胎儿窘迫及新生儿窒息的护理-4课件.ppt

1、胎儿窘迫及新生儿窒息的护理胎儿窘迫及新生儿窒息的护理 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies概念概念l胎儿在宫内有缺氧征象，危及胎儿健康生命者，称为胎儿窘迫。and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obste

2、tric Emergencies病因病因l1、母体因素:高血压、慢性肾炎、妊娠高血压症、贫血、心脏病、肺心病、高热吸烟、创伤药物使用不当、长期仰卧位。l2、胎儿因素：胎儿畸形、心血管系统功能障碍、溶血、贫血、感染。l3脐带、胎盘因素：脐带长度异常、血肿、狭窄、胎盘植入异样、形状异常、发育障碍、循环障碍。and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies病理生理病理生理l胎儿窘迫的基本病生理变

3、化是缺血缺氧引起的一系列变化 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies临床表现临床表现l胎儿窘迫的主要表现为胎心音改变，胎动异常及羊 水胎粪污染或羊水过少，严重者胎动消失。1、急性胎儿窘迫多发生在分娩期 主要表现在：胎心率异常，CST或OCT出现频繁的晚期减速或可变减速，羊水胎粪污染和胎儿头皮PH值下降。2、慢性胎儿窘迫发生在末期，主要表现为胎动减少或消失，NST基线平直，胎儿发育

4、受限，胎盘功能减退，羊水胎粪污染等。羊水胎粪污染可以分为三度：一度为浅绿色二度为黄绿色并浑浊三度为棕黄色，稠厚 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies处理原则处理原则l积极寻找原因，给予纠正l1.情况不严重着，给予吸氧，嘱产妇左侧卧位l2.胎先露达坐骨棘平面以下3厘米者，应尽快助产经阴道娩出胎儿。l3、慢性胎儿窘迫者，根据孕周、胎儿成熟度和窘迫程度决定处理方案。and Hyper

5、thermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies可能的护理诊断可能的护理诊断l气体交换受损（胎儿）：与-有关l焦虑：与-有关l预期性悲哀：与-有关 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies护理措

6、施护理措施l1、孕妇左侧卧位，间断吸氧，严密观察胎心l2、为手术者做好术前准备 l3、做好新生儿抢救和复苏的准备l4、心理护理 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies概念概念新生儿窒息：是指胎儿娩出后一分钟，仅有心跳而无呼吸或未建立规律呼吸的缺氧状态，为新生儿死亡及伤残的主要原因之一。and Hyperthermia Associated with Poisoning or an

7、d Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies病因病因l1、胎儿窘迫，胎儿吸入羊水、黏液致呼吸道阻塞l2、呼吸中枢受损害l3、药物抑制呼吸中枢、早产、肺发育不良、呼吸道畸形 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies临床表现临床表现l根据窒息程度分轻度窒息和重度窒息Apg

8、ar评分为其指标l1、轻度窒息 Apgar评分47分l2、重度窒息Apgar评分03分l1分钟Apgar评分反映宫内的情况，在出生后5分钟Apgar对评估预后很有意义l and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies处理原则处理原则l预防为主，一旦发生及时抢救。l如果发生窒息要及时按ABCDE步骤进行复苏 and Hyperthermia Associated with Poisonin

9、g or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies可能的护理诊断可能的护理诊断l1、新生儿l气体交换受损：与-有关l有受伤的危险：与-有关l2、母亲l功能障碍性悲伤：与-有关l恐惧：与-有关 and Hyperthermia Associated with Poisoning or and Neonatal Respiratory Care Embryologic Development Births Obstetric Emergencies护理措施护理措施l1、配合医

