Gelfand Steven L, Vento Maximo, Sastre Juan, Lust W David, Smith Mark A, Perry George, Walsh Michele, Martin Richard
Division of Neonatology, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA.
Neonatology. 2008;94(4):293-9. doi: 10.1159/000151649. Epub 2008 Sep 11.
With current evidence, no specific oxygen concentration can yet be recommended in the resuscitation of the depressed term neonate.
To design a neonatal rat model of resuscitation that mimics birth hypoxia and allows the study of the effects of resuscitation on outcome.
Several key determinants were established utilizing P12 Sprague-Dawley rat pups. These include the ventilatory settings necessary to maintain normocarbic conditions and the amount and duration of hypoxia required to cause significant disruption of oxidative metabolism in the subjects' brains. Biochemical and cellular markers of oxidative injury were then compared in response to normoxic versus hyperoxic resuscitation.
Oxidative stress is produced in 12-day-old intubated rat pups with 15 min of 5% oxygen followed by 30 min of 100% oxygen or room air. Oxidized glutathione levels increased immediately after hypoxia and resuscitation then returned to control values at 24 h regardless of the resuscitate. Reduced glutathione levels were, however, significantly decreased 24 h after resuscitation with pure oxygen compared with the room air-resuscitated group (391 +/- 35 vs. 508 +/- 71 nmol/ml; p = 0.037). Stress from either resuscitate did not translate into evidence of oxidative modification detected by immunocytochemistry at 30 days.
We have demonstrated the ability to ventilate, create hypoxic stress, and resuscitate neonatal rats. While resuscitation with 21 or 100% oxygen results in a transient increase in oxidative glutathione levels, the oxygen-resuscitated group alone demonstrated a reduction in reduced glutathione 24 h later. Furthermore, these pups can then be returned to their dams for rearing, allowing ongoing evaluation of long-term effects of hypoxia and various modes of resuscitation.
基于目前的证据,尚无法为足月新生儿复苏推荐特定的氧浓度。
设计一种模拟出生时缺氧的新生大鼠复苏模型,以研究复苏对结局的影响。
利用12日龄的斯普拉格-道利大鼠幼崽确定了几个关键决定因素。这些因素包括维持正常碳酸血症所需的通气设置,以及导致受试动物大脑氧化代谢显著紊乱所需的缺氧量和持续时间。然后比较常氧与高氧复苏后氧化损伤的生化和细胞标志物。
对12日龄插管大鼠幼崽给予15分钟5%氧气,随后30分钟100%氧气或室内空气,可产生氧化应激。缺氧和复苏后氧化型谷胱甘肽水平立即升高,然后在24小时时恢复至对照值,与复苏方式无关。然而,与室内空气复苏组相比,纯氧复苏24小时后还原型谷胱甘肽水平显著降低(391±35对508±71 nmol/ml;p = 0.037)。两种复苏方式产生的应激在30天时均未转化为免疫细胞化学检测到的氧化修饰证据。
我们已证明有能力对新生大鼠进行通气、制造缺氧应激和复苏。虽然用21%或100%氧气复苏会导致氧化型谷胱甘肽水平短暂升高,但仅氧气复苏组在24小时后还原型谷胱甘肽水平降低。此外,这些幼崽随后可放回母鼠处饲养,以便持续评估缺氧和各种复苏方式的长期影响。