新生儿首次呼吸前后脐带动静脉血液氧和二氧化碳变化探索呼吸调控机制的初步报告Ⅰ—血液氧和二氧化碳分压脐带动静脉差值的组间分析  

Preliminary report on partial pressure changes of oxygen and carbon dioxide in umbilical artery and vein before and after the first breath in Chinese neonates Ⅰ--The group difference of partial pressure of oxygen and carbon dioxide between umbilical artery and vein in newborns

作　　者：刘方[1] 孙兴国[1] 李启威 葛万刚 李浩[1] 刘艳玲 慈政 陈升平 宋桂芹 王桂芝 谭晓越[1] 崔闫[1] 张也 朱嘉宝 李银俊 邓维[1,6] 黄燕 马铭欣 陈荣 邹昱馨 台文琦 徐凡 石超 LIU Fang;SUN Xing-guo;LI Qi-wei;GE Wan-gang;LI Hao;LIU Yan-ling;CI Zheng;CHEN Sheng-ping;SONG Gui-qin;WANG Gui-zhi;TAN Xiao-yue;CUI Yan;ZHANG Ye;ZHU Jia-bao;LI Yin-jun;DENG Wei;HUANG Yan;MA Ming-xin;CHEN Rong;ZOU Yu-xin;TAI Wen-qi;XU Fan;SHI Chao(Department of Cardiology,Fuwai Hospital,Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College,Beijing 100037;Electric Power Teaching Hospital of Capital Medical University(Beijing Electric Power Hospital of State Grid Co.of China),Beijing 100073;Weifang Medical University,Weifang 261053;The Second Hospital of Hebei Medical University,Shijiazhuang 050005;Kangle Hospital of Chengguan District,Lanzhou 730030;The Affiliated Rehabilitation Hospital of Chongqing Medical University,Chongqing 400050;Dalian Children’s Hospital,Dalian 116000;Liaocheng People’s Hospital,Liaocheng 252000,China)

机构地区：[1]国家心血管病中心,中国医学科学院阜外医院,心血管疾病国家重点实验室,国家心血管疾病临床医学研究中心,北京协和医学院,北京100037 [2]国家电网公司北京电力医院,北京100073 [3]潍坊医学院,山东潍坊261053 [4]河北医科大学第二医院,石家庄050000 [5]兰州市城关区康乐医院,甘肃兰州730030 [6]重庆医科大学附属康复医院,重庆400050 [7]辽宁省大连儿童医院,大连116000 [8]聊城市立医院儿童医院,山东聊城252000

出　　处：《中国应用生理学杂志》2021年第1期1-8,共8页Chinese Journal of Applied Physiology

基　　金：国家高技术研究发展计划(863计划)课题资助项目(2012AA021009);国家自然科学基金医学科学部面上项目(81470204);中国康复医疗机构联合重大项目基金(20160102);中国医学科学院国家心血管病中心阜外医院科研开发启动基金(2012-YJR02);首都临床特色应用研究与成果推广(Z161100000516127);北京康复医院2019-2021科技发展专项(2019-003);北京协和医学院教学改革项目(2018E-JG07);北京协和医学院-国家外国专家局外国专家项目(2015,2016,T2017025,T2018046,G2019001660);重庆市卫计委医学科研计划项目(2017MSXM090);重庆市科委社会事业与民生保障科技创新专项项目(cstc2017shmsA130063)。

