Del Gaudio Costantino, Carotti Adriano, Grigioni Mauro, Morbiducci Umberto
Department of Industrial Engineering, University of Rome Tor Vergata, INSTM Research Unit Rome Tor Vergata, Rome - Italy.
Int J Artif Organs. 2012 May;35(5):376-84. doi: 10.5301/ijao.5000087.
Fetal cardiac surgery (FCS) represents a challenging issue for the in utero treatment of congenital heart defects. However, FCS has still not gained the sufficient reliability for clinical practice due to an incompletely elucidated fetal stress response. For example, blood sampling can contribute to its onset, leading to fetoplacental unit dysfunction, one of the main causes of failure of the surgical procedure. In order to address this issue, the role of the autonomic control system during an experimental procedure of cardiac bypass on ewe fetuses was investigated by means of recurrence quantification analysis (RQA), a well-recognized method for the analysis of nonlinear systems. RQA was applied to time series extracted from fetal arterial pressure recordings before and after the cardiac bypass established by means of an extracorporeal circuit, including an axial blood pump, and taking advantage of the capability of the placenta to work as a natural oxygenator. Statistically significant correlations were found among RQA-based metrics and fetal blood gas data, suggesting the possibility to infer the clinical status of the fetus starting from its hemodynamic signals.This study shows the relevance of RQA as a complementary tool for the monitoring of the fetal status during cardiac bypass.
胎儿心脏手术（FCS）是先天性心脏缺陷宫内治疗面临的一个具有挑战性的问题。然而，由于胎儿应激反应尚未完全阐明，FCS在临床实践中仍未获得足够的可靠性。例如，采血可能导致其发作，进而导致胎儿-胎盘单位功能障碍，这是手术失败的主要原因之一。为了解决这个问题，通过递归量化分析（RQA）这一公认的非线性系统分析方法，研究了自主控制系统在母羊胎儿心脏搭桥实验过程中的作用。RQA应用于通过体外循环（包括轴流血泵）建立心脏搭桥前后从胎儿动脉压记录中提取的时间序列，并利用胎盘作为天然氧合器的功能。基于RQA的指标与胎儿血气数据之间存在统计学上的显著相关性，这表明从胎儿血流动力学信号推断胎儿临床状态具有可能性。本研究表明RQA作为心脏搭桥期间监测胎儿状态的补充工具具有重要意义。
