孕羊羊水栓塞后血液动力学、呼吸的改变

目的:研究羊水栓塞对血液动力学、呼吸的影响。方法:健康孕晚期山羊16只,根据注入液体性质不同随机分为4组:原羊水组(AF组),胎粪污染羊水组(MAF组),过滤羊水组(FAF组),生理盐水对照组(NS组),每组4只。于液体注入前、注入后即刻、10、30、60、90、180min采集血液动力学、呼吸指标及心电图检查,呼吸频率由专人用听诊器听取获得。结果:注入生理盐水后血液动力学指标有一过性改变,但无统计学意义(P>0.05)。注入羊水后,孕羊动脉收缩压、舒张压、平均动脉压下降,肺动脉压、肺毛细血管楔压、中心静脉压升高,胎粪组改变最明显(P<0.05),原羊水组与过滤羊水组无显著差异,血压改变以羊水注入后10min最明显,多数30min内恢复正常,部分肺动脉压在60min后恢复。孕羊心率和呼吸增快,但与生理盐水组的差异无统计学意义(P>0.05)。胎粪组中有两只孕羊出现左心衰,其余组未见左心衰。结论:注入羊水后,体循环血压明显下降,肺循环压及中心静脉压明显升高,且是一过性的。注入的羊水是否过滤处理,对孕羊血液动力学的影响无明显差异。

Hemodynamic and respiratory effects of amniotic fluid embolism in the pregnant goats

Objective:To explore hemodynamic and respiratory effects of amniotic fluid embolism in the pregnant goats.Methods:Sixteen pregnant goats(Capra hircus)in the third trimeste pregnancy were divided into four groups randomly(n=4 for each group):control group(normal saline group,NS),raw amniotic fluid group(AF),filtered amniotic fluid group(FAF),meconium-stained amniotic fluid group(MAF).Hemodynamic and electrocardiogram measurements were repeated before fluid infusion and at once,10,30,60,90,and 180 minutes after infusion.Respiratory rate was collected by auscultation at the same time.Results :There were transient hemodynamic changes after normal sodium solution infusion,but had no significant(P>0.05).Significant increases in the central venous pressure,pulmonary artery pressure,and pulmonary capillary wedge pressure with concurrent fall in mean arterial pressure,systolic blood pressure and diastolic blood pressure after amniotic fluid infusion were observed.The changes seen in meconium-stain amniotic fluid group were significantly greater than those in the other groups(P<0.05).The hemodynamic changes were similar with raw and filtered amniotic fluid.These changes,in most instances,returned to normal within 30 minutes of the amniotic fluid embolism.The pulmonary artery pressure did occasionally take up to 60 minutes to normalize to the pre-injection levels.Elevated heat and respiratory rate were noted,but had no significance in contrast to NS control group(P>0.05).No significant effects were observed on cardiac or respiratory function except in the meconium group,in which transient left ventricular dysfunction had happened.Conclusion:The Capra hircus model is ideal model for the further study of amniotic fluid embolism.After the infusion of amniotic fluid,there has significant increase in the central venous pressure and pulmonary circulation,along with decrease in system circulation pressure,but these changes are transient.The effects are not altered whether the amniotic fluid is filtered or not.