宫内心脏介入术中胎羊应激反应研究

Stress reaction of fetal lamb under intrauterine cardiac intervention

目的研究宫内胎羊心脏介入手术中胎羊的应激反应。方法9头中晚期双胎孕羊,术中监测胎羊心率、血气、血乳酸和血糖,测定介入操作前、后胎羊/新生羊儿茶酚胺、皮质醇及胰岛素水平;胎羊/新生羊肝脏组织HE及PAS染色。结果胎羊心脏介入术中胎心率、血气值与术前无差别,但出现代谢性酸中毒,血乳酸增加(P<0.05);胎羊儿茶酚胺、皮质醇和血糖含量增高(P均<0.01),胰岛素含量无明显变化。肝糖原PAS染色显示行介入手术的胎羊较对照胎羊肝糖原消耗明显。产后新生羊血糖、儿茶酚胺及皮质醇水平恢复正常,肝糖原PAS染色显示肝脏糖原恢复。结论胎羊心脏介入手术中胎羊存在一定程度的应激反应,可能导致机体器官可逆性病理改变。

Objective To explore the stress reaction of fetal lamb under intrauterine cardiac intervention. Methods Nine bigeminal pregnant ewes （between 101 and 127 days of the gestation age） underwent fetal cardiac intervention. The heart rate, blood gas value, serum lactic acid and glucose levels were monitored in the fetal lamb during the procedure, and the levels of serum catecholamine, cortisol and insulin were determined pre-procedure, after-procedure and in newborn lambs. HE and PAS staining were made for the fetal/neonatal hepatic tissue. Results There were no significant changes in fetal heart rate, blood gas value before and during intervention, but metabolic acidosis was detected with markedly increased serum lactic acid during intervention （P 〈 0.05）. The serum catecholamine, cortisol, and glucose increased significantly （P 〈 0.01 ） , while no significant change of serum insulin level was found. PAS staining showed a great consumption of hepatic glycogen during fetal cardiac intervention. However, the levels of serum glucose, catecholamine and eortisol all returned to normal, and PAS staining of the hepatic glycogen also recovered in neonatal lamb after birth. Conclusions Moderate stress reaction may occur during fetal cardiac intervention that may induce reversible pathological changes of body organs.