对患有膈疝的羔羊来说,基于生理学的脐带钳夹术对心肺功能的益处可持续至少 8 小时。

IF 2.1 3区 医学 Q2 PEDIATRICS Frontiers in Pediatrics Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI:10.3389/fped.2024.1451497
Paige J Riddington, Philip L J DeKoninck, Marta Thio, Calum T Roberts, Risha Bhatia, Janneke Dekker, Aidan J Kashyap, Benjamin J Amberg, Karyn A Rodgers, Alison M Thiel, Ilias Nitsos, Valerie A Zahra, Ryan J Hodges, Stuart B Hooper, Kelly J Crossley
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引用次数: 0

摘要

导言患有先天性膈疝的婴儿出生后会出现严重的呼吸功能不全和肺动脉高压。在去除胎盘支持前给肺部通气(生理脐带夹闭,PBCC)可增加膈疝(DH)羔羊的肺血流量(PBF)并降低肺血管阻力(PVR)。我们假设,PBCC 的这些益处至少会在出生后 8 小时内持续存在:方法:21 只妊娠 138 天(dGA)的左侧膈疝(86 dGA)羔羊通过剖腹产分娩。脐带在通气开始前夹闭(立即夹闭脐带,ICC,n = 9)或在潮气量达到 4 毫升/千克后夹闭,最长延迟 10 分钟(PBCC,n = 12)。羔羊通气时间为 8 小时,最初使用常规机械通气,但在 30 分钟后根据需要改用高频振荡通气。在整个研究过程中测量了通气参数、心肺生理学和动脉血气:结果:通气开始后,两组羔羊的 PBF 都有所增加,8 h 时,PBCC DH 组羔羊的 PBF 高于 ICC DH 组羔羊(5.2 ± 1.2 vs. 1.9 ± 0.3 ml/min/g;p p = 0.003),PBCC DH 组羔羊的 PVR 显著低于 ICC DH 组羔羊(p = 0.0002)。PBCC(58%)和ICC(55%)羔羊的气胸发生率都很高,导致8小时的样本量减少(ICC n = 4,PBCC n = 4):结论:与 ICC 相比,PBCC 可增加 DH 羔羊的 PBF 并降低 PVR,其效果在通气开始后至少持续 8 小时。
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The cardiopulmonary benefits of physiologically based cord clamping persist for at least 8 hours in lambs with a diaphragmatic hernia.

Introduction: Infants with congenital diaphragmatic hernia can suffer severe respiratory insufficiency and pulmonary hypertension after birth. Aerating the lungs before removing placental support (physiologically based cord clamping, PBCC) increases pulmonary blood flow (PBF) and reduces pulmonary vascular resistance (PVR) in lambs with a diaphragmatic hernia (DH). We hypothesized that these benefits of PBCC persist for at least 8 h after birth.

Methods: At ∼138 days of gestation age (dGA), 21 lambs with a surgically induced left-sided DH (∼86 dGA) were delivered via cesarean section. The umbilical cord was clamped either before ventilation onset (immediate cord clamping, ICC, n = 9) or after achieving a tidal volume of 4 ml/kg, with a maximum delay of 10 min (PBCC, n = 12). The lambs were ventilated for 8 h, initially with conventional mechanical ventilation, but were switched to high-frequency oscillatory ventilation after 30 min if required. Ventilatory parameters, cardiopulmonary physiology, and arterial blood gases were measured throughout the study.

Results: PBF increased after ventilation onset in both groups and was higher in the PBCC DH lambs than the ICC DH lambs at 8 h (5.2 ± 1.2 vs. 1.9 ± 0.3 ml/min/g; p < 0.05). Measured over the entire 8-h ventilation period, PBF was significantly greater (p = 0.003) and PVR was significantly lower (p = 0.0002) in the PBCC DH lambs compared to the ICC DH lambs. A high incidence of pneumothoraces in both the PBCC (58%) and ICC (55%) lambs contributed to a reduced sample size at 8 h (ICC n = 4 and PBCC n = 4).

Conclusion: Compared with ICC, PBCC increased PBF and reduced PVR in DH lambs and the effects were sustained for at least 8 h after ventilation onset.

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来源期刊
Frontiers in Pediatrics
Frontiers in Pediatrics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
3.60
自引率
7.70%
发文量
2132
审稿时长
14 weeks
期刊介绍: Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.
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