Islas-Fabila Paloma, Orozco-Gregorio Hector, Roldan-Santiago Patricia, Waytula Marilyn, Gonzalez-Hernandez Milagros, Vega-Manriquez Xochil, Jimenez-Collado Carlos Antonio, Bonilla-Jaime Herlinda
Doctoral Program in Biological Sciences and Health, Universidad Autónoma Metropolitana, México City, México.
Private Professional Practice, México City, México.
Vet Med (Praha). 2022 Mar 22;67(6):271-297. doi: 10.17221/43/2021-VETMED. eCollection 2022 Jun.
The objective of this review is to ascertain the advantages and disadvantages of several treatments and therapeutic protocols that have been used for the prevention and treatment of perinatal asphyxia in human neonates and in different animal models. Perinatal asphyxia is one of the main causes of mortality worldwide and is an important factor in triggering physio-metabolic disorders that result in serious neurological consequences and learning disorders not only in human foetuses and neonates, but also in animals. In recent years, the search for new pharmacological protocols to prevent and reverse physio-metabolic disorders and brain damage derived from perinatal asphyxia has been and continues to be the subject of intense research. Currently, within these pharmacological protocols, therapeutic strategies have been evaluated that use respiratory and hormonal stimulants, as well as hypothermic therapies in combination with other putative neuroprotective agents. Similarly, energy supplements have been evaluated with the objective of preventing perinatal asphyxia and treating new-borns with this condition, and to decrease the incidence of neonatal and foetal deaths associated with it. However, despite these promising advances, this pathology has persisted, since the administration of these therapies in low doses may not exert a neuroprotective effect or, in high doses, can trigger adverse effects (such as reduced cardiac contractility, reduced cerebral blood flow, poor perfusion, sympathetic and neuroendocrine stimulation, and increased blood viscosity) in human foetuses and neonates as well as in different animal models (rats, piglets, sheep and rabbits). Therefore, it is important to determine the minimum effective dose with which these therapies exert a neuroprotective effect, as well as the mode of administration, the duration of therapy, etc. Therefore, until a powerful strategy is found to improve the consequences of suffocation, this topic will continue to be the subject of intensive research in the future.
本综述的目的是确定几种已用于预防和治疗人类新生儿及不同动物模型围产期窒息的治疗方法和治疗方案的优缺点。围产期窒息是全球主要死因之一，是引发生理代谢紊乱的重要因素，不仅会导致人类胎儿和新生儿出现严重的神经后果和学习障碍，在动物中也是如此。近年来，寻找预防和逆转围产期窒息所致生理代谢紊乱和脑损伤的新药理学方案一直是并将继续是深入研究的课题。目前，在这些药理学方案中，已经评估了使用呼吸和激素刺激剂以及低温疗法并结合其他假定神经保护剂的治疗策略。同样，也评估了能量补充剂，其目的是预防围产期窒息并治疗患有这种病症的新生儿，以及降低与之相关的新生儿和胎儿死亡发生率。然而，尽管取得了这些令人鼓舞的进展，但这种病理状况仍然存在，因为低剂量使用这些疗法可能不会产生神经保护作用，而高剂量使用则可能在人类胎儿和新生儿以及不同动物模型（大鼠、仔猪、绵羊和兔子）中引发不良反应（如心脏收缩力降低、脑血流量减少、灌注不良、交感神经和神经内分泌刺激以及血液粘度增加）。因此，确定这些疗法发挥神经保护作用的最小有效剂量以及给药方式、治疗持续时间等非常重要。因此，在找到一种有效的策略来改善窒息后果之前，这个话题在未来仍将是深入研究的课题。
