Kapur P, Holm B A, Irish M S, Sokolowski J, Patel A, Glick P L
The Buffalo Institute of Fetal Therapy, Children's Hospital of Buffalo, and the Department of Pediatric Surgery, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, 14222, USA.
J Pediatr Surg. 1999 Feb;34(2):354-6. doi: 10.1016/s0022-3468(99)90208-7.
BACKGROUND/PURPOSE: Improved outcomes of preterm infants born to mothers treated prenatally with corticosteroids have been documented. The authors investigated the role of prenatal maternal corticosteroid therapy in congenital diaphragmatic hernia (CDH).
Five CDH lambs of ewes given 0.5 mg/kg betamethasone intravenously 24 hours before delivery (single-dose), four CDH lambs of ewes similarly dosed at 48 and 24 hours before delivery (double-dose), five untreated CDH lambs and five control lambs were studied. After 2 hours of ventilation, compliance, arterial oxygen (PO2) and carbon dioxide (pCO2) concentrations were recorded. Lavage protein and phospholipid levels were measured, and lung tissue was analyzed for antioxidant enzyme activity (AOE).
No improvement in gas exchange was noted in either treatment group. Significant increases in compliance (P = .02) were noted in the double-dose steroid group, which were different from that of untreated CDH lambs or controls. Minimal changes in AOE activities were seen with steroid administration.
Although the metabolic changes were not significant, the marked improvement in compliance seen in the double-dosed steroid group suggests a potential role for prenatal maternal corticosteroids in CDH. Further timing and dosage studies are warranted in this model.
背景/目的：已有文献记载，产前接受皮质类固醇治疗的母亲所生早产儿的预后有所改善。作者研究了产前母体皮质类固醇治疗在先天性膈疝（CDH）中的作用。
研究了5只在分娩前24小时静脉注射0.5mg/kg倍他米松的母羊所生的CDH羔羊（单剂量）、4只在分娩前48小时和24小时接受类似剂量注射的母羊所生的CDH羔羊（双剂量）、5只未经治疗的CDH羔羊和5只对照羔羊。通气2小时后，记录顺应性、动脉血氧（PO2）和二氧化碳（pCO2）浓度。测量灌洗蛋白和磷脂水平，并分析肺组织的抗氧化酶活性（AOE）。
两个治疗组的气体交换均未改善。双剂量类固醇组的顺应性显著增加（P = 0.02），与未经治疗的CDH羔羊或对照组不同。给予类固醇后，AOE活性变化最小。
虽然代谢变化不显著，但双剂量类固醇组顺应性的显著改善表明产前母体皮质类固醇在CDH中可能发挥作用。在该模型中，有必要进一步进行时间和剂量研究。
