宫内主动脉瓣球囊成形术对胎羊及新生羊生长发育的影响

Impact of intrauterine balloon aortic valvuloplasty on growth and development in fetal and newborn lambs

目的研究宫内心脏介^手术对胎羊及新生羊生长发育的影响，以及孕羊应用吲哚美辛对胎羊的影响。方法选择50只双胎妊娠的中晚期孕羊，随机分为吲哚美辛孕羊组（24只）及对照孕羊组（26只），吲哚美辛孕羊组于手术前5d至术后7d给予吲哚美辛1．5-2mg／（kg·d）口服，对照孕羊组给予安慰剂。全部孕羊均行胎羊宫内心脏介入手术，孕羊麻醉后在超声引导下选择合适部位，经皮／子宫穿刺胎羊心前区胸壁后进入左心室，其中妊娠双胎之一为心脏介入胎羊，另一为对照胎羊，以手术成功、孕羊及胎羊存活为手术技术成功，孕羊继续妊娠至分娩。于手术时、手术后每周B超测量胎羊的心脏横径、主动脉内径、双顶径、股骨径；足月分娩新生羊生后每天测量体质量、身长、体高、胸围。结果共有32只孕羊的手术技术成功，其中吲哚美辛孕羊组的手术技术成功率为66．7％，对照孕羊组为61．5％，两组间差异无统计学意义（P〉0．05）。选择吲哚美辛孕羊组及对照孕羊组各8只，共16只孕羊继续观察至分娩。11只孕羊足月分娩，娩出胎羊22只，其中吲哚美辛孕羊组7只，对照孕羊组4只，两组孕羊的足月分娩率差异无统计学意义（x^2=2．62，P〉0.05）。各组胎羊在官内的心脏横径、主动脉内径、双顶径、股骨径及新生羊出生时至生后14d的体质量、身长、体高、胸围差异均无统计学意义。结论宫内心脏介入手术后，孕羊能够继续妊娠至足月分娩，手术对胎羊、新生羊的生长发育无明显不良影响，孕羊长期应用吲哚美辛对胎羊生长发育无明显影响。

Objective To investigate the effect of intrauterine cardiac intervention on growth and development in fetal and newborn lambs, and the effect of indometacin on growth and development in fetal lamb. Methods Fifty pregnant goats with twin gestation were selected and divided into indometacin group （24 goats） and control group （26 goats） randomly. Indo- metacin group was fed with 1.5-2 mg/（kg·d） indomethacin during the period of 5 days before and 7 days after surgery, placebo was given to control group. Intrauterine cardiac intervention was performed to all the pregnant goats under ultrasound gui- dance after anesthesia. The puncture needle was inserted through the maternal abdominal wall, across the uterine wall and into the left ventricle via the precordium chest wall. One fetus of the twins from each pregnant goat was taken as the intervention group, and the other served as the control group. A technically successful aortic valvuloplasty was defined as those with suc- cessful operation, survival of pregnant goat, and viable fetal lambs at the end of observation. Goats continued gestation until spontaneous delivery. Transverse cardiac diameter, aortic dimension, biparietal diameter and femur length were measured weekly after operation and before delivery. Weight, length, height and chest circumference of newborn lambs were measured daily. Results Technically successful aortic valvuloplasty was achieved in 32 pregnant goats in both groups. Of them, 66.7% （16/24） was successful in the indometacin group and 61.5% （16/26） in the control group. There was no significant difference between the two groups （P〉0.05）. Eight goats were selected in the indometacin group and in the control group each. The 16 goats were observed until delivery. Eleven goats had a full-term pregnancy and gave birth to 22 newborn lambs. Seven of 11 goats were from indometacin group, Four from control group and there was no statistical difference in full-term delivery rate between the two groups. The data of transverse cardiac diameter, aortic dimension, biparietal diameter and femur length in different groups of fetal lambs were compared and no significant difference was found among groups （F〉0.05）. Weight, length, height and chest circumference of newborn lambs with a full-term delivery were compared from the first day to the 14th day after birth, there were no significant differences between the two groups in each aspect and point, either （P〉0.05）. Conclu- sions After intrauterine cardiac intervention, the pregnant goat could survive until full-term delivery. The procedure may not have an adverse effect on the growth and development in the fetal and newborn lamb. Indometacin, which was administered to the pregnant goat may not affect the growth and development of fetal lambs.