胎羊间断性脐带闭塞的血气及血流动力学变化分析  

Relationship between hemodynamics and blood gas in the near-term ovine fetus after intermittent umbilical cord occlusion

作　　者：何韶铮[1] 吕国荣[1] 王振华[1] 李伯义[1] 陈秋月[1] 金鹏[1] 苏瑞娟[1] 

机构地区：[1]福建医科大学附属第二医院超声科,泉州362000

出　　处：《中华超声影像学杂志》2006年第11期860-863,共4页Chinese Journal of Ultrasonography

基　　金：福建医科大学科研发展基金项目(FJGXY04023)

摘　　要：目的 探讨胎羊间断性脐带闭塞后的血流动力学特点及与脐动脉血气变化的关系。方法 12只晚孕山羊于妊娠116～130d行宫内外科手术，用套囊充气闭合器完全夹闭脐带，每次钳夹90s，间隔30min，重复5次。于第一次钳夹前5min、每次钳夹后3min均应用彩色多普勒血流显像技术检测血流参数，抽取胎羊脐动脉血做血气分析。结果 实验组钳夹后脐动脉搏动指数（PI）、肾动脉（RA）、静脉导管PI、左心室Tei指数、右心室Tei指数均升高（P〈0．（15），并且高于对照组（P〈0．05）；动脉血酸碱度（pH）、动脉血氧分压（PaO2）下降（P〈0．05），动脉血二氧化碳分压（PaCO2）升高（P〈0．05），与对照组比较差异有统计学意义（P〈0．01）。实验组脐动脉PI、肾动脉PI、静脉导管PI、右心室Tei指数、左心室Tei指数与血PH呈负相关（r=-0．431，r=-0．5（16，r=-0．358，r=-0．538，r=-0．681，P〈0．01），与血Pa02呈负相关（r=-0．446，r=-0．478，r=-0．435，r=-0．684，r=-0．725，P〈0．01），与血PaCO2呈正相关（r=0．410，r=0．524，r=0．699，r=0．682，r=0．780，P〈0．01）。结论 晚孕期脐带间断闭塞可导致胎羊宫内缺氧及多项血流动力学指标变化，静脉导管PI和Tei指数与血气指标的相关性好。因此，静脉导管PI和Tei指数可能成为预测胎儿宫内缺氧简便而有效的指标。Objective To study the hemodynamic characteristics, changes of blood gas and the relationship between them in a near-term ovine fetus model with intermittent umbilical cord occlusion. Methods Twelve near-term fetal sheep underwent umbilical cord occlusions（90 s total cord occlusions 5 times at 30 min intervals） at 116 ~ 130 days gestation. Doppler echocardiographic examinations were performed 5 minutes before the first umbilical cord occlusion, 3 minutes after each occlusion. Fetal arterial blood was sampled at 5 rain before the first umbilical cord occlusion and 3 rain after each occlusion for blood gas and pH. Results In experimental group animals, the umbilical artery（UA）, renal artery（RA）, and ductus venous（DV） waveform pulsatility index（PI） values, right ventricular（RV） and left ventricular（LV） Tei indices increased with cord occlusions （all P 〈0.05）,and still significantly rose as compared with the control animals （all P 〈0. 05）. Umbilical cord occlusion caused decline in arterial PaO2 （ P 〈0. 05） ,decline in pH （ P 〈0.05）, and rise in PaCO2 （ P 〈0.05）, still significantly change as compared with the control animals （all P 〈0.01）. There were negative correlation between UAPI, RAPI, DVPI, RV Tel index, LV Tei index and pH（r = -0.431, r = -0.506, r = -0.358, r = -0.538, r = -0.681, P〈0.01）.There were negative correlation between UAPI, RAPI, DVPI, RV Tel index, LV Tel index and PaO2 （ r = -0.446, r = -0.478, r = -0.435, r = -0.684, r = -0.725, P 〈0.01）. There were significant relationship between them and PaCO2 （ r = 0. 410, r = 0. 524, r = 0. 699, r = 0. 682, r = 0. 780, P 〈0.01）. Conclusions Umbilical cord occlusion during the latter part of pregnancy, which caused severe but limited hypoxemia, also caused hemodynamic parameters changed. There was a strong positive correlation between the DVPI, RV/LV Tei index and blood gas and pH with hypoxia. Therefore, DVPI and Tei index might be an easy and useful quantitative paremeter for

关 键 词：超声检查 多普勒 彩色 胎儿缺氧 血液动力学现象 血气分析 

分 类 号：R714.5[医药卫生—妇产科学]