Yli Branka M, Kjellmer Ingemar
Delivery Department, Mother-Child Clinic, Oslo University Hospital, Oslo, Norway.
Department of Paediatrics, Institute of Clinical Science, University of Gothenburg, Gothenburg, Sweden.
Best Pract Res Clin Obstet Gynaecol. 2016 Jan;30:9-21. doi: 10.1016/j.bpobgyn.2015.05.004. Epub 2015 Jun 21.
A foetus exposed to oxygenation compromise is capable of several adaptive responses, which can be categorised into those affecting metabolism and those affecting oxygen transport. However, both the extent and duration of the impairment in oxygenation will have a bearing on these adaptive responses. Although intrapartum events may account for no more than one-third of cases with an adverse neurological outcome, they are important because they can be influenced successfully. This review describes the mechanisms underlying foetal hypoxia during labour, acid-base balance and gas exchange, and the current scientific understanding of the role of intrauterine asphyxia in the pathophysiology of neonatal encephalopathy and cerebral palsy. Although the mechanisms involved include similar initiating events, principally ischaemia and excitotoxicity, and similar final common pathways to cell death, there are certain unique maturational factors that influence the type and pattern of cellular injury.
暴露于氧合受损环境中的胎儿能够产生多种适应性反应，这些反应可分为影响代谢的反应和影响氧运输的反应。然而，氧合受损的程度和持续时间都会对这些适应性反应产生影响。尽管分娩期事件导致不良神经结局的病例可能不超过三分之一，但它们很重要，因为它们可以得到有效干预。本综述描述了分娩期间胎儿缺氧、酸碱平衡和气体交换的潜在机制，以及目前关于宫内窒息在新生儿脑病和脑瘫病理生理学中作用的科学认识。尽管所涉及的机制包括相似的起始事件，主要是缺血和兴奋性毒性，以及相似的细胞死亡最终共同途径，但存在某些独特的成熟因素会影响细胞损伤的类型和模式。
