椎管内阻滞对子痫前期孕鼠内皮细胞糖萼及分娩结局的影响

 目的 探讨椎管内阻滞对子痫前期孕鼠的围产期炎症反应、内皮细胞糖萼脱落及分娩结局的影响。方法 选择SPF级SD雌性大鼠20只，8~12周龄，建立子痫前期孕鼠的动物模型，随机分为生理盐水组（N组，n=10）和鞘内置管组（I组，n=10）。N组孕鼠皮下注射生理盐水，I组孕鼠经鞘内导管注入0.75%布比卡因40 μL，每8 h重复一次，直至仔鼠娩出。使用ELISA法在不同时间点测定两组的糖萼标志物黏结蛋白聚糖-1（syndecan-1）、硫酸乙酰肝素（heparan sulfate，HS）、高迁移率族蛋白（high mobility group box-1，HMGB-1）、肿瘤坏死因子α（tumor necrosis factorα，TNF-α）水平，测量收缩压（systolic blood pressure，SBP）和24 h尿蛋白定量，记录分娩结局。结果 I组中1只孕鼠在注射布比卡因后死亡，其余19只孕鼠纳入研究。妊娠第16天和第19天，N组syndecan-1（P<0.001，P=0.001）、HS （P<0.001，P=0.001）、HMGB-1（P<0.001，P=0.001）及TNF-α（P=0.025，0.006）水平均显著高于I组。N组顺产率显著低于I组（P=0.018），而N组与I组的剖宫产率和流产率差异均无统计学意义，N组异常仔鼠的发生率显著高于I组（P<0.001），N组仔鼠体质量显著低于I组（P<0.001）。第19天，N组SBP水平显著高于I组（P<0.001）。结论 椎管内阻滞可以减弱子痫前期孕鼠的糖萼损伤和炎症反应，降低血压并改善分娩结局。

Effect of neuraxial block on endothelial glycocalyx and obstetrics consequences of pregnant mice with preeclampsia

Objective To evaluate the treatment effects of neuraxial block on inflammation,endothelial glycocalyx and obstetrics consequences in pregnant mice with preeclampsia. Methods Twenty female SD rats aged 8-12 weeks were selected.After the establishment of the animal model of pre-eclampsia pregnant mice,pregnant mice were randomly divided into normal saline group (group N,n=10) and intrathecal tube group (group I,n=10).Normal saline was injected subcutaneously in group N,0.75% bupivacaine 40 μL was injected through intrathecal tube every 8 h until the neonatal rats were delivered in group I.The outcomes included levels of syndecan-1,heparan sulfate (HS),high mobility group box-1 (HMGB-1),tumor necrosis factor α (TNF-α),systolic blood pressure (SBP),proteinuria for 24 h and obstetricsconsequences. Results One pregnant rat died after being injected with bupivacaine in group I,so a total of 19 pregnant mice were included in this study.The levels of Syndecan-1 (P<0.001,P=0.001),HS (P<0.001,P=0.001),HMGB-1 (P<0.001,P=0.001) and TNF-α (P=0.025,P=0.006) in group N at 16 d and 19 d were significantly higher than that in group I,respectively.The rate of natural birth in group N was significantly lower than that in group I (P=0.018).However,there was no statistically significant differences in cesarean section rate and abortion rate between the two groups.The incidence of abnormal neonatal rats in group N was significantly higher than that in group I (P<0.001),and the weight of neonatal rats in group N was significantly lower than that in group I (P<0.001).SBP level of group N at 19 d was significantly higher than that of group I (P<0.001). Conclusions Neuraxial block can reduce endothelial glycocalyx damage and inflammation,lower blood pressure and improve obstetric outcomes in preeclampsia pregnant rats.