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1、 目的要求 To be familiar with etiology、 mechanism and prevention To master the clinical manifestation and treatment summary(概述) vNeonatal cold injury is a disorder, which is due to coldness(寒冷) , premature birth(早产) , infection(感染) and asphyxia(窒息). vThe clinical manifestations are hypothermia(低温 ) asso
2、ciated with lethargy(嗜睡), edema(水肿 ) and sclerema(硬化) of the skin, and some degree of systemic organ injury. n 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 f
3、atty 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
4、体温(low 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 re
5、nal failure) 肺出血(pulmonary hemorrhage) 呼吸衰竭(respiratory failure) DIC Pulmonary hemorrhage(肺出血) n 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 新生儿水肿 新生儿皮下坏疽 TreatmentTreatment 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 n
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