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【医学PPT课件】产间胎儿监护

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医学PPT课件 胎儿监护胎心监护 医学PPT课件】 胎心监护ppt课件 【PPT】 产 产间胎儿监护 胎心监护医学ppt课件 胎儿监护PPT课件 监护ppt课件 胎心监护课件
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产间胎儿监护产间胎儿监护 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 产间胎儿监护 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 目标 •复习持续胎儿电子监护(CEFM)的证据 •明确在使用间断听诊还是CEFM时关键的 因素 •采用DR C BRAVADO口诀 •根据对产妇和胎儿全面评估来制定计划 •讨论未来胎儿监护发展趋势 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. CEFM的历史 •1818年:第一次听到胎心 •1838年:使用胎儿听诊器 •19世纪60年代:开始EFM •1980:近半数以上的产妇在分娩中采用 CEFM Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 使用CEFM的产妇指征 • 高血压疾患 • 糖尿病 • 心脏病 • 严重贫血或血红蛋白疾病 • 甲亢 • 胶原血管病 • 肾脏疾病 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 使用CEFM的胎儿指征 •多胎妊娠 •宫内生长受限 •早产(小于37周) •臀位 •Rh同种免疫 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 使用CEFM的产科指征 •引产或加强宫缩 •产程延长 •阻滞麻醉 •宫缩异常 •颗粒胎粪 •间断听诊怀疑胎心异常 •入院时胎心率曲线异常 •产程中阴道出血 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 胎儿监护的效果 • 持续监护 F活动受限 F与医生的接触 F与护士的直接接触 F手术分娩率 • 间断听诊 F需要足够的训练有素的人员 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. CEFM的结果 • 12随机对照研究,58000例 F1分钟Apgar评分小于7分,无差别 F新生儿抽搐发作轻度减少 F入住NICU率无差别 F剖宫产率和阴道手术助娩率增加,尤其是 在低危妊娠时 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 监护方法的选择 •决定于人员和是否觉得舒适 •与患者讨论 •衡量产妇和胎儿的风险程度 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 间断听诊--频率 低危患者高危患者 第一产程 活跃期 每15~30分钟每15分钟 第二产程 每5~15分钟每5分钟 (或是在每次宫缩后) Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 听诊的步骤 •多普勒探头确定胎心最强的位置 •要区别产妇的脉搏和胎儿的脉搏 •触诊子宫收缩 •两次宫缩之间的胎心率至少要计数60秒 钟(基线胎心率) •在宫缩之后1分钟也要测定胎心率 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 将CEFM作为一种筛查手段 •局限性 F特异性低 F不可靠的曲线预后不一定差 •优点 F敏感性较高 F可靠的曲线预后良好 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. DR C BRAVADO • Determine Risk风险确定 • Contraction宫缩 • Baseline RAte基线心率 • Variability变异 • Accelerations 加速 • Decelerations 减速 • Overall Assessment 总体评估 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. DR DR == Determine RiskDetermine Risk((风险确定)) •产前的危险因素 •产中的危险因素 •胎儿储备 •产程进展 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. C = Contraction (C = Contraction (宫缩宫缩) ) • 监护 的方法 F触诊 F外监护探头 F宫内压监护 • 类型和强度 F 适当 F过度刺激(在15分钟内 7) Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. BRA = Baseline Rate (基线) •至少需要10分钟才可确定 •正常:110~160 •间断听诊:在宫缩间测定 •基线心率可受下列因素影响 F早产 F胎儿状态的改变 F母体发热、位置改变、使用药物 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 心动过缓 160 140 120 100 80 80 60 40 20 0 60 轻度: 100 - 110 bpm 重度: 200 bpm Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. V = VariabilityV = Variability(变异)(变异) •正常:在基线上下10~15bpm •反应出正常的中枢神经系统功能 •是胎儿预后的最好预测指标 •在放螺旋电极时最为准确 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 变异降低的原因 • 缺氧/酸血症 • 胎儿睡眠周期 • 早产 • 先天异常(中枢神经系统) • 药物 F神经系统抑制剂 F抗胆碱能药物/抗副交感药物 F皮质激素 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 变异性 正常的变异是一可靠胎心率曲线最为重要的特点 240 210 180 150 120 90 60 30 240 210 180 150 120 90 60 30 降低正常 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. A = Accelerations (A = Accelerations (加速加速) ) • 定义 F增加≥15bpm F持续≥ 15秒以上 • 存在时说明胎儿情况良好 • 缺少时 F低危患者可能通常是假阳性结果 F需要进一步评估(BPP,CST) Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 