胎羊炎症反应综合征静脉导管血流动力学变化与炎性介质关系的研究

目的 探讨胎羊内注射内毒素(LPS)后的静脉导管血流动力学变化及其与胎羊炎性介质变化的关系.方法 10只中晚孕山羊分为两组(实验组和对照组各5只),实验组于妊娠120～130 d行超声引导下胎羊脐静脉或脐-门静脉窦穿刺术,注射LPS(Escherichia coli O111:B5;L1885)约10μg/kg胎羊质量,对照组注射等量生理盐水.并分别于注射LPS前(0.5 h)、注射LPS后1 h、3 h、6 h应用彩色多普勒血流显像检测静脉导管血流频谱变化.同时抽取脐静脉血,用ELISA方法检测TNF-α、IL-6含量,并评价TNF-α、IL-6与静脉导管血流参数之间的相关性.结果 实验组给药后静脉导管搏动指数(DVPI)、心室收缩期峰值速度(S)、心室舒张期峰值流速(D)、血流量(DVQ)、静脉导管指数(DVI)、心室收缩期峰值速度/心房收缩期峰值流速(S/A)、(S-A)/D随给药时间升高,并且高于对照组(均P＜0.05);心房收缩期峰值流速(A波)下降,并且低于对照组(P＜0.05);静脉导管峡部的内径(DVD)无明显变化.实验组DVPI与血清IL-6、TNF-α呈正相关(P均＜0.05);实验组A波值与血清IL-6、TNF-α呈负相关(均P＜0.05);S波、DVI、D波、DVQ、S/A、(S-A)/D与血清IL-6呈正相关(均P＜0.05),与TNF-α无明显相关(均P＞0.05);静脉导管峡部内径与血清IL-6、TNF-α均无明显相关.结论 DVPI、A值可能成为预测胎儿全身炎症反应综合征简便而有效的指标.

Relationship between hemodynamics changes of ductus venosus and inflammatory cytokines in the ovine fetus with systemic inflammatory response syndrome

Objective To study the hemodynamic characteristics of ductus venosus,and its relationship to inflammatory cytokines in ovine fetus with systemic inflammatory response syndrome.Methods Ten near-term fetal sheep radomly divided into two groups.Five of them were in experimental group,and five of them were in control group.All of the animals underwent abdominal cordocentesis guided by ultrasound at the term of 120-130 days,with a LPS injection at a dosage of 10 μg/kg of fetal weight in experimental group,and the same quantity of 0.9% NaCl solution in control.Doppler echocardiography were performed to determine hemodynamics changes of ductus venosus at 0.5 hour before the LPS injection,and at 1 hour,3 hours,6 hours after LPS injection.Meanwhile,fetal umbilical vein blood was sampled for ELISA essay of serum TNF-α and IL-6 at each of the above time points.Results In experimental group,the ductus venosus waveform PI values(DVPI),maximum velocity during cardiac ventricle systole(S)and during cardiac ventricle diastole(D),ductus venosus index(DVI),ductus venosus blood flow(DVQ),the ratio of S and ductus venous maximum velocity during atrial contracton(S/A),(S-A)/D increased with the time after LPS injection,and still significantly increased as compared with the control animals(all P＜0.05).A decreased with the time after LPS injection,and still significantly changed as compared with the controls(P＜0.05).And the ductus venosus diameter(DVD)had not obvious change(P＞0.05).There were significantly positive correlations between DVPI and TNF-α,IL-6(all P＜0.05),negative corelations between A and TNF-α,IL-6(all P＜0.05),and positive correlations between S wave,DVI,DVQ,D wave,S/A,(S-A)/D and IL-6(all P＜0.05),but not obvious relationships between S wave,DVI,DVQ,D wave,S/A,(S-A)/D and TNF-a(all P＞0.05).Condusions DVPI and A might be easy and useful quantitative parameters in the evaluation of fetal systemic inflammatory respome syndrome with LPS injection.