Gleason C A, Traystman R J
Department of Pediatrics, (Eudowood Neonatal Pulmonary Division), Anesthesiology/Critical Care Medicine, Johns Hopkins, University School of Medicine, Baltimore, Maryland 21287-3200, USA.
Pediatr Res. 1995 Dec;38(6):943-8. doi: 10.1203/00006450-199512000-00019.
Previous studies in near-term sheep have shown that maternal cocaine injection causes acute fetal cerebral vasodilation along with transient hypoxemia and hypertension. Preterm sheep fetuses have lower cerebral O2 consumption (CMRO2) and their cerebrovascular responses to hypoxemia are attenuated compared with near-term fetuses. We therefore tested the hypothesis that fetal cerebrovascular responses to maternal cocaine injection may also differ earlier in gestation. We studied nine immature fetal sheep at 0.65 gestation using the same experimental protocol we used in previous studies in near-term sheep. Fetal studies were done in utero, 2 d after vascular catheter placement. We measured cerebral blood flow (CBF) using microspheres, arterial and sagittal sinus O2 content, and cocaine concentrations. We calculated cerebrovascular resistance (CVR) as mean arterial blood pressure divided by CBF. Measurements were made before and 2, 5, and 15 min after a 2 mg/kg maternal cocaine injection. At 2 min, fetal Cao2 decreased (18 +/- 6%, mean +/- SEM), and there was cerebral vasoconstriction (CVR increased by 22 +/- 5%). At 5 min, CBF increased (19 +/- 9%), but because blood pressure increased also, CVR returned to baseline, and therefore there was no vasodilation compared with baseline. Furthermore, at 5 min there was a 22 +/- 6% decrease in Cao2 and a 21 +/- 6% increase in mean arterial blood pressure. There were no changes in CMRo2 throughout the study, but at 2 min, cerebral O2 delivery decreased. Differences in cerebrovascular responses to maternal cocaine injection earlier in gestation may be due to differences in vascular development and/or to developmental differences in responses to cocaine, cocaine metabolites, and/or to hypoxemia.
此前对近足月绵羊的研究表明,母体注射可卡因会导致急性胎儿脑血管舒张,同时伴有短暂性低氧血症和高血压。与近足月胎儿相比,早产绵羊胎儿的脑氧消耗量(CMRO2)较低,且其脑血管对低氧血症的反应减弱。因此,我们检验了以下假设:胎儿脑血管对母体注射可卡因的反应在妊娠早期可能也有所不同。我们使用与之前对近足月绵羊研究相同的实验方案,对9只处于妊娠0.65期的未成熟胎儿绵羊进行了研究。胎儿研究在子宫内进行,血管插管放置2天后进行。我们使用微球测量脑血流量(CBF)、动脉和矢状窦氧含量以及可卡因浓度。我们将脑血管阻力(CVR)计算为平均动脉血压除以CBF。在母体注射2mg/kg可卡因之前以及注射后2、5和15分钟进行测量。在2分钟时,胎儿动脉血氧含量(Cao2)下降(18±6%,平均值±标准误),出现脑血管收缩(CVR增加22±5%)。在5分钟时,CBF增加(19±9%),但由于血压也升高,CVR恢复到基线水平,因此与基线相比没有血管舒张。此外,在5分钟时,Cao2下降22±6%,平均动脉血压升高21±6%。在整个研究过程中CMRo2没有变化,但在2分钟时,脑氧输送量下降。妊娠早期胎儿脑血管对母体注射可卡因反应的差异可能是由于血管发育的差异和/或对可卡因、可卡因代谢产物和/或低氧血症反应的发育差异所致。