加速 80 60 40 20 0 240 210 180 150 120 90 60增加15 bpm 胎动或刺激后出现的加 速是评估胎儿情况是否良好的方法 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. D = Decelerations (D = Decelerations (减速减速) ) •需要结合宫缩的类型 •根据间断听诊无法分类 应考虑行连续胎心电子监护 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 80 60 40 20 0 180 160 140 120 100 80 60 早减速与宫缩同时发生:通常是良性的,与胎 头受压有关 早减速 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 80 60 40 20 0 140 120 100 80 60 160 180 可变减速形态不一,与宫缩之间的关系不 定,可能会有“肩”部征。 可变减速 “肩”部征 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 80 60 40 20 0 140 120 100 80 60 160 180 在宫缩发生后开始,最低点出现在宫 缩高峰之后,在宫缩结束后回复到基 线。 晚期减速 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 晚期减速 80 60 40 20 0 160 140 120 100 80 180 200 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. O = Overall Assessment (全面评估) • 评估胎儿情况 F可靠(I类) F可疑(II类) F不可靠(III类) • 处理计划 F根据临床情况 F包括进一步监护的方案 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 胎监结果的解释 • I类图形为正常胎监 • I类图形预示胎儿正常的酸碱状态 • I类图形只需常规处理,不需要特殊的干预 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. • II类图形是不确定的 • II类图形并不能预示异常的胎儿酸碱状态, 不过目前没有充分的证据将其划归到I类或 III类 • II类图形需评估,并继续监测后再评估,同 时要综合考虑临床的其他因素 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. • III类图形是异常的 • III类图形预示着异常的胎儿酸碱状态 • III类图形需及时的评估,并根据临床情况采 取措施迅速改善这种异常的图形,包括但不限 于:母体供氧,停止刺激,纠正母体的低血压 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. I类胎监图形包括: F胎心基线率: 110–160bpm F基线变异适度:5-25bpm F无晚期减速和变异减速 F有或者无早期减速 F有或无加速 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. II类胎监图形包括: • II类图形包括所有不能划分在I或者III类中的,是临 床处理中遇到的主要部分 • 胎心基线 F心动过缓但有基线变异 F心动过速 • 基线变异 F最小的基线变异(25bpm) Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. II类胎监图形包括: • 加速 F胎儿刺激以后无法诱导出加速 • 周期的或者间歇性的减速 • 频繁的变异减速伴随最少的或者适量的基线变异 • 延长的减速≥2 min 但是<10 min) • 频繁的晚期减速,伴有适量的基线变异 • 变异减速伴有其他的表现如缓慢的回升到基线, overshoots或者“肩征” Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. III类胎监图形包括: • 基线变异消失并有下面任何一种情况 F频繁的晚期减速 F频繁的变异减速 F心动过缓 • 正弦波形 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 正弦波型 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 正弦波型 FIGURE 6.36. Intrapartum sinusoidal fetal heart rate (FHR) pattern. There are also moderate variable decelerations present. (From Klavin M, et al.: Clinical concepts of FHR monitoring. Hewlett-Packard Co., Boston, 1977:106) Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 对FHR监测图形的进一步解释: • 在变异降低的时候,如有反复出现的加速,应该认为是可 靠的。 • 单一的标准的早期减速较少见,通常是良性的,因此没有 很特别的意义。 • 在产时发生的减速很多时候可能是变异减速。 • 如果胎儿心动过缓的时间超过3分钟,紧急的医学处理包括 紧急分娩胎儿的准备,这要求如果9分钟内胎心不恢复, 应将孕妇送入手术室,如果胎心在9分钟内恢复了,根据 孕妇和胎儿的情况再次评估分娩方式。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. l 单纯的胎儿心动过速,胎心160–180 bpm,加速存在而且没 有其他不良的表现,, where accelerations are present and no other adverse features appear, should not be regarded as suspicious. However, an increase in the baseline heart rate, even within the normal range, with other non-reassuring or abnormal features should increase concern. l For women having continuous EFM, a documented systematic assessment based on these definitions and classifications should be undertaken every hour. l During episodes of abnormal FHR patterns when the woman is lying supine
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