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会计学NeonatalAsphyxiaanditsNewConceptonResuscitationNewWordspregnantwomaninvalidApgarscoreumbilicalcordprimaryapneaasynersisHIE(hypoxic-ischemicencephalopathy)ICH(intracranialhemorrhage)MOD(multipleorgansfunctiondamage)hypercapniahypoxemiaNeonatalasphyxiaisakindofgasexchangedisorder,thatcouldcausehypoxemia,hypercapniaandmetabolismacidosis,whichisaccountedonthatnewbornhasnoautorespirationoronlyhasirregular,intermittentandfeeblerespirationatbirth,orpresentrespiratorydepressionafterbirth.It’sincidenceisabout5%occupiedtheviablebirth,andcancause20%deathintoltalnewnataldeath.Thenatureofasphyxiaitselfishypoxia.UsuallyweadoptApgarscoretojudgethedegreeofasphyxiation.AsphyxiacouldcausenotonlyHIE,butalsoMOD,andistheoneoftheimportantcausesofdeath,dysnoesiaandinvalid(cerebralpalsy)innewbornsallovertheworld.Neonatalmortalityisabout19.0‰(2005)inourcountry.Thefirstthreedeathcausesareprematurebirth&lowbirthweight,asphyxiaandpneumonia.Thereare1millionnewborndeathcausedbyneonatalasphyxia(total4millionyearly-2005.WHO),and>1millionneonatessufferfromdysnoesia,cerebralpalsyandotherdeformitycausedbyittoo.placentapraeviashortcord胎儿因素suckingfetalheadPathophysiologyBlockedswitchofrespiration&circulationfromfetustonewbornHypoxia-ischemiaalterindifferenceorgansasasphyxiaBreathalter1．PrimaryapneaWhenhypoxia,thebabymaybreathdeeplyandquicklyatfirstl-2mins,ifnomanagementintime,itmayoccurbreathinhibitionandreflectiveheartratedecreasinginashorttime.．2．SecondaryapneaIfthehypoxiapersistence,thebabymayoccurgaspingrespiration,heartratecontinuestepdown,theBPbegintodescend,musculartensionlost,thebabyispaleandrespiratorymovementasynersis,hemayoccuradeepgaspatlastandthenenterthesecondaryapnea.(needpositivepressure)/bloodgasPaCO2↑，PH&PaO2↓mixedacidosisGlucosemetabolicdisordercatecholamine&glucagonreleaseearly↑→bloodsugarnormalor↑thenglycogendepletion,bloodsugar↓HyperbilirubinemiaBilirubincombinewithalbumin↓、thevigorofliverenzyme↓→unconjugatedbilirubin↑Hyponatremiaatrialnatriureticpeptide,A
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