新版新生儿心肺复苏指南的进展和不同专家讲座

新版新生儿心肺复苏指南进展与不一样温州医学院从属黄岩医院新生儿科黄勇新版新生儿心肺复苏指南的进展和不同第1页background年10月，美国心脏协会（AHA）以及欧洲复苏委员会（ERC）和国际复苏联络（ILCOR）委员会定时发出5年后最终一个版本-新新生儿心肺复苏指南。TheAmericanHeartAssociation(AHA)theEuropeanResuscitationCouncil(ERC)theInternationalLiaisonCommitteeonResuscitation(ILCOR)新版新生儿心肺复苏指南的进展和不同第2页sourceAmericanHeartAssoc-iation.AmericanHeartAssociation(A-HA)guidelinesforcar-diopulmonaryresusc-itation(CPR)andem-ergencycardiovascularcare(ECC)ofpediatricandneonatalpatients:pediatricbasiclifesup-port.Pediatrics.May;117(5):e989-1004.KattwinkelJ,PerlmanJM,AzizK,ColbyC,elal.

neonatalresuscitation:AmericanHeartAssociationGuidelinesforCardiopulmonaryResuscitationandEme-rgencyCardiovascularCare.Circulation.;122(suppl3):S909–S919.新版新生儿心肺复苏指南的进展和不同第3页NewbornResuscitationAlgorithm.KattwinkelJetal.Circulation;122:S909-S919Copyright©AmericanHeartAssociation新版新生儿心肺复苏指南的进展和不同第4页⑴pulseoximetryApulseoximetercanprovideacontinuousassessmentofthepulsewithoutinterruptionofotherresuscitationmeasures,butthedevicetakes1to2minutestoapply,anditmaynotfunctionduringstatesofverypoorcardiacoutputorperfusion.脉搏氧饱和度监测在新生儿心肺复苏中是必需其它复苏办法无须中止缺点：心输出量不足或灌注不足，效果不佳新版新生儿心肺复苏指南的进展和不同第5页(2)UseofO2inthedeliveryroomTwometa-analysesofseveralrandomizedcontrolledtrialscomparingneonatalresuscitationinitiatedwithroomairversus100%oxygenshowedincreasedsurvivalwhenresuscitationwasinitiatedwithair.足月儿或靠近足月儿开始复苏能够用0.21空气各种供氧办法，如T-复合器予1.0纯氧复苏，无助于生存率提升新版新生儿心肺复苏指南的进展和不同第6页(3)skincolorOtherstudieshavesho-wnthatclinicalassessm-entofskincolorisaverypoorindicatorofoxyh-emoglobinsaturationdu-ringtheimmediateneon-atalperiodandthatlackofcyanosisappearstobeaverypoorindicatorofthestateofoxygenationofanuncompromisedbabyfollowingbirth.皮肤颜色：评价指标差生后存在发绀期宫外10分钟达正常水平新版新生儿心肺复苏指南的进展和不同第7页⑷CO2Detectors

ThenumberofstudiesonCO2detectorsinneonatesremainsverysmallandmostreportscomefromretrospectivestudies.Untilmoresolidevidenceprovesthattheiruseimprovespatientoutcome,werefrainfromrecommendingCO2detectorsaspartoftheroutineDRmanagement.

大部分汇报来自回顾性研究不提议CO2探测器日常管理需要更坚实证据证实他们使用提升了病人复苏结果新版新生儿心肺复苏指南的进展和不同第8页⑸RespiratorysupportPositivepressureventilation(PPV)intheDRisbestadministeredbyapressurelimitedT-pieceresuscitatorassuchdevicesallowmorecontrolofthedeliveredpressureandtidalvolumes.在产房正压通气（PPV）是最好管理压力有限T型复苏器允许压力控制和潮气量新版新生儿心肺复苏指南的进展和不同第9页⑹MeconiumaspirationWesuggesttocontinuewiththecurrentpracticeofclearingtheairwaybeforePPVisstartedinanyinfant,inparticularthosebornfromthick,MSAF,untilfurtherevidencebecomesavailable。正压通气前呼吸道应清理尤其是那些出生稠厚胎粪污染患儿。胎粪污染吸引存在争议新版新生儿心肺复苏指南的进展和不同第10页⑺TemperaturecontrolWerecommendtheuseofplasticcoveronlyforinfantswithaGA<28weeks.Inanycircumstances,closemonitoringoftheinfant’stemperatureismandatory,becausebothhypothermiaandhyper-thermianegativelyaffectsneonataloutcome.胎龄＜28周，使用塑料纸覆盖强制执行体温过高与体温过低影响复苏结果新版新生儿心肺复苏指南的进展和不同第11页⑻InducedhypothermiaInducedhypothermiashouldbeofferedtoalltermornearterminfantswithevolvingHIE.胎龄＞36周中重度HIE亚低温治疗（33.5°-34.5°C间）窗口期—6小时治疗期—72小时降低死亡率和残疾率新版新生儿心肺复苏指南的进展和不同第12页⑼Drugsandfluids

1.epinephrineIntheabsenceofasuffcientIVaccess,anintra-osseousaccessmayalsobeused.肾上腺素心率连续＜60次／分肾上腺素1:10000溶液（0.1毫克/毫升）0.1-0.3毫升/千克静脉不可用时，骨内给药新版新生儿心肺复苏指南的进展和不同第13页⑼-2.SodiumbicarbonateDuetolackofevidence,sodiumbicarbonatemayonlybeconsideredduringprolongedcardiacarrestsunresponsivetoothertherapyandonacompassionateusebasis,andonacase-by-casebasisinthepostresus-citationcareofnewlyborninfants证据缺乏指证：心跳停顿，抢救无反应新版新生儿心肺复苏指南的进展和不同第14页⑼-3.NaloxoneNaloxoneshouldnotbeusedduringresuscitationorthepost-resuscitationcareofdepressednewlyborninfants.不应使用新版新生儿心肺复苏指南的进展和不同第15页⑼-4.VolumeexpansionIsotoniccrystalloidsolutionorblood(10mL/kgIV)shouldbeusedfortheinitialIVvolumeexpansioninadepressednew-borninfantintheDRwithahistoryorclinicalsignsofsignificanthypovo-lemia,butrarelyonanempiricbasis.应该是等渗晶体溶液或血（10毫升/千克IV）用于产时血容量显著降低，无循证医学证据早产儿易引发颅内出血新版新生儿心肺复苏指南的进展和不同第16页⑼-5.GlucoseIVinfusionWesuggesttostartbygivinga10%glucose(dextrose)IVsolu-tionintheDRasearlyaspossible,andindepend-entlyfromresuscitationstatus(i.e.startinfusionduringresuscitation).产房，提议早期给予10％葡萄糖溶液独立于复苏状态（即在复苏开始输液时）新版新生儿心肺复苏指南的进展和不同第17页⑽Delayedcordclamping

Forterminfants,cordclampingmaybedelayedfor1–2min.

Delayedcordclampingmaybeofbenefittoterminfantsbornincountrieswithpoormaternalnutritionalstateand/orinsuffici-entpostnatalfollow-up.对于足月儿，钳夹脐带最好推迟1-2分钟主要针对营养情况不佳孕产妇新版新生儿心肺复苏指南的进展和不同第18页(11)Eth