Maternal insufflation during the second trimester equivalent produces hypercapnia, acidosis, and prolonged hypoxia in fetal sheep.
Maternal insufflation during the second trimester equivalent produces hypercapnia, acidosis, and prolonged hypoxia in fetal sheep.
复制标题
妊娠中期期间母体充气会导致胎羊出现高碳酸血症、酸中毒和长时间缺氧。
DOI：
10.1097/00000542-200412000-00013
复制
发表时间：
2004
期刊：
影响因子：
8.8
通讯作者：
Reynolds,JamesD
中科院分区：
文献类型：
--
作者：
Uemura,Kenichiro;McClaine,RebeccaJ;delaFuente,SebastianG;Manson,RobertoJ;Campbell,KurtA;McClaine,DeborahJ;White,WilliamD;Stamler,JonathanS;Eubanks,WSteve;Reynolds,JamesD
BackgroundAnecdotal报告表明，第二个三个月是最安全的时间进行腹腔镜手术对怀孕的病人，但这种假设还没有被测试experienced.MethodsPreviously仪器早产羊（总n= 8）在妊娠第90天（任期，145天）被麻醉，然后吹入二氧化碳60分钟，在15毫米汞柱的压力。心血管参数被连续记录，而血气状态被确定之前，并在15分钟的时间间隔期间和长达2小时后insufflation.ResultsInsufflation产生最小的产妇血气或心血管的变化，除了子宫血流量显着减少。灌注减少增加了胎儿动脉血二氧化碳分压，降低了胎儿pH值、氧饱和度和氧含量;还有进行性胎儿低血压和心动过缓。人工放气后，子宫血流恢复正常，胎儿二氧化碳分压和pH值的变化在1小时内解决。然而，胎儿氧饱和度和内容仍然压抑，胎儿心血管状态继续下降，在2小时postinsufflation monitoringperiod.ConclusionPrevious studies with near-term sheep determined that CO2 pneumocarnitus produces respiratory acidosis but does not decrease fetal oxygenation.相反，目前的研究结果表明，在早产胎儿中，吹入诱导的高碳酸血症和酸中毒伴随着长时间的胎儿缺氧和心血管抑制。这一结果表明，应进行额外的工作，以确认在孕中期进行微创手术的假定安全性。
BackgroundAnecdotal reports suggest that the second trimester is the safest time to conduct a laparoscopic procedure on a pregnant patient, but this supposition has not been tested empirically.MethodsPreviously instrumented preterm sheep (total n= 8) at gestational day 90 (term, 145 days) were anesthetized and then insufflated with carbon dioxide for 60 min at a pressure of 15 mmHg. Cardiovascular parameters were continuously recorded while blood gas status was determined before and at 15-min intervals during and up to 2 h after insufflation.ResultsInsufflation produced minimal maternal blood gas or cardiovascular changes except for a significant reduction in uterine blood flow. The decrease in perfusion increased fetal arterial blood partial pressure of carbon dioxide and decreased fetal pH, oxygen saturation, and oxygen content; there was also progressive fetal hypotension and bradycardia. After manually deflating the ewe, uterine blood flow returned to normal, and the fetal partial pressure of carbon dioxide and pH changes resolved within 1 h. However, fetal oxygen saturation and content remained depressed, and fetal cardiovascular status continued to decline during the 2-h postinsufflation monitoring period.ConclusionPrevious studies with near-term sheep determined that carbon dioxide pneumoperitoneum produces respiratory acidosis but does not decrease fetal oxygenation. In contrast, the current findings indicate that in the preterm fetus, insufflation-induced hypercapnia and acidosis are accompanied by prolonged fetal hypoxia and cardiovascular depression. This result suggests that additional work should be conducted to confirm the presumed safety of conducting minimally invasive procedures during the second trimester.