宫内气管阻塞，一种先天性膈疝的新治疗方法，可降低胎羊羊水钠和氯浓度。

Intrauterine tracheal obstruction, a new treatment for congenital diaphragmatic hernia, decreases amniotic fluid sodium and chloride concentrations in the fetal lamb.

作者信息

Evrard V A, Flageole H, Deprest J A, Vandenberghe K, Verhaeghe J, Lerut T E

机构信息

Center for Surgical Technologies, Leuven, Belgium.

出版信息

Ann Surg. 1997 Dec;226(6):753-8. doi: 10.1097/00000658-199712000-00012.

DOI:10.1097/00000658-199712000-00012

PMID:9409574

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1191152/

Abstract

OBJECTIVE

To evaluate the effect of fetal tracheal occlusion on sodium and chloride concentrations in amniotic and tracheal fluid.

SUMMARY BACKGROUND DATA

Intrauterine tracheal occlusion has been proposed to reverse pulmonary hypoplasia, an important prognostic factor in congenital diaphragmatic hernia. In early human trials, technical failure of the obstructive device has been reported.

METHODS

Eight fetal lambs (gestational age = 95 days) were subjected to fetal tracheoscopy, and amniotic and tracheal fluid samples were taken. In multiple pregnancies (n = 6), amniotic fluid was also sampled from the contralateral amniotic sac and used as a control. Subsequently, endotracheal obstruction, using a detachable balloon, was performed. After 14 days, all fetuses were delivered, and sodium and chloride concentrations in amniotic and tracheal fluid were measured again. Statistical analysis was done using a two-tailed Student's t test, paired or unpaired as appropriate.

RESULTS

In controls, between 95 and 109 days gestational age, no significant changes occurred in sodium or chloride concentrations in amniotic or tracheal fluid. After 2 weeks of tracheal obstruction, however, chloride and sodium concentrations in amniotic fluid decreased (chloride = 76.7 mEq/L vs. 107.6 mEq/L, p = 0.0003; sodium = 109.6 mEq/L vs. 125.9 +/- 5.2 mEq/L, p = 0.019). A concomitant increase in chloride and sodium concentration was observed in tracheal fluid (chloride = 145.4 mEq/L vs. 130.0 mEq/L, p = 0.047; sodium = 153.1 mEq/L vs. 142.9 mEq/L, p = 0.051). When comparing groups at 109 days, chloride and sodium concentrations in amniotic fluid were markedly lower in the treated group versus controls (p = 0.0004 and p = 0.05 for chloride and sodium, respectively).

CONCLUSION

Complete tracheal occlusion in ovine fetuses results in a significant decrease of amniotic fluid sodium and chloride concentrations.

摘要

目的

评估胎儿气管闭塞对羊水和气管液中钠和氯浓度的影响。

总结背景数据

子宫内气管闭塞已被提议用于逆转肺发育不全，这是先天性膈疝的一个重要预后因素。在早期人体试验中，已报道阻塞装置出现技术故障。

方法

对8只胎羊（胎龄=95天）进行胎儿气管镜检查，并采集羊水和气管液样本。在多胎妊娠（n=6）中，也从对侧羊膜囊中采集羊水并用作对照。随后，使用可分离球囊进行气管阻塞。14天后，所有胎儿均分娩，并再次测量羊水和气管液中的钠和氯浓度。使用双尾学生t检验进行统计分析，根据情况采用配对或非配对检验。

结果

在对照组中，胎龄在95至109天之间，羊水或气管液中的钠或氯浓度没有显著变化。然而，气管阻塞2周后，羊水氯和钠浓度降低（氯=76.7mEq/L对107.6mEq/L，p=0.0003；钠=109.6mEq/L对125.9±5.2mEq/L，p=0.019）。气管液中氯和钠浓度同时升高（氯=145.4mEq/L对130.0mEq/L，p=0.047；钠=153.1mEq/L对142.9mEq/L，p=0.051）。在109天时比较各组，治疗组羊水氯和钠浓度明显低于对照组（氯和钠分别为p=0.0004和p=0.05）。