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1、新生儿寒冷损伤综合征,目的要求,To be familiar with etiology、 mechanism and prevention To master the clinical manifestation and treatment,summary(概述),Neonatal cold injury is a disorder, which is due to coldness(寒冷) , premature birth(早产) , infection(感染) and asphyxia(窒息). The clinical manifestations are hypothermia(低
2、温) associated with lethargy(嗜睡), edema(水肿) and sclerema(硬化) of the skin, and some degree of systemic organ injury.,Etiology and Mechanism,1. 内因(Intrinsic factors) 1) 温度调节中枢(thermotaxic center ) 发育不成熟 2) 散热过多( excessive heat loss ) 3) 体内储存热量少4)棕色脂肪( brown fat )的化学产热方式为主,缺乏寒颤等物理产热方式 5)饱和脂肪酸( saturated
3、 fatty acid )含量多, 熔点高。,2.外因(Extrinsic factors) 1) 寒冷(coldness) 2) 摄入不足(intake deficiency) 3) 早产(premature birth) 4) 疾病(diseases) 感染 ( infection) 窒息( asphyxia ),3、多器官功能损害低体温、硬肿 局部血液循环淤滞缺氧、酸中毒毛细血管多器官功能损害,Clinical Manifestation,1、一般情况(General manifestation) 少动(decreased activity)少哭少吃(poor feeding)低体温(l
4、ow temperature) 2、皮肤表现(Skin feature) 1)硬化(cold, bright red, edema and sclerema ),2)顺序(gradation) 小腿(calf) 大腿(thigh)臀部9Buttock ) 面部( Face) 上肢(upper limb )全身(Total body)3)分度(Grades of severity ) According to an area of sclerema 轻度(mild): 50%,3、多器官功能损伤 循环衰竭(circulatory collapse) 急性肾功能衰竭(acute renal fai
5、lure) 肺出血(pulmonary hemorrhage) 呼吸衰竭(respiratory failure)DIC,Pulmonary hemorrhage(肺出血),辅助检查血常规 血气分析 电解质 血糖 肾功 心电图 胸片,诊断 分度轻度重度,诊断与鉴别诊断,新生儿水肿 新生儿皮下坏疽,诊断与鉴别诊断,Treatment,复温(rewarming) body temperature 30 将患儿置于中性温度(neutral temperature) 的温箱中,于 6 12hr恢复体温。 body temperature30 将患儿置于比肛温高12 的温箱中,待肛 温恢复至35 时,维持箱温的温度于中性 温度。,Open radiant warmer bed incubator,Treatment,热量和液体供给 Calorie: 50kcalkg.d, 逐渐增加至 1002 00kcalkg.d Liquid: mlkcal 对症治疗: 有微循环障碍者纠酸、扩容、血管活性药。 有肺出血者行机械通气 及时处理肾功能障碍及DIC 预防感染,