文档介绍：Hypoxic-ischemic encephalopathy (HIE)
新生儿缺氧缺血性脑病
Children’s Hospital of
Chongqing Medical University
Prof. Jialin Yuetabolism:
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++
Ca++
Ca++
Ca++
Ca++
Ca++
Ca++
Ca++
Ca++
Ca++
Ca++
N-methyl-D-aspartate (NMDA) receptor
Synaptic production of
Neuroexcitatory
Amino acid esp.
Glutamate
Ca++
reperfusion injury
Ca++
Neuronal cell
oxygen free radicals
pump
pump
excitable neurotransmitter
neuropathology：
脑细胞水肿(edema )
脑细胞坏死(necrosis of brain cells )
脑细胞凋亡(apoptosis ）
commonly occur after 6-
24 h, keep in several
days to wks
promptly intervention could
decrease damage
Cell death
primarily neuron necrosis
delayed neuron injure
time
after damage duo to hypoxia
ideograph of mitochondria
normal mitochondria
Clinical manifestation
history：asphyxia
nervous system：
basic: conscious disturbance,tension
of muscle, primitive reflex
severe：convulsions, bulge fontanel,
irregular respiration , pupils disorder
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
Electroencephalogram (EEG):
-- may be normal during first few day
-- poor prognosis: suppressed or
frequent seizure activity
aEEG
Investigations: Imaging assessment
cranial ultrasound：
水肿，实质病变，脑室，脑血流速度及指数等
brain CT scan：CT valu