Hellmeyer L, Exner C, Folz B, Hiller M, Sierra F, Lukasewitz P, Steinfeld T, Werner J A, Heldmaier G, Schmidt S
Department of Obstetrics and Perinatal Medicine, Philipps-University of Marburg, Baldingerstrasse, 35033 Marburg, Germany.
Arch Gynecol Obstet. 2007 Apr;275(4):245-8. doi: 10.1007/s00404-006-0252-x. Epub 2006 Sep 20.
Prenatal tracheal occlusion using endoscopic techniques obstructs the normal egress of lung fluid during pulmonary development and stimulates lung growth in cases of congenital diaphragmatic hernia (CDH). Although FETO might be an effective strategy for treatment of CDH, the mechanism especially due to the supposed increasing transpulmonary pressure is unknown.
The purpose of this study was to monitor the pressure below the attached balloon in the fetal lamb telemetrically.
Four time-dated pregnant Merino ewes underwent fetal and maternal surgery. A special prepared silicone catheter was placed below the epiglottis by laryngoscopy on day 110 or 140 of gestation. The tracheal pressure below the fixed catheter could be monitored telemetrically using the Data Sciences TA11-PA-C40 pressure device. Hundred and twenty measurement points were recorded over a period of 2 min.
A maximum of lung pressure rate was found immediately after implantation (23.7 +/- 4.6 mm Hg). During the first hour, the pressure decreased to an average value of 16.9 mmHg. About 70 h after the block, this value decreased to a minimum level of 8.3 +/- 0.4 mmHg.
Decreasing pressure variation might indicate that lung growth has stopped and that the ideal point of time to remove the balloon is achieved. Increasing pressure has to be related to the morphometric analysis of the lung's structural development and maturation, comparing the efficacy of FETO in preventing or reversing pulmonary hypoplasia. Further investigation of continuous telemetric monitoring of tracheal pressure in the fetal lamb is required.
在肺发育过程中，采用内镜技术进行产前气管闭塞可阻碍肺液的正常流出，并刺激先天性膈疝（CDH）病例中的肺生长。尽管胎儿内镜气管封堵术（FETO）可能是治疗CDH的有效策略，但其机制，尤其是由于假定的经肺压力增加，尚不清楚。
本研究的目的是通过遥测监测胎羊附着球囊下方的压力。
对4只按预产期计算的怀孕美利奴母羊进行胎儿和母体手术。在妊娠第110天或140天通过喉镜检查将特制的硅胶导管置于会厌下方。使用Data Sciences TA11-PA-C40压力装置可遥测固定导管下方的气管压力。在2分钟内记录120个测量点。
植入后立即发现最大肺压力率（23.7±4.6毫米汞柱）。在第一个小时内，压力降至平均值16.9毫米汞柱。封堵后约70小时，该值降至最低水平8.3±0.4毫米汞柱。
压力变化减小可能表明肺生长已停止，且已达到移除球囊的理想时间点。压力增加必须与肺结构发育和成熟的形态学分析相关，比较FETO在预防或逆转肺发育不全方面的疗效。需要进一步研究对胎羊气管压力进行连续遥测监测。
