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Ⅱ—同一个新生儿同一时间的脐带动静脉血液氧和二氧化碳分压差值个体化分析  

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 Ⅱ--The personalized analysis of partial pressure of oxygen and carbon dioxide difference between umbilical artery and vein at same time in same newborn

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9-14,共6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:为探讨新生儿自主呼吸产生机制,前文已对新生儿出生后自主呼吸开始前脐带动静脉氧气和二氧化碳差值进行了人群组间分析;而本部分则对相关信息进行个体化分析。方法:在产前经所有胎儿父母签署知情同意书,新生儿出生后还没有呼吸之前在脐带动脉和脐带静脉分别连续逐搏取血,仅有3例同时采集到Pua和Puv血液样本进行血气分析测定,计算分析脐带静脉和脐带动脉的异同和动态变化。结果:虽然准备了数十产妇,但仅有3例同时采集到Pua和Puv血液样本,同一时间的PuvO_(2)显著高于PuaO_(2)(P均<0.01),平均相差(24.17±7.09)mmHg;而PuvCO_(2)显著低于PuaCO_(2)(P均<0.01),平均相差(-7.67±3.70)mmHg。在同一时间的Puv-uaO_(2)显著高于PuvuaCO_(2)(P<0.05)。结论:新生儿出生后自主呼吸前,全部氧气供应由脐带静脉运输,只要胎盘开始剥离则新生儿的PuaO_(2)随时间(心跳次数)逐渐降低,当PuaO_(2)达到触发呼吸阈值(最低值)诱发第一次吸气开始其自主呼吸。Objective:In order to explore the mechanism of neonatal spontaneous breathing,the difference of oxygen and carbon dioxide between umbilical cord arteries and veins before the start of spontaneous breathing after birth has been analyzed among people.In this part,the related information is analyzed individually.Methods:After all fetal parents signed the informed consent before birth,and before the newborn was born and did not breathe,the umbilical cord was exposed as quickly as possible,and the heparinized arterial indwelling needle was inserted into the umbilical artery and umbilical vein in the direction of newborn and placenta,and then blood was taken continuously.Although dozens of mothers were selected,but only 3 cases were collected from Pua and Puv blood samplers at the same time for blood gas analysis and determination,and the differences and dynamic changes of umbilical vein and umbilical artery were calculated and analyzed.Results:In all 3 none spontaneous breathing newborns,PuvO_(2) was significantly higher than PuaO_(2) at the same time(P<0.01),with an average difference of(24.17±7.09)mmHg;while PuvCO_(2) was significantly lower than PuaCO_(2)(all P<0.01),with an average difference of(-7.67±3.70)mmHg.The difference of Puv-uaO_(2) was significantly higher than those of Puv-uaCO_(2)(P<0.05).Conclusion:PuaO_(2) decreases gradually with time(heartbeat frequency)before spontaneous breathing after the delivered fetus as a newborn,and it induces the first inhalation to start spontaneous breathing when it reaches the threshold of triggering breathing.

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]