文档介绍：新生儿缺氧缺血性脑病 Hypoxic-Ischemic Encephalopathy(HIE)
Department of pediatrics
陈平洋
第七章第六节
中南大学儿科学教研室
Purpose
To be familiar with etiology, Mechanism and prevention
To master clinical manifestation, diagnosis and treatment
To understand the prognosis
Summary
HIE(缺氧缺血性脑病)is caused by perinatal asphyxia(围生期的窒息)
HIE is a disease primarily of the term infant
Hypoxia(低氧血症)
cerebral metabolism
(脑代谢)disorder
acidemia . ATP
Na .Ca pump
function ↓
cellular ↑
cerebral edema
(脑水肿)
diminished
cerebral perfusion
(脑灌注) ↓
ischemia ↓
cerebral necrosis
(脑梗死)
cerebral edema
Intracranial
pressure(颅内压)↑
blood capillary
Permeability
(毛细血管通
透性)↑
Intracranial
hemorrhage
(颅内出血)
↓
Etiology and Mechanism(病因与发病机制)
Selective vulnerabilities(选择易损性)
Occur in selected areas of the brain stem, (脑干)thalamencephalon(丘脑)and
cerebellum(小脑) where metabolism is
vigorous and which are most sensitive to
hypoxicischemic(缺氧缺血性) injury(损伤).
Who is risk baby?
1. Fetal distress in uterus(胎儿宫内窘迫)
2.  Infants who are asphyxiated(窒息)
3.  Infants who develop postnatal(产后)
asphyxiacted insults:
severe pulmonary disease, apnea(呼吸暂
停), congenital heart disease(先天性心
脏病)
Clinical Diagnosis and Grades of Severity
1consciousness
(意识)
2muscle tone(肌张力)
3primitive reflexes
4convulsion(惊厥)
5respiratoryfailure
6pupils(瞳孔)
7anteriorfontanelle
8duration(病程)
9prognosis(预后)
Irritability
(易激惹)
Normal
Hyperactive
None
None
Normal
Normal
<24 hr
Good
lethargic(昏睡)
Hypotonic(增高)
monly seen
None or mild
Normal or miosis
(缩小)
Full(饱满)
24hr to 14days
Variable
a(昏迷)
id(弛缓)
monly monly seen
Unequal,
poor light reflex
Tension(紧张)
Days to weeks
Death or severe
sequela(后遗症)
Moderate
Mild
Diagnosis
1、History
Perinatal asphyxia(围生期窒息)
2、Clinical manifestation
Brain injury(脑水肿)
Some degree of an injury
3、Ultrasound examinations (超声检查)
4、CT scan of the brain or MRI
5、 EEG
6、 Ck-BB(肌酸磷酸激酶)
Treatment
1、Control convulsions (控制惊厥)
luminal(鲁米那) loading dose : 20mg/kg
aeq