Kamimura T, Murata Y, Quilligan E J, Ibara S, Fujimori K, Nakamura Y, Sakamoto H
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, Orange 92613-1491, USA.
Am J Obstet Gynecol. 1996 Feb;174(2):535-9. doi: 10.1016/s0002-9378(96)70423-4.
Our purpose was to determine the adequacy of oxygenation, particularly cranial and cardiac oxygenation, in exteriorized fetal lambs on right atrium to artery extracorporeal membrane oxygenation.
Thirteen fetal lambs were placed on right atrium to artery extracorporeal membrane oxygenation between the gestational ages of 113 and 133 days. Various PO2 and oxygen saturation (SO2) values were obtained by varying the oxygen concentrations at the oxygenator membrane. Blood gases, pH, and SO2 were observed on samples taken before and after membrane oxygenation from the left ventricle and through the cranial carotid arterial catheter. These were compared with control values obtained before the cessation of umbilical circulation. Fetal coronary oxygenation was represented by left ventricle PO2 and SO2 and cranial oxygen by carotid artery PO2 and SO2.
We classified oxygen saturation as low, medium, and high on the basis of the level of postmembrane SO2. Carotid artery cranial oxygenation in the low SO2 group was equivalent to control values, but that in the medium and high SO2 groups was significantly higher than in the control group. Left ventricle oxygenation was consistently lower than cranial oxygenation in any SO2 group. In the low group left ventricle oxygenation was significantly lower than the control values.
Right atrium to artery extracorporeal membrane oxygenation appears sufficient to oxygenate the fetal cranial circulation but may be inadequate for the efficient distribution of oxygenated blood into the left ventricle and thus the coronary circulation.
我们的目的是确定在右心房至动脉体外膜肺氧合（ECMO）支持下的体外化胎羊的氧合是否充分，特别是颅脑和心脏的氧合情况。
13只胎羊在妊娠113至133天期间接受右心房至动脉ECMO支持。通过改变氧合器膜处的氧浓度获得不同的氧分压（PO2）和氧饱和度（SO2）值。在膜氧合前后，从左心室和通过颈总动脉导管采集样本，观察血气、pH值和SO2。将这些结果与脐循环停止前获得的对照值进行比较。胎儿冠状动脉氧合用左心室PO2和SO2表示，颅脑氧合用颈动脉PO2和SO2表示。
我们根据膜后SO2水平将氧饱和度分为低、中、高三个等级。低SO2组的颈动脉颅脑氧合与对照值相当，但中、高SO2组的颈动脉颅脑氧合显著高于对照组。在任何SO2组中，左心室氧合始终低于颅脑氧合。在低SO2组中，左心室氧合显著低于对照值。
右心房至动脉ECMO似乎足以使胎儿颅脑循环得到氧合，但可能不足以将氧合血有效地分配到左心室，从而影响冠状动脉循环。
