临床医学新生儿黄疸ppt课件.pptVIP

Neonatal Hyperbilirubinemia新生儿高胆红素血症;RBC Hb Bilirubin ( 胆红素) Free bilirubin (游离胆红素);Unconjugated bilirubin (未结合胆红素) Transport, Uptake;Neonatal bilirubin metabolism;Neonatal bilirubin metabolism (Contd.) ;Neonatal bilirubin metabolism (Contd.);Neonatal bilirubin metabolism (Contd.);Physiologic Jaundice;Physical Jaundice in Full Term Infant ;Nonphysiologic Jaundice;Causes and Clinical Features;Causes and Clinical Features;Breastfeeding and Jaundice母乳性黄疸 ;Breastfeeding and Jaundice;Bilirubin Encephalopathy胆红素脑病;Bilirubin Encephalopathy;Hemolytic disease of the newborn新生儿溶血病; Rhesus Hemolytic DiseaseRh 溶血病; 1、Pathogenesis Mother RhD (－), Fetus RhD(＋);1、Pathogenesis;2、Clinical Manifestations a. Fetal hydrops (胎儿水肿) b. Jaundice：early onset, rise rapidly and severe c. Anemia d. Hepatosplenomegaly (肝脾肿大) e. Bilirubin encephalopathy;3、Diagnosis; ABO Hemolytic Disease;1、Pathogenesis;2、Clinical feature Jaundice, anemia and Hepatosplenomegaly 3、Diagnosis a. Blood group b. Coombs’ Test Direct Coombs’ test Elution test; Management 1. Phototherapy (光疗) (1) Indication：full-term 15 mg /dl (2) Light：blue lamps，wavelength 450～ 460nm (3) Mechanism：photochemical reaction Structural isomerization (4) Technique：single or double phototherapy;Phototherapy;2. Decreasing free bilirubin Albumin, plasma 3. Inhibiting bilirubin production competitive inhibitors of heme oxygenase (血红素加氧酶) 4.Increasing bilirubin conjugation Phenobarbital 5.Inhibiting hemolysis High-dose intravenous immune globulin (IVIG) ;6.Exchange transfusion (交换输血) (1) Indication In Rh hemolytic disease,total bilirubin20mg/dl (2) Mechanisms Remove antibodies, antibody-coated RBCs (sensitized red blood cells) and bilirubin，correct anemia ;(3) BloodRh hemolytic dise