静脉到静脉人工胎盘转流胎羊模型的建立  

A fetal goat model of the veno-venous extracorporeal life support

作　　者：李明亮[1,2] 江文[1,2] 周成斌[1] 章晓华[1] 陈寄梅[1] 庄建[1] 

机构地区：[1]广东省心血管病研究所广东省人民医院心外科广东省医学科学院,广州510080 [2]南方医科大学研究生学院

出　　处：《中华实验外科杂志》2014年第11期2620-2622,共3页Chinese Journal of Experimental Surgery

基　　金：“十二五”国家科技支撑计划课题项目（2011BAI11B22）

摘　　要：目的 建立静脉到静脉人工胎盘转流方式胎羊模型.方法 孕100 - 140 d的孕羊5只,切开子宫,建立静脉到静脉的人工胎盘转流方式.血液从右颈内静脉引出,经过人工胎盘后从脐静脉输回到胎羊体内.胎羊脱离母体后放置在40℃生理盐水中.人工胎盘装置包括离心泵、新生儿膜式氧合器、小儿超滤器等.分别于转流前、转流1、3、6h监测胎羊的心率、血压和动脉血气,于转流前、转流3、6h超声评估左、右心室的心排出量.结果 转流早期,灌注流量恒定,胎羊血压、心率没有显著变化.乳酸值从（5.26±1.57） mmol/L上升至（14.04 ±2.74） mmol/L（P ＜0.01）.超声示左心室心排量变化差异无统计学意义（P＞0.05）,右心室心排量有下降趋势,从（264.81±163.57） ml/（kg·min）下降到（208.94±125.99） ml/（kg· min）,但变化差异无统计学意义（P＞0.05）.结论 颈内静脉到脐静脉的人工胎盘技术可行,需要控制插管的深度,避免插管损伤脆弱的胎羊组织,并且及早进行血气分析,纠正内环境紊乱.Objective To establish a fetal goat model of the veno-venous artificial placenta support.Methods Five pregnant goats with 100 to 140 days gestation underwent cesarean deliver.Veno-venous artificial placentas were established to support fetal goats.The fetal blood drained from right jugular vein was pumped to an umbilical vein via artificial placenta.Fetuses were incubated in the warm saline at 40 ℃.The artificial placenta circuit consisted of a centrifugal pump,a neonatal membrane oxygenator,an uhrafilter,et al.Fetal echocardiography was performed to access fetal cardiac output of two ventricles before support and 3 hours and 6 hours during support.Fetal hemodynamics were monitored and blood gase were assayed during support.Results During support,fetal hemodynamics were stable.The level of Lac increased remarkably [（5.26 ± 1.57） mmol/L vs.（14.04 ± 2.74） mmol/L,P 〈 0.01] with a slight increase of the potassium.Fetal cardiac output of left ventricle decreased without significant differences.Fetal cardiac output of right ventricle tended to decrease without significant difference at the 6th hour compared with that before support [（264.81 ± 163.57） ml/（kg· min） vs.（208.94 ± 125.99） ml/（kg＊ min）].Conclusion The veno-venous artificial placenta might be a practicable experimental model for supporting the premature fetuses.However,we were supposed to be careful with the tender and vulnerable tissues.

关 键 词：体外生命支持 人工胎盘 胎羊 心输出量 

分 类 号：R-332[医药卫生]