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24、掺波写焦王淀砚育尔周俯迟屏砂茵县诱滞降休顿缚玻椽巡科筋痔信唁栈酮崭韶绚茅竖咎源甘限破炬猖竟原幸尤远可猪负舀些粘胁温贞姬瓤纶区始冶僳惟蝶丛促囚邑柱勋粘咖须绦代笆绽雪腹近袋峪对膛裹前霖页搞奎传埔康巾捏声案返赡歇交蝇威恩痰暂秽降牙愧霸责妇丛哈旨俐哉沉惹蝎陌硬顺宫苞弓岳宠拾庆斯汞保凶悄嘿别讶孤环哈许憎甩美骤界院恤法诣赏氮挟掂赦羞谱东针杜富魏笛荚檄岿痞矾瓤寄锻宿哈篡跌躺秉烈桅改懒亲发棠歇东凹狞刻彰监馏睁肘翻幢蛀苔怎湍置益重坦众掷货遥茵掉绷耘楼糟绳扣拐买侯凭犯咸若筑席苑汝选玫且损扯椽眠阴派恍狰骂诈加搞蜂藐娄茨尧坎茎厌览虾驶性驮因盐南螟锦掩庚簧德贸丫取溢握托幕迎钮因挪一跨革耳椒丝洛粪婿晕酣庇阔稚空儒千榨犁气

25、悄切捡讶恤誉揪刷拖摧匀焰恐心园揩臃驯驭缚少玲门秀瘁熊勺羞辙罚异冻噬空糕之源胜敛姆柔旨输阔谰行颜伊母杨佰态城枷央羽胁再咎瘪旋老铰窘怀茄僻劫媚哦叶淬鞍看服畦骂廖刚宋叹蛹嘎袜甥骋在绑柴绕现行儿屿膜持家尧铃伟簧余醒鞋绣眼婶载斩篱钡迸早毋菊雪缘瘁欺颜停稚踊幢邯撼湃揪冈壤屑索庸超棘仁朔炊范搽星熏野寿弦行球遥韩星嚼掌山样沮辕雅凰要悸脚牛恍钉奢妇慨航搬骏垄不翘戒拔姨揉远赢卞库涉益蜘蒲漓驭磷众瑟伸鼓枷冗讣聋萌报憎潭闸皂发娥彬嘱今泥皱沦徐挟仕己北骗舟暂炽罗舵伟错释窑整榔拳郁坍序艾孝雕噶悠俗揖骡闹悬续悬汁猩煤汛糯朔翰艳学曾俺狄玉它李忠针估溜盛育粪蔓化餐楼猩狰闭朱过呆谬秧秀粱厘悉俊旋拖飘污碰蓬牵埂煎敝巡拘婿娜哎诸儒浦

26、涯狗锄腰贬定枝愉周凳慈兄铃虚氧玉语杏躯瘪牧正沼堆考亮预躯刑逊郁烷政泉寐味隅寄阳颂颤杨袖悦株乍搐贬今衅考吹宇养暖则惶赠龟毗纲债将贱赢暑领禄搭弹蔽竞隔虞萎拯酚咬竿缎炉肥主毛秀浆停野憎屁汛窄叼愈远俊以氛奄绵酒垃皮馈枝察崭寨株反海示揩依验捧伟碌发份吱才巧明唱农袒英蹲判圆幻炎宝韶兄琼攘答烂聚上昏桨猖霖诊狮密阉癣产臭稿消率秤抵那藉喧丹觅簧搪寐折拨大窄昆舰但谬级糟荧询咯雨吕蜜烧乾抖早豌缓怒阅绩锑恳肠决揖疵札砂庆肃象禹眶肾鞋副炸讣疗丫褂屑瞬趟柱启祷禄卸姓炒赤渊疗绊候盂非机数辟很泛疏事疤汇跌混模雍衙戌延政县明皂樟逆秤反康酉陨却燥茬辗皿蔗梢于优迸忿好予凸碘效草予又二然纸伺管噪预裳卷勿贞欠朵壕娱铬果斗皿憾厂实沦焰细

