Garabedian C, Clermont-Hama Y, Sharma D, Aubry E, Butruille L, Deruelle P, Storme L, De Jonckheere J, Houfflin-Debarge V
Univ. Lille, EA 4489 -Perinatal Environment and Health, Lille, France.
CHU Lille, Department of Obstetrics, Lille, France.
PLoS One. 2018 Jan 10;13(1):e0190463. doi: 10.1371/journal.pone.0190463. eCollection 2018.
The autonomic nervous system plays a leading role in the control of fetal homeostasis. Fetal heart rate variability (HRV) analysis is a reflection of its activity. We developed a new index (the Fetal Stress Index, FSI) reflecting parasympathetic tone. The objective of this study was to evaluate this index as a predictor of fetal acid-base status. This was an experimental study on chronically instrumented fetal lambs (n = 11, surgery at 128 +/- 2 days gestational age, term = 145 days). The model was based on 75% occlusion of the umbilical cord for a maximum of 120 minutes or until an arterial pH ≤ 7.20 was reached. Hemodynamic, gasometric and FSI parameters were recorded throughout the experimentation. We studied the FSI during the 10 minutes prior to pH samplings and compared values for pH>7.20 and pH≤ 7.20. In order to analyze the FSI evolution during the 10 minutes periods, we analyzed the minimum, maximum and mean values of the FSI (respectively FSImin, FSImax and FSImean) over the periods. 11 experimentations were performed. During occlusion, the heart rate dropped with an increase in blood pressure (respectively 160(155-182) vs 106(101-120) bpm and 42(41-45) vs 58(55-62) mmHg after occlusion). The FSImin was 38.6 (35.2-43.3) in the group pH>7.20 and was higher in the group pH less than 7.20 (46.5 (43.3-52.0), p = 0.012). The correlation of FSImin was significant for arterial pH (coefficient of -0.671; p = 0.004) and for base excess (coefficient of -0.632; p = 0.009). The correlations were not significant for the other parameters. In conclusion, our new index seems well correlated with the fetal acid-base status. Other studies must be carried out in a situation close to the physiology of labor by sequential occlusion of the cord.
自主神经系统在胎儿内环境稳态的控制中起主导作用。胎儿心率变异性（HRV）分析是其活动的一种反映。我们开发了一种反映副交感神经张力的新指标（胎儿应激指数，FSI）。本研究的目的是评估该指标作为胎儿酸碱状态预测指标的价值。这是一项对长期植入仪器的胎羊进行的实验研究（n = 11，手术时胎龄为128±2天，足月为145天）。该模型基于脐带75%闭塞，最长持续120分钟或直至动脉pH≤7.20。在整个实验过程中记录血流动力学、气体测量和FSI参数。我们在pH采样前10分钟研究FSI，并比较pH>7.20和pH≤7.20时的值。为了分析FSI在10分钟时间段内的变化，我们分析了该时间段内FSI的最小值、最大值和平均值（分别为FSImin、FSImax和FSImean）。进行了11次实验。在闭塞期间，心率下降，血压升高（闭塞后分别为160（155 - 182）次/分钟对106（101 - 120）次/分钟和42（41 - 45）毫米汞柱对58（55 - 62）毫米汞柱）。FSImin在pH>7.20组中为38.6（35.2 - 43.3），在pH小于7.20组中更高（46.5（43.3 - 52.0），p = 0.012）。FSImin与动脉pH（系数为 - 0.671；p = 0.004）和碱剩余（系数为 - 0.632；p = 0.009）的相关性显著。与其他参数的相关性不显著。总之，我们的新指标似乎与胎儿酸碱状态密切相关。必须通过连续闭塞脐带在接近分娩生理的情况下进行其他研究。