摘　　要：目的:胎儿没有实际上的呼吸,新生儿出生后才开始呼吸,我们假设人的第一次呼吸主要是由于低氧而触发。本研究对流经主动脉体外周化学感受器后的脐带动脉血液氧分压(PuaO_(2))变化规律和下限进行分析以探讨新生儿自主呼吸产生机制。方法:选择签署知情同意书的正常分娩产妇数十例,仅14例新生儿在自主呼吸开始前成功完成脐带动脉或静脉置管。分别进行逐搏取血及顺序血气分析,计算血气指标的平均值、最高值和最低值,统计比较脐带动静脉的异同。结果:在14例新生儿自主呼吸开始前完成采集脐带动脉(Pua)样本9例,脐带静脉(Puv)样本8例。就PO_(2)而言,所有9例PuaO_(2)随时间(心跳次数)呈逐渐降低倾向,直至在自主呼吸产生大约8~10次心跳后Pua挛缩、基本上无法取得足够的血样。PuaO_(2)平均值是(25.94±6.79,18.04~37.51)mmHg,最高值是(29.11±6.46,23.00~45.90)mmHg,最低值是(21.34±5.54,14.00~33.60)mmHg;但PuaCO_(2)变化趋势和规律则不够稳定,PuaCO_(2)平均值是(47.26±7.71)mmHg。PuvO_(2)随时间(心跳次数)虽也呈逐渐降低趋势,但多数还呈现随母亲呼吸节律的规律性交替升降的倾向,特别是母亲吸氧时。所有8例PuvO_(2)平均值是(53.35±21.35,32.56~100.73)mmHg,最高值是(90.38±48.44,43.40~153.00)mmHg,最低值是(36.96±14.90,24.80~73.80)mmHg;PuvCO_(2)平均值是(41.04±6.44)mmHg。虽然有着较大的个体差异,但PuvO_(2)平均值、最高值和最低值均显著较PuaO_(2)高(P<0.05);PuvCO_(2)虽略低于PuaCO_(2),但无显著差异(P>0.05)。结论:胎儿娩出为新生儿后自主呼吸前PuaO_(2)随时间(心跳次数)逐渐降低,在达到触发呼吸的阈值时诱发第一次吸气,从而开始自主呼吸。Objective:The fetus has no actual respiration,and the newborn begins to breathe after birth.We assume that the first breath dominantly generated by hypoxia.In this study,the changes and lowest limit of blood oxygen partial pressureof umbilical artery(PuaO_(2))after chemoreceptor were analyzed to explore the mechanism of neonatal spontaneous breathing.Methods:With signed consent form by all fetal parents before birth,14 newborns successfully completed the umbilical artery or vein catheterization and drawn blood according to the heartbeat.All blood samples analyzed by blood gas analyzer,calculated and analyzed the similarities and differences between umbilical vein(Puv)and umbilical artery(Pua).Results:Although we completed 14 newborns,there were only 9 cases of umbilical artery samples and 8 cases of umbilical vein samples were collected.Only 3 cases collected both Pua and Puv blood samples at the same time(see serial paper II).PuaO_(2) in gradually decreased with time(heartbeat frequency),until Pua contracted after spontaneous breathing produced about 8~10 heartbeats,and then could not get enough blood samples.Only 3 newborns were able to take blood samples after spontaneous breathing for 8~10 heartbeats,and their PuaO_(2) were jumped to 186.0,137.0 and 93.8 mmHg respectively.The mean value of PuaO_(2) was(25.94±6.79,18.04~37.51)mmHg,the highest value was(29.11±6.46,23.00~45.90)mmHg,and the lowest value was(21.34±5.54,14.00~33.60)mmHg.Although PuvO_(2) decreased gradually with time(heartbeat)too,most of them also showed the tendency of alternately rising and falling with the regularity of mother’s respiration.The mean value of PuvO_(2) was(53.35±21.35,32.56~100.73)mmHg,the highest value was(90.38±48.44,43.40~153.00)mmHg,and the lowest value was(36.96±14.90,24.80~73.80)mmHg.Although there were large individual differences,the mean,highest and lowest values of PuvO_(2) were significantly higher than those of PuaO_(2)(P<0.05);although PuvCO_(2) slightly lower than PuaCO_(2),it was no significant difference(P

关 键 词：新生儿出生后呼吸前 脐带动脉和脐带静脉连续逐搏取血 血液气体分析 脐带动脉血氧分压 呼吸调节控制信号 

分 类 号：R332[医药卫生—人体生理学]