Analysis of factors affecting placental transfer of anesthetic drugs and umbilical circulation with the delivered human-placenta perfusion model.

通过人胎盘灌注模型分析影响麻醉药物胎盘转移和脐循环的因素。

• 批准号: 07457363
• 负责人: TASHIRO Chikara
• 金额: $ 3.65万
• 依托单位: Hyogo College of Medicine
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1995
• 资助国家: 日本
• 起止时间: 1995 至 1997
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-07457363/
• 关键词: placenta; obstetric anesthesia; volatile anesthetics; solubility; oxygen delivery to fetus; cesarean section; 揮発性麻酔薬; 帝王切開; 胎盤潅流; 臍帯血流; 麻酔薬溶解度

The human-placenta perfusion study has not been completed because of two reasons : (1)only a small number of placenta were available, (2)its valiability was too short to finish the secheduled protocol. Although we will continue to do this placental model study by improving our methodology, the following two findings were driven out in our project term.1. The solubilities of various anesthetic agents into several placental perfusion solutions.The solubilities (liquid/gas partition coefficient ; lambda) of volatile anesthetics in plasma substitutes, albumin solution, fat emulsions, perfluorochemical emulsion (FC-43), and aqueous solutions. The order of magnititude of lambda value was halothane>enflurane>isoflurane>sevoflurane in all solutions except FC-43, while lambda values in four anesthetics were almost the same at 5.5. The determination method for propofol was established by using head space sampling.2. The improvement of placental oxygen transfer to the fetus during cesarean delivery.(1)Use of sevoflurane anesthesia with 100% oxygen before cesarean section was proved to improve oxygen delivery to fetus without severe fetal depression, prolonged uterine relaxation and increased blood loss.(2)5% maltose-acetated Ringer solution prior to spinal anesthesia was proved to increase fetal oxygenation with increasing the difference of P50 in hemoglobin dissociation curve between mother and baby (prevention of fetal acidosis).

人胎盘灌注研究尚未完成，原因有两个：（1）只有少量胎盘可用，（2）其有效性太短，无法完成保密协议。虽然我们将继续通过改进我们的方法来进行胎盘模型研究，但在我们的项目期间，我们得出了以下两个发现。各种麻醉剂在几种胎盘灌注液中的溶解度。挥发性麻醉剂在血浆代用品、白蛋白溶液、脂肪乳剂、全氟化学乳剂（FC-43）和水溶液中的溶解度（液/气分配系数; λ）。除FC-43外，其他所有麻醉剂的λ值大小顺序为氟烷>安氟醚>异氟醚>七氟醚，而四种麻醉剂的λ值几乎相同，均为5.5。建立了顶空进样法测定丙泊酚的含量.剖宫产时胎盘氧向胎儿转运的改善。（1）剖宫产术前使用七氟醚麻醉，100%氧气，可改善胎儿氧供，无严重的胎儿抑郁，延长子宫松弛时间，增加失血量。(2)5腰麻前应用%麦芽糖醋酸林格液可增加胎儿氧合，增加母婴血红蛋白解离曲线P50的差异（预防胎儿酸中毒）。

项目成果

Shim JC, Kaminoh Y, et al.: "Solubility of volatile.anesthetics in plasma substitutes,albumin,intravenous fat emulsions,perfluorochemical jemulsion,and aqueous solutions." Journal of Anesthesia. 10. 276-281 (1996)

Shim JC、Kaminoh Y 等人：“血浆替代品、白蛋白、静脉脂肪乳剂、全氟化学乳剂和水溶液中挥发性麻醉剂的溶解度。”

Noriko Ochiai, Chikara Tashiro, Ryu Okutani, Keiko Kinouchi, Seiji Kitamura: "Sevoflurane anesthesia wita 100% oxygen improves oxygen delivert to fetus during cesarean section." Internationa Journal of Obstetric Anaesthesia. (in press).

Noriko%20Ochiai,%20Chikara%20Tashiro,%20Ryu%20Okutani,%20Keiko%20Kinouchi,%20Seiji%20Kitamura:%20“七氟烷%20麻醉%20wita%20100%%20氧气%20改善%20氧气%20分娩%20至%20胎儿%20期间%