Takeuchi Daiji, Momma Kazuo
Section of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Biol Neonate. 2006;89(1):42-9. doi: 10.1159/000088197. Epub 2005 Sep 8.
The closing mechanisms of the ductus venosus (DV) have not yet been revealed.
The aims of this study were to document the perinatal closing process of the DV, to study the suppression of prostaglandins by indomethacin, and to determine the effects of umbilical blood flow to the fetal DV.
The proximal and distal DV diameters were studied in near-term fetal and neonatal rats with the rapid whole-body freezing method.
The DV diameter changed sensitively at birth, and decreased by 10% immediately after the cessation of the umbilical circulation. Umbilical hemorrhage caused an additional decrease in the DV diameter compared with neonate without the hemorrhage. The neonates showed a DV diameter decreased by 20% at 30 min and 30% at 60 min after birth. The fetal DV was tubular, and the neonatal DV was horn-shaped with a smaller inlet than outlet. A small dose (0.1 mg/kg) of indomethacin administered to the pregnant rats induced a reduction in prostaglandins and decreased the fetal DV diameter to 80% of the control. Indomethacin at a large dose (10 mg/kg), administered to the dams, induced a reduction in prostaglandins, severe constriction of the ductus arteriosus, and decreased blood flow through the descending aorta umbilicus, and caused a further reduction in the DV diameter to 70-80% of the control. A large dose of nifedipine (10 mg/kg), which causes cardiac suppression and heart failure in the fetus, was administered to near-term rats to study the effect of decreased fetal cardiac output and blood flow passing through the DV. Nifedipine induced a 20% decrease in the DV diameter for 2-8 h. In all 1-hour-old neonates with or without pretreatment, the inlet diameter of the DV was reduced more than the outlet diameter, and the DV showed a horn-shaped morphology.
In conclusion, perinatal cessation of the umbilical circulation and umbilical hemorrhage are associated with an immediate decrease in DV diameter. The DV diameter is also reduced in other conditions associated with decreased umbilical blood flow, such as induced by nifedipine which leads to heart failure and constricting of the ductus arteriosus induced by indomethacin. The constricting effect of a small dose of indomethacin suggests that prostaglandins dilate the DV physiologically.
静脉导管(DV)的关闭机制尚未明确。
本研究旨在记录DV围产期的关闭过程,研究吲哚美辛对前列腺素的抑制作用,并确定脐血流对胎儿DV的影响。
采用快速全身冷冻法研究近足月胎儿和新生大鼠的DV近端和远端直径。
DV直径在出生时变化敏感,脐循环停止后立即减小10%。与未出血的新生儿相比,脐部出血导致DV直径进一步减小。新生儿出生后30分钟时DV直径减小20%,60分钟时减小30%。胎儿DV呈管状,新生儿DV呈喇叭形,入口小于出口。给孕鼠注射小剂量(0.1mg/kg)吲哚美辛可降低前列腺素水平,并使胎儿DV直径降至对照组的80%。给母鼠注射大剂量(10mg/kg)吲哚美辛可降低前列腺素水平,使动脉导管严重收缩,经降主动脉脐部的血流减少,并使DV直径进一步降至对照组的70 - 80%。给近足月大鼠注射大剂量硝苯地平(10mg/kg),该药可导致胎儿心脏抑制和心力衰竭,以研究胎儿心输出量降低及通过DV的血流减少的影响。硝苯地平使DV直径在2 - 8小时内减小20%。在所有出生1小时的新生儿中,无论是否进行预处理,DV的入口直径比出口直径减小得更多,且DV呈喇叭形。
总之,围产期脐循环停止和脐部出血与DV直径立即减小有关。在其他与脐血流减少相关的情况下,如硝苯地平导致心力衰竭以及吲哚美辛导致动脉导管收缩时,DV直径也会减小。小剂量吲哚美辛的收缩作用表明前列腺素在生理上可扩张DV。