宫内主动脉瓣球囊成形术对胎羊血流动力学的影响

Hemodynamic and growth effect of indomethacin on fetal goat model of intrauterine balloon aortic valvuloplasty

目的 研究吲哚美辛对宫内主动脉瓣球囊成形术（IU BAV）胎羊血流动力学变化、胎羊生长发育及孕羊妊娠结局的影响.方法 40只妊娠106～124 d双胎孕羊及其胎羊为研究对象,建立IUBAV胎羊模型.根据干预措施实施情况,40只孕羊采用简单随机法分为干预对照组（淀粉安慰剂,20例）及干预组（吲哚美辛,20例）.再根据IUBAV实施情况,80只胎羊分为4组.A1组：孕羊安慰剂＋胎羊手术对照;A2组：孕羊安慰剂＋胎羊IUBAV;B1组：孕羊吲哚美辛＋胎羊手术对照;B2组：孕羊吲哚美辛＋胎羊IUBAV,每组各20只.研究IUBAV术后孕羊足月产率、胎羊心率、胎龄（GD）、双顶径（BPD）、主动脉瓣环直径（AD）、脐动脉/主动脉收缩期血流峰速与舒张末期血流速度的比值（S/D）、动脉导管直径及经动脉导管血流峰速及血流频谱、足月新生羊体质量及红细胞比容,并比较各组间指标的变化.结果 吲哚美辛使用后,孕羊早产率由使用前的50.00％下降到8.33％.IUBAV术后脐动脉/主动脉的S/D增加,术后3d逐渐恢复正常,组间差异有统计学意义（P＜0.05）;吲哚美辛使用后,胎羊心率、S/D波动受到一定程度保护性抑制.吲哚美辛使用后,各组胎羊动脉导管直径、经动脉导管血流峰速组间差异均无统计学意义（P均＞0.05）,血流频谱形态正常.IUBAV术后各组胎羊双顶径及主动脉瓣环直径、足月新生羊体质量及红细胞压积组间差异均无统计学意义（P均＞0.05）.结论 吲哚美辛可以改善IUBAV术后孕羊妊娠结局,对手术导致的胎羊血流动力学变化有保护作用,且不会造成胎羊动脉导管收缩、宫内发育迟滞等,是宫内心脏介入手术有效的保护措施.

Objective To investigate the fetal hemodynamic and growth effect,maternal pregnant outcome of indomethacin on pregnant goat model of intrauterine balloon aortic valvuloplasty（IUBAV）.Methods Forty twin pregnant goats（106-124 gestational days,term：150 days） were designed as the research objects and IUBAV model was established.According to whether adopting indomethacin to pregnant goat,40 pregnant goats were randomly divided into control group（placebo to pregnant goat,n =20） and indomethacin group（feeding indomethacin to pregnant goat,n =20）.According to the IUBAV and indomethacin administration,80 fetal sheep were then enrolled into 4 groups.A1 group：maternal placebo ＋ fetal control,A2 group：placebo ＋ fetal IUBAV,Bl group：maternal indomethacin ＋ fetal control,B2 group：maternal indomethacin ＋ fetal IUBAV.Following parameters were included and statistical analysis was done among different groups,which included fetal heart rate,biparietal diameter,aortic annulus diameter,umbilicaL/aortic systolic peak velocity and the end diastolic velocity ratio（S/D）,the diameter of the ductus arteriosus and peak velocity and flow pattern of trans ductus blood flow,body weight and hematocrit of full-term newborn goats.Results After indomethacin adopting,the post-procedure preterm birth rate of pregnant goats was decreased from 50.00％ to 8.33％.Fetal heart rate and umbilical/aortic S/D increased post-procedure,and gradually recovered to 3-day post-procedure,and there existed significant statistical differences among the groups （P ＜ 0.05）.After indomethacin administration,protective inhibition effects were displayed on the fluctuation degree of umbilical/aortic S/D（P ＜ 0.05）.In all groups,the diameter of the fetal ductus arteriosus,peak velocity and flow pattern of transarterial ductus blood flow were revealed to be stable and there was no significant difference （P ＞ 0.05） after indomethacin administration.After IUBAV,there was no significant difference among all groups in fetal biparietal diameter,aortic annular diameter,body weight and hematocrit of full-term newborn goats（P ＞0.05）.Conclusions Indomethacin can improve post-IUBAV pregnancy outcome of pregnant ewes,provide protective inhibition effects on hemodynamic changes to fetal goats,and could avoid fetal ductus constriction,intrauterine growth retardation,which is proved to be an effective protective measure of fetal cardiac intervention.