Uystepruyst Christophe, Coghe J, Dorts Th, Harmegnies N, Delsemme M-H, Art T, Lekeux P
Laboratory for Functional Investigation, Department of Physiology, Faculty of Veterinary Medicine, University of Liège, Bât. B42, Sart Tilman, B-4000 Liège, Belgium.
Vet J. 2002 May;163(3):267-82. doi: 10.1053/tvjl.2001.0683.
The purpose of this study was to evaluate whether the timing of elective caesarean section (ECS) during parturition affects pulmonary and metabolic adaptation to extra-uterine life in healthy Belgian White and Blue (BWB) calves delivered at term. Vaginal palpation was performed and deliveries divided into six categories of timing for ECS: cervix closed (TECS 1); passive and active cervical dilatation (TECS 2 and TECS 3); full cervical dilatation (TECS 4); spontaneous rupture of allantoic (TECS 5) and amniotic (TECS 6) membranes. One hundred and eighteen BWB calves were examined at birth, 5, 15, 30, 45 and 60 min and 2, 3, 6, 12 and 24 h after birth using the following measurements: physical examination (time between birth and sternal recumbency [T-SR]); heart rate (mHR); arterial blood gas analyses (arterial partial pressure in oxygen [PaO(2)], in carbon dioxide [PaCO(2)], arterial haemoglobin oxygen saturation [SaO(2)], alveolo-arterial difference in oxygen [AaDO(2)]); pulmonary function tests using the oesophageal balloon catheter technique (respiratory rate [RR], total pulmonary resistance [R(L)], dynamic lung compliance [C(Ldyn)], tidal volume [V(T)] and minute volume [V(E)]); arterial and venous blood acid-base balance analyses (arterial and venous pH [pHa and pHv], bicarbonate concentration [HCO(3)a and HCO(3)v], base excess [BEa and BEv]); rectal temperature (RT); jugular venous blood sampling for determination of metabolic variables (blood glucose [G], plasma lactate [L], serum cortisol [C], plasma noradrenaline [NA] and adrenaline [A] concentrations); haematological variables (red blood cell count [RBC], total haemoglobin concentration [Hb], Packed Cell Volume [PCV]) and passive immune transfer variables (total serum protein [TP] and beta(2)gammaglobulin [beta(2)gamma] concentrations).TECS significantly (P</=0.05) influenced PaO(2), SaO(2), AaDO(2), RR, V(T), V(E), C(Ldyn), RT, G, NA, A, RBC, Hb and TP: compared to TECS> or =4 calves, TECS< or =3 calves showed lower PaO(2), SaO(2), V(T), C(Ldyn), RT, G, NA, A, RBC, Hb and TP and higher AaDO(2), RR, V(E). TECS differences progressively decreased and disappeared between 6 and 12 h after birth in TECS 2 and 3 calves but remained up to 24 h in TECS 1 calves. Improved postnatal respiratory and metabolic adaptation in TECS> or =4 calves were mainly related to differences in exposure to labour and subsequent hormonal surge: catecholamines, particularly A, enabled more effective removal of lung liquid and/or release of surfactant which contribute to better gas exchanges and induced greater energy mobilization to maintain adequate body temperature. It was concluded waiting for full cervical dilatation before performing CS should be encouraged because it promotes postnatal respiratory and metabolic adaptation in full-term BWB calves.
本研究的目的是评估足月分娩时择期剖宫产(ECS)的时机是否会影响健康的比利时白蓝花(BWB)犊牛宫外生活的肺和代谢适应。进行阴道触诊,并将分娩分为ECS的六个时机类别:宫颈闭合(TECS 1);被动和主动宫颈扩张(TECS 2和TECS 3);宫颈完全扩张(TECS 4);尿囊(TECS 5)和羊膜(TECS 6)膜自然破裂。对118头BWB犊牛在出生时、出生后5、15、30、45和60分钟以及2、3、6、12和24小时进行检查,采用以下测量方法:体格检查(出生至胸骨卧位的时间[T-SR]);心率(mHR);动脉血气分析(动脉血氧分压[PaO₂]、二氧化碳分压[PaCO₂]、动脉血红蛋白氧饱和度[SaO₂]、肺泡-动脉氧分压差[AaDO₂]);使用食管气囊导管技术进行肺功能测试(呼吸频率[RR]、总肺阻力[R(L)]、动态肺顺应性[C(Ldyn)]、潮气量[V(T)]和分钟通气量[V(E)]);动脉和静脉血酸碱平衡分析(动脉和静脉pH值[pHa和pHv]、碳酸氢盐浓度[HCO₃a和HCO₃v]、碱剩余[BEa和BEv]);直肠温度(RT);采集颈静脉血样以测定代谢变量(血糖[G]、血浆乳酸[L]、血清皮质醇[C]、血浆去甲肾上腺素[NA]和肾上腺素[A]浓度);血液学变量(红细胞计数[RBC]、总血红蛋白浓度[Hb]、红细胞压积[PCV])和被动免疫转移变量(总血清蛋白[TP]和β₂γ球蛋白[β₂γ]浓度)。TECS显著(P≤0.05)影响PaO₂、SaO₂、AaDO₂、RR、V(T)、V(E)、C(Ldyn)、RT、G、NA、A、RBC、Hb和TP:与TECS≥4的犊牛相比,TECS≤3的犊牛显示出较低的PaO₂、SaO₂、V(T)、C(Ldyn)、RT、G、NA、A、RBC、Hb和TP以及较高的AaDO₂、RR、V(E)。TECS 2和3的犊牛在出生后6至12小时之间,TECS差异逐渐减小并消失,但TECS 1的犊牛差异一直持续到24小时。TECS≥4的犊牛出生后呼吸和代谢适应的改善主要与分娩暴露和随后的激素激增差异有关:儿茶酚胺,特别是A,能够更有效地清除肺液和/或释放表面活性剂,这有助于更好的气体交换并诱导更大的能量动员以维持适当的体温。得出的结论是,应鼓励在进行剖宫产之前等待宫颈完全扩张,因为这可促进足月BWB犊牛出生后的呼吸和代谢适应。