CARDIOVASCULAR EFFECTS OF PATENT DUCTUS-ARTERIOSUS IN PRETERM LAMBS WITH RESPIRATORY-DISTRESS
CARDIOVASCULAR EFFECTS OF PATENT DUCTUS-ARTERIOSUS IN PRETERM LAMBS WITH RESPIRATORY-DISTRESS
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DOI：
10.1016/s0022-3476(87)80126-9
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发表时间：
1987-10-01
影响因子：
5.1
通讯作者：
ROMAN, C
中科院分区：
文献类型：
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作者：
CLYMAN, RI;MAURAY, F;ROMAN, C
我们创建了一个模型来研究动脉导管未闭（PDA）对患有呼吸窘迫的早产羔羊的心血管和肺部影响。在47只妊娠129至133天（足月，145天）的胎羊中，我们用福尔马林浸润动脉导管，并在其周围放置机械封堵器，以便调节其通畅性。两天后，羊羔被送来，给绵羊表面活性剂，麻痹，他们的肺机械通气。这些早产的羔羊可以增加一倍以上的左心室输出时，挑战与增加程度的左向右分流通过PDA。这是通过增加每搏输出量而不是增加心率来实现的。在40分钟的观察期内，当导管通畅时，动态顺应性或功能性残余容量没有变化。当导管通畅时，动脉PaO2显著增加（即使有小的左向右分流），PaCO2降低（有大分流）。尽管心脏有能力处理PDA增加的容积负荷，但由于灌注压降低和局部血管收缩的共同作用，单个器官的血流发生了显著变化。腹部器官的血流量显着减少，即使有小的PDA分流。器官血流量的减少可以解释早产儿PDA的某些病理生理学表现。
We created a model for studying the cardiovascular and pulmonary effects of patent ductus arteriosus (PDA) in premature lambs with respiratory distress. In 47 fetal lambs at 129 to 133 days gestation (term, 145 days), we infiltrated the ductus arteriosus with formalin and placed a mechanical occluder about it so that its patency could be regulated. Two days later the lambs were delivered, given sheep surfactant, paralyzed, and their lungs mechanically ventilated. These premature lambs could more than double their left ventricular output when challenged with increasing degrees of left-to-right shunts through the PDA. This was accomplished by an increase in stroke volume, not by an increase in heart rate. During the 40-minute observation period, there was no change in dynamic compliance or functional residual capacity while the ductus was patent. When the ductus was patent, there was a significant increase in arterial PaO2 (even with small left-to-right shunts) and a decrease in PaCO2 (with large shunts). Despite the heart''s ability to handle the increased volume load of a PDA, there were significant alterations in individual organ blood flows, resulting from a combination of decreased perfusion pressure and localized vasoconstriction. The abdominal organs had significant reductions in blood flow even with small PDA shunts. This decrease in organ blood flow may explain some of the pathophysiologic manifestations of PDA in preterm infants.