Hull A D, Brace R A
Division of Perinatal Medicine, Department of Reproductive Medicine, University of California San Diego, USA.
Am J Obstet Gynecol. 2001 Aug;185(2):501-6. doi: 10.1067/mob.2001.116097.
Previous reports suggested that immature ovine fetuses have a greater erythropoietin response to hemorrhage than those near term. This study tested the hypothesis that immature ovine fetuses would expand their red cell mass more rapidly than near term fetuses after hemorrhage.
Chronically catheterized immature ovine fetuses at 109.5 +/- 0.3 (mean +/- SE) days' gestation (term = 150 days) were studied over a 10-day period. They either underwent hemorrhage of 40% of their measured blood volume on day 3 or were in a time control group monitored without hemorrhage. Red cell mass, hematocrit, blood volume, plasma volume, and plasma erythropoietin concentrations were measured at 24- and 48-hour intervals. Responses in the immature fetuses were compared with responses in near term fetuses.
In the control group red cell mass, hematocrit, blood, and plasma volumes increased significantly, whereas plasma erythropoietin concentration decreased significantly with advancing gestational age. In immature fetuses that underwent hemorrhage, the relative changes in red cell mass, hematocrit, and plasma erythropoietin concentration were not significantly different from those seen in the near term fetuses. The only significant posthemorrhage difference was that the increases in blood and plasma volumes were greater in the immature compared with the near term fetuses.
Immature and mature fetuses have similar erythrocyte and erythropoietin responses to moderately severe hemorrhage. The larger blood and plasma volume responses in the immature fetuses are consistent with the concept that they have a greater extracellular fluid volume.
先前的报告表明,未成熟的绵羊胎儿对出血的促红细胞生成素反应比足月胎儿更强。本研究检验了这样一个假设,即未成熟的绵羊胎儿在出血后比足月胎儿能更快地增加其红细胞量。
对妊娠109.5±0.3(均值±标准误)天(足月为150天)的慢性插管未成熟绵羊胎儿进行了为期10天的研究。它们在第3天要么经历了相当于其测量血容量40%的出血,要么处于未出血的时间对照组。每隔24小时和48小时测量红细胞量、血细胞比容、血容量、血浆容量和血浆促红细胞生成素浓度。将未成熟胎儿的反应与足月胎儿的反应进行比较。
在对照组中,红细胞量、血细胞比容、血液和血浆容量显著增加,而血浆促红细胞生成素浓度随着胎龄增加显著降低。在经历出血的未成熟胎儿中,红细胞量、血细胞比容和血浆促红细胞生成素浓度的相对变化与足月胎儿相比无显著差异。出血后唯一显著的差异是,与足月胎儿相比,未成熟胎儿的血液和血浆容量增加更大。
未成熟和成熟胎儿对中度严重出血的红细胞和促红细胞生成素反应相似。未成熟胎儿更大的血液和血浆容量反应与它们细胞外液量更大的概念一致。