1、新版新生儿心肺复苏新版新生儿心肺复苏指南的进展与不同指南的进展与不同温州医学院附属黄岩医院 新生儿科 黄 勇backgroundn2010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）委员会定期发出5年后最后一个版本-新的新生儿的心肺复苏指南。n The American Heart Association (AHA)n the European Resuscitation Council (ERC) nthe International Liaison Committee on Resuscitation (ILCOR)sourcePediatric
2、s.2006 May;117(5):e989-1004.port. el al. neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Eme-rgency Cardiovascular Care.2010;122(suppl 3):S909S919. Newborn Resuscitation Algorithm.Kattwinkel J et al. Circulation 2010;122:S909-S919Copyright Ame
3、rican Heart Associationpulse oximetrynA pulse oximeter can provide a continuous assessment of the pulse without interruption of other resuscitation measures, but the device takes 1 to 2 minutes to apply, and it may not function during states of very poor cardiac output or perfusion. (2) Use of O 2 i
4、n the delivery room nTwo meta-analyses of several randomized controlled trials comparing neonatal resuscitation initiated with room air versus 100% oxygen showed increased survival when resuscitation was initiated with air. n足月儿或接近足月儿开始复苏可以用0.21空气n各种供氧措施，如T-复合器予1. 0纯氧复苏，无助于生存率提高(3) skin colornOther
5、studies have sho-wn that clinical assessm-ent of skin color is a very poor indicator of oxyh-emoglobin saturation du-ring the immediate neon-atal period and that lack of cyanosis appears to be a very poor indicator of the state of oxygenation of an uncompromised baby following birth. n皮肤颜色：评价指标差n生后存
6、在发绀期n宫外10分钟达正常水平CO 2 Detectors n The number of studies on CO 2 detectors in neonates remains very small and most reports come from retrospective studies.Until more solid evidence proves that their use improves patient outcome, we refrain from recommending CO 2 detectors as part of the routine DR man
7、agement. n大部分报告来自回顾性研究n不建议CO2探测器的日常管理n需要更坚实的证据证明他们的使用提高了病人复苏结果 Respiratory supportn Positive pressure ventilation (PPV) in the DR is best administered by a pressure limited T-piece resuscitator as such devices allow more control of the delivered pressure and tidal volumes.n在产房正压通气（PPV）是最好的管理n压力有限的T型
8、复苏器允许压力控制和潮气量Meconium aspiration nWe suggest to continue with the current practice of clearing the airway before PPV is started in any infant, in particular those born from thick, MSAF, until further evidence becomes available。n正压通气前呼吸道应清理n特别是那些出生稠厚的胎粪污染患儿。n胎粪污染吸引存在争议Temperature control n We recomme
9、nd the use of plastic cover only for infants with a GA 28 weeks. In any circumstances, close monitoring of the infant s temperature is mandatory, because both hypothermia and hyper- thermia negatively affects neonatal outcome. n胎龄28周，使用塑料纸覆盖n强制执行n体温过高与体温过低影响复苏结果Induced hypothermian Induced hypotherm
10、ia should be offered to all term or near term infants with evolving HIE. n胎龄36周n中重度HIEn亚低温治疗（33.5 - 34.5C间） n窗口期 6小时n治疗期72小时n降低死亡率和残疾率 Drugs and fluids 1.epinephrine nIn the absence of a suffcient IV access, an intra-osseous access may also be used. n肾上腺素n心率持续60次分n肾上腺素1:10 000溶液（0.1毫克/毫升）0.1 - 0.3毫升
11、/公斤n静脉不可用时，骨内给药 -2.Sodium bicarbonate n Due to lack of evidence, sodium bicarbonate may only be considered during prolonged cardiac arrests unresponsive to other therapy and on a compassionate use basis, and on a case-by-case basis in the postresus-citation care of newly born infantsn证据缺乏n指证：心跳停止，抢救
12、无反应 -3.Naloxone n Naloxone should not be used during resuscitation or the post-resuscitation care of depressed newly born infants. n不应使用 -4.Volume expansion n Isotonic crystalloid solution or blood (10 mL / kg IV) should be used for the initial IV volume expansion in a depressed new-born infant in t
13、he DR with a history or clinical signs of significant hypovo-lemia, but rarely on an empiric basis. n应该是等渗晶体溶液或血（10毫升/公斤IV）n用于产时血容量明显减少，无循证医学证据n早产儿易引起颅内出血 -5.Glucose IV infusion n We suggest to start by giving a 10% glucose (dextrose) IV solu- tion in the DR as early as possible, and independ-ently
14、from resuscitation status (i.e. start infusion during resuscitation). n产房，建议早期给予10葡萄糖溶液n独立于复苏状态（即在复苏开始输液时） Delayed cord clamping n For term infants, cord clamping may be delayed for 1 2 min. Delayed cord clamping may be of benefi t to term infants born in countries with poor maternal nutritional sta
15、te and / or insuffici- ent postnatal follow-up. n对于足月儿，钳夹脐带最好推迟1 - 2分钟n主要针对营养状况不佳的孕产妇(11)Ethical considerations n When extremely preterm delivery or resuscitation is anticipated, the parental wishes should be obtained after unbiased counseling and their opinions should be respected. n胎龄23周，体重400克n征询父母意见
