Fetal model of single ventricle physiology: hemodynamic effects of oxygen, nitric oxide, carbon dioxide, and hypoxia in the early postnatal period.
Fetal model of single ventricle physiology: hemodynamic effects of oxygen, nitric oxide, carbon dioxide, and hypoxia in the early postnatal period.
复制标题
单心室生理学胎儿模型：产后早期氧气、一氧化氮、二氧化碳和缺氧的血流动力学影响。
DOI：
10.1016/s0022-5223(96)70272-6
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Hanley,FL
中科院分区：
文献类型：
--
作者：
Reddy,VM;Liddicoat,JR;Fineman,JR;McElhinney,DB;Klein,JR;Hanley,FL
背景在单心室生理学的患者中，并行的体循环和肺循环的流量分布在很大程度上取决于各自血管床中的相对阻力。虽然新生儿姑息治疗单心室患者已变得越来越普遍，围产期和围手术期的医疗管理往往主要是基于个人和机构的经验，是复杂的过渡到出生后的生活和心肺转流的影响。缺乏一个动物模型，适当地模仿单心室生理学阻碍了在这方面的进展。目前的研究的目的是调查呼吸操作对肺血流动力学的影响，在新生儿早期在一个可重复的模型，单心室生理学创建在utero.MethodsA 10 mm Damus-Kaye-Stansel肺动脉吻合术在胎羊（n = 14）。孕140 ± 1.2天，结扎主肺动脉远端，经5 mm肺动脉-肺动脉分流管提供肺血流。在足月分娩后2至3天，羔羊（n = 11）进行开放性胸骨切开术和深低温停循环30分钟。无论是之前和之后的旁路，呼吸操作，包括管理一氧化氮（80 ppm），100%的氧气，10%的氧气，和5%的二氧化碳，进行和血液动力学变量measured. ResultsNO和氧气引起的肺血管阻力下降和肺/体循环血流量比的增加，无论是之前和之后的旁路。缺氧和二氧化碳产生了显着上升，肺血管阻力和显着下降的比率，肺，体循环bloodflow.ConclusionsOxygen，一氧化氮，和二氧化碳都似乎是有用的手段操纵肺血管阻力和肺/体循环血流量比在新生羔羊与单心室生理，但需要进一步研究以了解它们的剂量反应效应和延长给药的效应。（《胸血管外科杂志》1996;112：437-49）
BackgroundIn patients with single ventricle physiology, the distribution of flow to the systemic and pulmonary circulations, which are in parallel, largely depends on the relative resistances in the respective vascular beds. Although neonatal palliation in patients with single ventricle physiology has become more common, medical management during the perinatal and perioperative periods is often based primarily on personal and institutional experience and is complicated by the transition to postnatal life and the effects of cardiopulmonary bypass. The lack of an animal model that suitably mimics single ventricle physiology has impeded progress in this area.ObjectiveThe purpose of the current study was to investigate the effects of respiratory manipulations on pulmonary hemodynamics in the early neonatal period in a reproducible model of single ventricle physiology created in utero.MethodsA 10 mm Damus-Kaye-Stansel aortopulmonary anastomosis was created in fetal sheep (n = 14) at 140 ± 1.2 days' gestation, with pulmonary blood flow provided through a 5 mm aortopulmonary shunt after ligation of the main pulmonary artery distally. Two to 3 days after delivery at term, lambs (n = 11) underwent an open sternotomy and 30 minutes of deep hypothermic circulatory arrest. Both before and after bypass, respiratory manipulations, including administration of nitric oxide (80 ppm), 100% oxygen, 10% oxygen, and 5% carbon dioxide, were performed and hemodynamic variables were measured.ResultsNitric oxide and oxygen caused a decrease in pulmonary vascular resistance and an increase in the pulmonary/systemic blood flow ratio, both before and after bypass. Hypoxia and carbon dioxide produced a significant rise in pulmonary vascular resistance and a significant drop in the ratio of pulmonary to systemic blood flow.ConclusionsOxygen, nitric oxide, and carbon dioxide all appear to be useful means of manipulating pulmonary vascular resistance and pulmonary/systemic blood flow ratio in neonatal lambs with single ventricle physiology, but further investigation is necessary to understand their dose responsive effects and the effects of prolonged administration. (J Thorac Cardiovasc Surg 1996;112:437-49)