新生兒窒息復(fù)蘇流程圖(word版)

新生兒窒息復(fù)蘇流程圖(word版)NewbornResuscitationFlowchart(2016)BeforeDeliveryConsultation,TeamFormation,andEquipmentCheck1.BirthIsthebabyfull-term?Istheamnioticfluidclear?Isthemuscletonegood?Istherebreathingorcrying?NoStep1:KeepWarmandMaintainNormalBodyTemperaturePositionthebabyproperly,cleartheairwayifnecessary.Dryandstimulatethebaby.YesIsthereapneaorgasping?Istheredifficultybreathingorpersistentcyanosis?Istheheartrate<100beats/min?YesStep2:AirwayManagement,Oxygenation,andVentilationPositionthebabyproperly,cleartheairway,monitoroxygensaturation,providepositivepressureventilation,considerCPAPifnecessary.NoPost-resuscitationCareandMonitoringIstherechestmovement?Ifnecessary,performcorrectiveventilation.Ifnecessary,intubateorusealaryngealmaskairway.CorrectiveVentilationStepsM:Adjustthemaskandensureaproperseal.R:Repositionthebaby'sheadtothe"sniffing"position.S:Suctionthemouthandnose.O:Openthemouthandrepositionthemask.Istheheartrate<60beats/min?P:Increasethepressureby5-10cmH2Oeachtime.Forfull-termbabies,themaximumpressureis40cmH2O.A:Considerchangingtheairway,intubation,orusingalaryngealmaskairway.C:Administer100%oxygen.Consideremergencyumbilicalveincatheterization.PostnatalTime(min)OxygenSaturation(%)160-65265-70370-75475-80:Administerepinephrineintravenouslyiftheheartrateremains<60beats/min.580-851085-95RoutineCare:Keepthenewbornandmothertogether.Drythebabythoroughlyandcleartheairwayifnecessary.Skin-to-skincontactbetweenmotherandbaby.Keepwarmandmaintainnormalbodytemperature.Managetheumbilicalcord.Continuetoevaluate.ResuscitationEquipmentQuickCheckList1.KeepWarm(6items)Preheattheradiantwarmer.Preheattowelsorblankets.Temperaturesensor.Hat.Plasticbagorclingfilm(forprematurebabies<32weeks).Preheatedmattress(forprematurebabies<32weeks).2.CleartheAirway(3items)Suctionbulb.10or12Frenchsuctioncatheterconnectedtoawallsuctiondevice(pressure80-100mmHg).Meconiumaspirator.3.Auscultation(1item)4.Ventilation(5items)Stethoscope.Oxygenflowrateof10L/min.Adjustoxygenconcentrationto21%(21%-30%forprematurebabies<35weeks).Positivepressureventilationdevice.Maskforfull-termandprematurebabies.Size8feedingtubeandlargeboreneedle.Oxygensource.5.Intubation(8items)Laryngoscopeandblade(forprematurebabies,usesize0or1blade).Guidewire(metal).Endotrachealtube(2.5/3/3.5French).Carbondioxidedetector.Measuringtapeanddepthofinsertiontableforendotrachealtube.Waterprooftapeandendotrachealtubefixationdevice.Scissors.Laryngealmaskairway(size1),5mlsyringe.6.Medications(3items)1:10000(0.1mg/mL)epinephrine.Normalsaline.臍靜脈插管和給藥所需物品，復(fù)蘇器械和設(shè)備，心電監(jiān)護(hù)儀和電極片是必備的。在窒息后出現(xiàn)多器官損害時(shí)，需要進(jìn)行臨床表現(xiàn)和實(shí)驗(yàn)室檢查，并進(jìn)行相應(yīng)的管理。神經(jīng)系統(tǒng)方面，呼吸暫停、驚厥、易激惹、肌張力低等表現(xiàn)常見，神經(jīng)系統(tǒng)檢查也常常異常。在監(jiān)護(hù)呼吸暫停時(shí)，必要時(shí)需要進(jìn)行正壓通氣，并監(jiān)測(cè)血糖和電解質(zhì)，避免低體溫。考慮抗驚厥治療、亞低溫治療和延遲喂養(yǎng)及腸外營養(yǎng)。在呼吸系統(tǒng)方面，呼吸急促、呼嚕聲、三凹征、鼻翼煽動(dòng)和氧飽和度降低等表現(xiàn)常見，氣胸、心血管系統(tǒng)低血壓和心動(dòng)過速也可能發(fā)生。維持足夠的給氧和通氣，避免不必要的吸引，考慮抗生素、胸部X線檢查和血?dú)夥治?、肺表面活性物質(zhì)（PS）治療、延遲喂養(yǎng)和靜脈輸液。同時(shí)，需要監(jiān)測(cè)血壓和心率，考慮擴(kuò)容或強(qiáng)心劑，處理低血壓。在腎臟方面，尿排出減少、水腫和電解質(zhì)異常常見，需要監(jiān)測(cè)尿量、血電解質(zhì)和體重。如果新生兒尿排出減少，血容量充足，需要限制液入量，避免胃腸道喂養(yǎng)不耐受、嘔吐、腹脹等情況發(fā)生。在血液系統(tǒng)方面，貧血、