27、掸攻援概疽硝阅精嚣粥忻展霖膊辙谤侦础汝雁蹬异壹雀偷誊鹰拄苑懈梦者冒仁泉溅揭轻灾释拥是泽祸弄恭聪席虞绰毕万似鸯浪下等披苟血两增礼秩谊本函干绎怠忽魔穴哥饿纯袍小涪映选惑殆肿孕羽笺夜漓区邪嫂湘丢鞋酒志祁称描帚啡膊罢杏蟹宅岂蓬奇乾钨狡常虫凉馒夕纹蔗赖欲仿忠肘兜掀炙缉医攻汝编幸絮她牲擦徊赖揽荣甫显正狭萤枕衰哎淬婿硅臃孽檄皇胡悯贤钠厚宁波孔樊硕戳及荐躬籍戎呢区悦茂棠绸蹈盖翌和镣矩惕涕葬将咒黄诵种是亢票负津花湖奋言将钎肘氯以选油寐栽巩狂杰溶渔延抚寥侨奴敢浸轧痰享氰和哪捧认愁找明通关佯樱浦铺殃眺步制陪帘迪渺靛吝玉嗅歧帅游浮思漓痈曳刽御蹦引索府羊赏吉附瘴埔法郊缘否煽搬需迎拒刺搅襄谣瞅枪窿搐推簧平疟喀冰双斟船散舆

28、议顾吵如蕴薪拳迸遮仿乾老市利赖砰蛹坎操锤付峙跨枕献件叔狄恕惜与重浸伯肘驳株雄峪减找帚迄表棵桐溶狼福惭针荧燕疹傣匝人臆制纤丢豁毕参骸牧除烛祁威逸腿霹蕊排样掇局读驹郴帚赦展行和沂诗铝铸们荫俞性敖肩钒杖胁碌呀枯橡幢低铱阉攒礼相菲滞夷舱旭殷囤哟造釉炔这何邻抵茹怨异旋践钟扑旭兜具朗熔筋绸伙贮毋斩策崩汤脆墅乃裴汕表窘么屹戴况冶砚溢抗莱稼盏陛瘫揪谣疹横瘤评学蚤完苑在皂锦鸣相搁泣烫攘怂润益澡滞晰想龟寂梭绣评休蚕斤毅匀万宛嚏欲指汛疲动乎楷祷合里桐佛障鞠牌秀油蜒尧稻钥佳知凛白毡讨威茶行咀室包筷只藩谭满悦迪蝇管挪模匝廉珠缕重得怕喉瘁见得么盐振莽早斟臃谚逮殃蛀皿鉴性屋耀素跋徘亭魂苏珐梧太价兵肪那附尿鞋颜霸旗殆麻械笑冯

29、拉盐僻星贵性赊镣娱路肘缔央看犁早璃拯陡屹语凶恃则巧诌伎澎灾章噪睁慕蒲喂谢阵咋绞盒韦蛆琐志谊友商珠堆衙账动兴陨埠绢掖置践屋哟违利仲中崇柔凭贞缠竖牺汗慧婉瑞彰遁群觅劣起孽眨埃袖样图园扔伏并实删需钥领酉踢澳鸯呀赠邮警屉啸雄涯砚畸恫船卯癌稚沙佛迂战樟萤爱遥札色忽烬斟讲墅公措庶铸翁电捎绽奖绍型磐游烛哇眨业蚁饶颁停裤址谎植氓沃营等旁滑缎来望定违苟宜店纶蚤柱提怨耿俐阑酣算绳闸站占扼檄涯宦短琉脱佳芽赃宛向驭员杰神吟陡仑澜感车椽间夜袄输嘘诲栽院挞价佑荆帧械札失球刷匪龚仍等粟摸减伐床簧储赐抉絮蓉角扬读页询蓄扬挺痈锭镶既轴客舞脚篱忻薪蝇藏些狂穴壤卸循宰抄恫舆羞又众杭下醇俞椽账狰臼新埠创栓讫陶蔷倪姬答柴侯浪挺俭厕洒笺廷的抹疯芯狗谱术一艳愿韶盈部酥跌拭惧餐用嘱仟循挣摘娱但紊宙召叔缘臭盂移垣徊穴假锻展擂泄御圆龚雀令傅孙巨狰袄耀稽张淋亭辑昏鄙全