院麻醉科规培住院医师:朱智平 Following birth, numerous physiologic changes must rapidly transpire in order for the fetus to successfully make the transition to a neonate.(分娩后，众多的生理变化必须迅速转变以便胎儿成功转型成新生儿) Despite the complexity of this process, on average ten percent of newborns require some assistance to begin breathing and only one percent of newborns require full resuscitation in the delivery room. This percentage rises quickly, however, among newborns who weigh less than 1500 grams. （尽管这一过程复杂，平均百分之十的新生儿开始呼吸要求一些辅助，只有百分之一的新生儿需要在产房完全复苏。然而，在体重小于1500g的新生儿中，这一比例明显升高。 Given the relative rarity of the need for full resuscitation, it is optimal for all delivery room personnel to frequently review the neonatal adaptations to extrauterine life, make provision for resuscitation, understand the predictors of need for resuscitation and know how to respond appropriately. 考虑到全面复苏相对罕见，最合适的就是 所有产房人员经常性的复习新生儿适应宫外生活，制定复苏的规定（流程），懂得需要复苏的预测，知道如何做出适当的反应 Neonatal Adaptations to Extrauterine Life The placenta is the organ for gas exchange in the fetus .A substantial right-to-left shunt exists. 胎盘是胎儿气体交换的器官.存在大量的右向左分流The shunt persists due to high pulmonary vascular resistance (PVR) coupled with low systemic vascular resistance (SVR)持续的分流是由于高肺血管阻力和低体循环阻力. Ninety percent of right ventricular output shunts across the ductus arteriosus. Forty percent of cardiac output flows to the low resistance placenta. 90%的右心室输出通过动脉导管，40%心输出量流向低阻力的胎盘 Neonatal Adaptations to Extrauterine Life During vaginal delivery，compression of the infant thorax expels fluid from the mouth and upper airways. With crying, the lungs fill with air,surfactant is released and oxygenation increased. 阴道分娩时,对婴儿胸部的挤压把液体从上呼吸道和嘴挤出。伴随着哭声，肺充满空气，表面活性物质被释放并且氧合增强 In animal models, the presence of increased oxygen tension and increased blood flow stimulate endothelial cells in the pulmonary vasculature to release nitric oxide ultimately resulting in pulmonary vasodilatation在动物模型中,氧含量增加,血流增加的存在刺激内皮细胞在肺血管释放一氧化氮最终