Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model
Carbon dioxide pneumoperitoneum induces fetal acidosis in a pregnant ewe model
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二氧化碳气腹诱发妊娠母羊模型胎儿酸中毒
DOI：
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
K. Thornburg
中科院分区：
文献类型：
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作者：
J. Hunter;L. Swanstrom;K. Thornburg
本研究的目的是评价妊娠绵羊模型中气腹对中期胎儿的生理影响。妊娠期腹腔镜胆囊切除术(LC)的效果存在争议。关于怀孕期间LC的安全性，人们主要关注的是二氧化碳肺炎对胎儿的生理后果。对8只妊娠100-120天的单胎母羊进行麻醉和插管。在母羊和胎儿体内放置颈动脉和颈内静脉导管。将两个套管针穿过母羊腹壁，在15 mm Hg压力下用CO2或N2O充气90-120分钟。术前、术中、术后每隔15分钟采集一次血流动力学和血气分析数据。在两只母羊中，试图通过过度换气来保持母体二氧化碳分压的恒定。在另外两只动物中，肺活量以5毫米汞为增量逐步增加至25毫米汞。一只胎儿在二氧化碳吸入期间死亡，但在建立侵入性监测期间，这只动物似乎生病了。胎儿呼吸性酸中毒在建立二氧化碳气体后可重复发生，但在注气前或在N2O气体下不会发生(P<；0.0001)。所有药物对血流动力学的影响都很小，但在二氧化碳吸入时，胎儿心动过速和高血压的发生率似乎比在N2O吸入时更高。基于母体二氧化碳分压图的呼吸机设置的改变导致呼吸性酸中毒的迟发和不完全纠正。尽管临床报道妊娠期间LC成功，但有CO2气腹的胎儿仍可能诱发严重的呼吸性酸中毒。在妊娠患者行腹腔镜手术时，替代气体(如N2O)或腹部悬吊装置可能比二氧化碳更可取。
The objective of this study was to evaluate the physiologic consequences of a pneumoperitoneum (pneumo) to the midterm fetus in a pregnant sheep model. The performance of laparoscopic cholecystectomy (LC) during pregnancy is controversial. The primary concern regarding the safety of LC during pregnancy is the physiologic consequences of the CO2 pneumo to the fetus. Eight ewes with singlet pregnancies between 100 and 120 days of gestation were anesthetized and intubated. Carotid artery and internal jugular catheters were placed in the ewe and in the fetus. Two trocars were placed through the abdominal wall of the ewe and the abdomen was inflated with CO2 or N2O at 15 mmHg pressure for 90–120 min. Hemodynamic and blood gas data were obtained every 15 min before, during, and after the pneumo. In two ewes attempts were made to keep maternal Pco2 constant with hyperventilation. In two other animals the pneumo was increased stepwise in five mmHg increments to 25 mmHg. One fetus succumbed during the CO2 pneumo, but this animal appeared to be ill during the establishment of invasive monitoring. Fetal respiratory acidosis occurred, reproducibly, after establishment of CO2 pneumo but did not occur before insufflation or under N2O pneumo (P<0.0001). Hemodynamic changes were minimal with all agents but it appeared that there a was greater prevalence of fetal tachycardia and hypertension during CO2 pneumo than during N2O pneumo. Alterations in ventilator settings based on maternal capnography resulted in late and incomplete correction of respiratory acidosis. Despite clinical reports of successful LC during pregnancy, significant respiratory acidosis may be induced in the fetus with CO2 pneumo. Alternative gases (e.g., N2O) or abdominal suspension devices may be preferable to CO2 when performing laparoscopy in pregnant patients.
妊娠晚期胎羊的慢性低氧血症会增加最大心肌血流量。
DOI：
10.1152/ajpheart.1992.263.4.h1327
发表时间：
1992
期刊：
The American journal of physiology
影响因子：
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作者：
Reller,MD;Morton,MJ;Giraud,GD;Wu,DE;Thornburg,KL
通讯作者：
Thornburg,KL