HIE新生儿缺氧缺血性脑病课件.ppt

Hypoxic-ischemicencephalopathy(HIE)

新生儿缺氧缺血性脑病

;Outline;causes

mothersfetus

antepartumintrapartumpostpartum

20％35％35％10％;CausesofHIE;EtiopathogenesisofHIE;Divingreflex;Secondaryredistribution;BranchofACA;terminfant：皮层矢状旁区受损

preterminfant：脑室周围的白质区受损;HIE新生儿缺氧缺血性脑病;脑室旁白质软化

periventricularleukomalacia,PVL;Suddenlycompletelyasphyxia;3.autoregulation↓→Pressure-passivecerebralcirculation(PPCC);Changeofbrainmetabolism:

1.oxygenfreeradicals→ruptureofcellmembrane

destroyBBB

(1)overproduction：cytochrome-oxydase↓；

reperfusion：xanthineoxidase↑

hypoxanthine----------------→urea+oxyradicals

(2)removenotenough：超氧化物歧化酶

（SOD）↓;Changeofbrainmetabolism:

2.imbalanceofNaCa：

anaerobicglycolysis→lacticacid↑,ATP↓→

pumpoutoforder→Ca++inflow→chaosofsignal

→Na++inflow→intra-cellularedema

3.excitableneurotransmitter:

glutamicacid；

β-opioidpeptide;neuropatholgy：

脑细胞水肿(edema)

脑细胞坏死(necrosisofbraincells)

脑细胞凋亡(apoptosis）;Clinicalmanifestation;HIE新生儿缺氧缺血性脑病;CriteriaofSarnatgradesforHIE;Attention:

部分患儿在宫内已发生HIE,

出生时Apgar评分正常,多脏器受损不明显

但生后数周或数月逐渐出现神经系统受

损症状。;investigation;investigations;investigations;HIE辅助检查;diagnose：;objective

1.增强代偿性生长

2.建立新的神经网络

3.纠正错误的传导与支配;发育中脑的可塑性

Plasticityduringgrowthofbrain

树突增长、增多

Dendronsgrowinlengthandnumber

轴突延伸

Axonselongation

突触增加

Increasesynapse

建立新的神经传导回路

Rebuildloopsofnerveconduction

——代偿性生长

----compensationgrowth;Hypoxic-ischemia

necrosis

neurons

damageapoptosis

cellbody

dendronaxonneural

network