心脏造影,缺氧和胎儿-新生儿神经损伤

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摘要

并发症发生在任何水平的胎儿供氧可导致低氧血症,最终可能导致缺氧/酸中毒和神经损伤。缺氧缺血性脑病(HIE)是由产时缺氧/酸中毒引起的短期神经功能障碍。这一诊断需要有几个发现,包括确认新生儿代谢性酸中毒、低Apgar评分、脑水肿的早期影像学证据,以及在出生后48小时内出现神经功能障碍的临床体征。脑瘫(CP)包括异质性的非进行性运动和姿势障碍,通常伴有认知和感觉障碍、癫痫、营养缺乏和继发性肌肉骨骼病变。虽然CP是与产时缺氧/酸中毒相关的最常见的长期神经系统并发症,但超过80%的病例是由其他因素引起的。关于轻微的长期神经功能障碍的数据有限,但它们表明,分娩时缺氧/酸中毒可能导致不太严重的智力和运动障碍。出生窒息是一个广义的术语,指分娩时窒息严重到足以引起一些新生儿神经损伤,但很少发生分娩时窒息或新生儿死亡。脑瘫和长期神经系统并发症,如学习困难和运动障碍,可能有出生窒息以外的原因。几个产时事件可导致窒息(即缺氧和代谢性酸中毒),增加神经损伤的可能性。心脏造影(CTG)是一种筛查工具,用于评估胎儿在分娩期间的健康状况,并确定窒息的可能性。异常的CTG,有时严重到足以被描述为病理痕迹,通常被称为“胎儿窘迫”,尽管许多有这种痕迹的胎儿可能没有缺氧和代谢性酸中毒。在目前的实践中,这些事件被恰当地称为“病理性CTG痕迹”或“酸中毒pH值”,而不是“胎儿窘迫”。准确地解释CTG是必要的,并且重要的是识别胎儿在分娩中显示病理性CTG,这可能意味着可能的缺氧和出生窒息。在解释CTG时考虑更广泛的临床背景,并根据发现采取及时和适当的措施可能有助于预防出生窒息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cardiotocography, Hypoxia, and Feto-Neonatal Neurological Damage
Complications occurring at any level of fetal oxygen supply can result in hypoxemia, which may ultimately lead to hypoxia/acidosis and neurological damage. Hypoxic-ischemic encephalopathy (HIE) is the short-term neurological dysfunction caused by intrapartum hypoxia/acidosis. This diagnosis requires the presence of several findings, including confirmation of newborn metabolic acidosis, low Apgar scores, early imaging evidence of cerebral edema, and the appearance of clinical signs of neurological dysfunction in the first 48 hours of life. Cerebral palsy (CP) comprises a heterogeneous group of nonprogressive movement and posture disorders, often accompanied by cognitive and sensory impairments, epilepsy, nutritional deficiencies, and secondary musculoskeletal lesions. Although CP is the most common long-term neurological complication associated with intrapartum hypoxia/acidosis, over 80% of cases are caused by other factors. Data on minor long-term neurological deficits are limited, but they suggest that less severe intellectual and motor impairments may result from intrapartum hypoxia/acidosis. Birth asphyxia is a broad term referring to intrapartum asphyxia severe enough to cause neurological damage in some newborns and, rarely, intrapartum or neonatal death. Cerebral palsy and long-term neurological complications such as learning difficulties and motor impairments may have causes other than birth asphyxia. Several intrapartum events can lead to asphyxia (i.e., hypoxia and metabolic acidosis), increasing the likelihood of neurological injury. The cardiotocograph (CTG) is a screening tool used to assess fetal well-being during labor and to identify the possibility of asphyxia. An abnormal CTG, sometimes severe enough to be described as a pathological trace, is commonly referred to as “fetal distress”, although many fetuses with such traces may not have hypoxia and metabolic acidosis. In current practice, these events are appropriately termed “pathological CTG trace” or “acidotic pH” rather than “fetal distress”. Accurate interpretation of the CTG is essential, and it is important to recognize a fetus displaying a pathological CTG in labor, which may imply possible hypoxia and birth asphyxia. Considering the broader clinical context when interpreting the CTG and taking timely and appropriate action based on the findings may help prevent birth asphyxia.
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