《儿科学》课程教学课件（PPT讲稿）07 新生儿缺氧缺血性脑病 Hypoxic-ischemic Encephalopathy（HIE）

Hypoxic-ischemic(HIE)encephalopathy新生儿缺氧缺血性脑病

Hypoxic-ischemic encephalopat hy (HI E) 新生儿缺氧缺血性脑病

OutlineNeonatal asphyxia-→oxygen-poor→ischemia→brain injured in perinatalperiodCurrent ly birth trauma , O2 deficiency&asphyxia ↑Severe consequence :neonatal death orchildren disablement, one of reason ofcerebral palsy in childrenhood. Commonin full term bb, also in premature

• Neonatal asphyxia→oxygen-poor →ischemia→brain injured in perinatal period • Cur r ent ly birt h t r auma↓，O2 deficiency &asphyxia↑ • Severe consequence ：neonatal death or children disablement, one of reason of cerebral palsy in childrenhood. • Common in full term bb, also in premature

causesPlacenta&umbilicafecotud smothershypoxiaAnte-&intr apart umantepartumintrapaPrOtSutmpartum20%35%35%10%

causes mot hers antepartum 20％ int r apart um 35％ 35％ 10％ hypoxia Placenta & umbilicaf le cot ru d s Ante- & intrapaprot su tmpartum

CausesofHIEalso causes of asphyxia:Maternal factors:illnesses,obstetricdeseases,smokingordrugaddictionpregnancies,olderthan35yearsteenageIntrapartum factors: umbilicalcore, malpositionplacental insufficiency,placental abruption· Fetal factors: congenital anomalies, IUGRhydrops fetalisapnea, HMD, MAS, PPHN, shock.Infant factors:

Causes of HIE also causes of asphyxia: • Maternal factors： illnesses， obstetric deseases，smoking or drug addiction, teenage pregnancies, older than 3 5 years • Intrapartum factors：umbilical core，malposition, placental insufficiency, placental abruption • Fetal factors：congenital anomalies, IUGR， hydrops fetalis • Infant factors： apnea, HMD, MAS, PPHN, shock

Etiopathogenesis of HIECerebral blood flow (CBF)I. fail incompensation:2 steps of redistribution

Etiopathogenesis of HIE Cerebral blood flow (CBF)： 1. fail in compensation： 2 steps of redistribution

Diving reflexThe first time ---skin子Maintain CBF but lead toAdrenalmulti organic damagegland

The first time - Diving reflex skin Adr enal gland Ma int a in CBF but le ad t o multi organic damage

Secondary redistribution大脑前动脉Anterior cerebralartery,ACA大厨中动脉前交道动脉middle cerebral颈内动脉artery.MCAPosterior cerebralartery,PCA后交通动脉大脑后动脉大脑后动脉小脑下前动脉推卖肤小脑上动脉基底动脉脊留前动脉图238大脑动脉环的组成和脑血管分市

Secondary redistribution Anterior cerebral artery, ACA middle cerebral artery,MCA Posterior cerebral artery,PCA

Branch of ACABranch of PCA大脑前动脉的分支天脑后动脉的分大脑前动脉大脑中动脉及其分支的分支大脑后动脉Branch ofMCA及其分支外侧面内侧面图239大脑的动脉分布

Branch of ACA Branch of MCA Branch of PCA

Conseguence ofsecondaryredistributionterm infant ：皮层矢状旁区受损preterm infant : periventricularleukomalacia (PVL)脑室周围的白质区受损

Consequence of secondar y redistribution term infant：皮层矢状旁区受损 preterm infant：periventricular leukomalacia (PVL) 脑室周围的 白质区受损

FegHnLArbabyt/sdBeijing Hed UniyCOAH3.5H-SP-CRVDid2002TMAGE矢状务区图3212天状旁区脑拟伤