Gratacós Eduard, Wu Jun, Devlieger Roland, Bonati Francesca, Lerut Toni, Vanamo Kari, Deprest Jan A
Center for Surgical Technologies, Faculty of Medicine, University Hospital Gasthuisberg and Katholieke Universiteit Leuven, Belgium.
Am J Obstet Gynecol. 2002 Mar;186(3):538-43. doi: 10.1067/mob.2002.120482.
Our purpose was to evaluate in a sheep model for endoscopic fetal surgery the impact of nitrous oxide-gas amniodistention compared with fluid amniodistention on duration of surgery, hemorrhagic events, and fetomaternal acid-base status.
Pregnant ewes (n = 16) at 92 to 104 days of gestation (term, 145 days) underwent amniodistention with Hartmann's solution (group I, n = 8) or nitrous oxide (group II, n = 8) at 38 degrees C. Endoscopic tracheal clipping according to a standardized surgical protocol was performed in all animals. The duration of fetoscopy (from insertion of first cannula until removal of last one), fetal surgery (fetal skin incision to skin closure), and number of bleeding episodes was recorded. Maternal and fetal blood gas values (pH, PO2, and PCO2) were measured at baseline and every 15 minutes during the experiment. Videotapes of the operations were assessed independently and scored by a visual analog scale in terms of smoothness of the operation and control of hemorrhagic events.
Mean duration of fetoscopy (+/-SEM) (68 +/- 16 minutes vs 92 +/- 23 minutes) and fetal surgery (19 +/- 6 minutes vs 42 +/- 18 minutes) as well as number of bleeding episodes (1.9 +/- 0.8 minutes vs 5.8 +/- 2.1 minutes) was significantly reduced in animals operated with use of nitrous oxide amniodistention. In both groups, fetal and maternal blood gases remained unchanged during the entire experiment. Visual analog scale (VAS) scores were significantly higher for procedures conducted with use of gas distention.
In a lamb model for fetal surgery, gas amniodistention with use of nitrous oxide results in a quicker operation procedure with less bleeding compared with fluid amniodistention, and without adverse side effects on fetomaternal acid-base status.
我们的目的是在一个用于内镜下胎儿手术的绵羊模型中，评估与液体羊水扩张相比，氧化亚氮气体羊水扩张对手术时间、出血事件以及母胎酸碱状态的影响。
怀孕母羊（n = 16）在妊娠92至104天（足月为145天）时，于38摄氏度下用哈特曼氏溶液（I组，n = 8）或氧化亚氮（II组，n = 8）进行羊水扩张。所有动物均按照标准化手术方案进行内镜下气管夹闭。记录胎儿镜检查时间（从第一个套管插入至最后一个套管移除）、胎儿手术时间（胎儿皮肤切开至皮肤缝合）以及出血次数。在基线时以及实验期间每15分钟测量母胎血气值（pH、PO2和PCO2）。对手术录像带进行独立评估，并通过视觉模拟量表根据手术的流畅程度和出血事件的控制情况进行评分。
使用氧化亚氮羊水扩张进行手术的动物，其胎儿镜检查平均时间（±SEM）（68±16分钟对92±23分钟）、胎儿手术时间（19±6分钟对42±18分钟）以及出血次数（1.9±0.8次对5.8±2.1次）均显著减少。在两组中，整个实验期间胎儿和母体的血气均保持不变。使用气体扩张进行的操作，视觉模拟量表（VAS）评分显著更高。
在一个胎儿手术的羔羊模型中，与液体羊水扩张相比，使用氧化亚氮进行气体羊水扩张可使手术过程更快，出血更少，且对母胎酸碱状态无不良副作用。
