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《新生儿颅内出血(Intracranial-Hemorrhage-of-the-Newborn).ppt》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。
1、IntracranialHemorrhageoftheNewborn (ICH)Contentsmastered:ThemaincausesofneonatalICHThemechanismofPVH-IVHClassificationandmanifestationofPVH-IVHDiagnosisofneonatalICHPreventionofneonatalICHAseverediseaseinneonateRelatedtoperinatalasphyxiaandtrauma,andmaturityoffetusTherearefourmajortypesSubdur
2、alhemorrhagePrimarysubarachnoidhemorrhageIntracerebellarhemorrhagePeriventricular-intraventricularhemorrhage(PVH-IVH)IntroductionEtiologyandEpidemiologyofICHTrauma(epidural,subdural,orsubarachnoid)fetalheadistoolargecomparedwiththesizeofthepelvicoutletprolongedlabor/breechorprecipitantdeliver
3、iesDeliverywithmechanicalassistanceAsphyxia/Hypoxic-ischemicencephalopathyMaturityofneonate:germinalmatrix,PVH/IVHfor20-30%infantswithBW<1500gPrimaryhemorrhagicdisturbance(subarachnoidorintracerebral)DICisoimmunethrombocytopenianeonatalvitaminKdeficiency(maternalphenobarbitalorphenytoin)Conge
4、nitalvascularanormalityIatrogenichemorrhage(sucktioning,infusing,ventilating)PVH/IVHMostcommonneonatalintracranialhemorrhageOccursprimarilyinprematureinfantsIncidenceisinverselyproportionalwithbirthweight:60~70%of500-to750-ginfants,10~20%of1000-to1500-ginfantsOccasionallyseeninnear-termandter
5、minfantsRarelypresentatbirth50%onthe1stday,80~90%betweenbirthandthe3rdday20~40%progressduringthe1stweekDelayedhemorrhageafterthe1stweekin10~15%ofthecasesNew-onsetIVHisrareafterthe1stmonthofliferegardlessofthebirthweightPathogenesisofPVH/IVHGelatinoussubependymalgerminalmatrixatperiventricular
6、areaEmbryonalneuronsandfetalglialcellsImmaturebloodvesselsofgerminalmatrix:thinwallsfortheirrelativelylargesize,lackofamuscularislayerPoorextravascularsupport:immatureinterendothelialjunctionsPredictivefactorsoreventsPrematurity,RDS,Hypoxic-ischemicorhypotensiveinjury,reperfusion,increasedord
7、ecreasedCBF,pneumothorax,hypervolemia,hypertension,etcPathogenesisofPVH/IVHIntravascularfactorsFluctuatingcerebralbloodflow,occurringprenatallyorpostnatally(relatedtopressure-passivecerebralcirculation,mechanicalventilation,sucktion,infusion)
