Initiation of resuscitation with high tidal volumes causes cerebral hemodynamic disturbance, brain inflammation and injury in preterm lambs.
Initiation of resuscitation with high tidal volumes causes cerebral hemodynamic disturbance, brain inflammation and injury in preterm lambs.
复制标题
DOI：
10.1371/journal.pone.0039535
复制
发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Hooper SB
中科院分区：
文献类型：
--
作者：
Polglase GR;Miller SL;Barton SK;Baburamani AA;Wong FY;Aridas JD;Gill AW;Moss TJ;Tolcos M;Kluckow M;Hooper SB
早产儿可能会在产房中无意中暴露于高潮气量 (VT)，导致肺部炎症和损伤，但人们对其对大脑的影响知之甚少。本研究的目的是比较最初 15 分钟的高 VT 复苏策略与伤害较小的复苏策略对脑血流动力学、炎症和损伤的影响。妊娠 126 天的早产羔羊在接受复苏之前进行手术器械：1）前 15 分钟的高 VT 目标为 10-12 mL/kg（n = 6）或 2）保护性复苏策略（Prot VT），包括预防性表面活性剂、20 秒持续充气和较低的初始 VT（7 mL/kg；n = 6）。随后两组均以 7 mL/kg 的 VT 进行通气。记录血气、动脉压和颈动脉血流量。使用近红外光谱法评估脑血量和氧合。收集大脑用于炎症、损伤、血管外渗、出血和氧化损伤的生化和组织学评估。使用不通风对照（UVC；n = 6）进行比较。与 Prot VT 羔羊相比，高 VT 羔羊的氧合较差，需要更多的通气支持。高VT导致最初15分钟内脑血流动力学不稳定、脑组织氧合指数不良和脑血管麻痹。虽然两种复苏策略都会增加肺部和大脑的炎症和氧化应激，但高 VT 复苏显着放大了这种效应（p = 0.014 和 p<0.001）。 60% 的高 VT 羔羊的大脑中存在明显的血管外渗，但 UVC 或 Prot VT 羔羊的大脑中没有明显的血管外渗。与 Prot VT 策略相比，高 VT 会导致更大的脑血流动力学不稳定、增加脑部炎症、氧化应激和血管外渗。开始针对 Prot VT 的复苏可能会减轻早产儿脑损伤的严重程度。
Preterm infants can be inadvertently exposed to high tidal volumes (VT) in the delivery room, causing lung inflammation and injury, but little is known about their effects on the brain. The aim of this study was to compare an initial 15 min of high VT resuscitation strategy to a less injurious resuscitation strategy on cerebral haemodynamics, inflammation and injury. Preterm lambs at 126 d gestation were surgically instrumented prior to receiving resuscitation with either: 1) High VT targeting 10–12 mL/kg for the first 15 min (n = 6) or 2) a protective resuscitation strategy (Prot VT), consisting of prophylactic surfactant, a 20 s sustained inflation and a lower initial VT (7 mL/kg; n = 6). Both groups were subsequently ventilated with a VT 7 mL/kg. Blood gases, arterial pressures and carotid blood flows were recorded. Cerebral blood volume and oxygenation were assessed using near infrared spectroscopy. The brain was collected for biochemical and histologic assessment of inflammation, injury, vascular extravasation, hemorrhage and oxidative injury. Unventilated controls (UVC; n = 6) were used for comparison. High VT lambs had worse oxygenation and required greater ventilatory support than Prot VT lambs. High VT resulted in cerebral haemodynamic instability during the initial 15 min, adverse cerebral tissue oxygenation index and cerebral vasoparalysis. While both resuscitation strategies increased lung and brain inflammation and oxidative stress, High VT resuscitation significantly amplified the effect (p = 0.014 and p<0.001). Vascular extravasation was evident in the brains of 60% of High VT lambs, but not in UVC or Prot VT lambs. High VT resulted in greater cerebral haemodynamic instability, increased brain inflammation, oxidative stress and vascular extravasation than a Prot VT strategy. The initiation of resuscitation targeting Prot VT may reduce the severity of brain injury in preterm neonates.
登录
查看更多内容
DOI：
10.1152/ajplung.00294.2010
发表时间：
2011-02-01
影响因子：
4.9
作者：
Hillman, Noah H.;Polglase, Graeme R.;Jobe, Alan H.
通讯作者：
Jobe, Alan H.
影响因子：
3.6
作者：
Polglase, Graeme R.;Hillman, Noah H.;Pillow, J. Jane
通讯作者：
Pillow, J. Jane
影响因子：
3.6
作者：
Polglase, Graeme R.;Hillman, Noah H.;Jobe, Alan H.
通讯作者：
Jobe, Alan H.
DOI：
10.1152/ajplung.2001.280.3.l527
发表时间：
2001-03-01
影响因子：
4.9
作者：
Kallapur, SG;Willet, KE;Bachurski, CJ
通讯作者：
Bachurski, CJ
影响因子：
3.3
作者：
Polglase, Graeme R.;Moss, Timothy J. M.;Hooper, Stuart B.
通讯作者：
Hooper, Stuart B.