Kilby M D, Szwarc R S, Benson L N, Morrow R J
Academic Department of Obstetrics and Gynaecology and Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Canada.
J Matern Fetal Med. 1998 Jan-Feb;7(1):51-8. doi: 10.1002/(SICI)1520-6661(199801/02)7:1<51::AID-MFM12>3.0.CO;2-O.
We investigated the acute hemodynamic effects of in utero fetal intravascular transfusion in anemic fetuses. A conductance catheter technique of measuring left ventricular (LV) volume and pressure-volume analysis was employed in six anemic ovine fetuses of 131 days gestation (range 131-133 days). The mean fetal weight at necropsy was 3,795 +/- 166g. An intravascular transfusion of 120 ml packed maternal red cells was given over 12 minutes (rate of 2.6 +/- 0.1 ml/kg/min) increasing the hematocrit from 22.5 +/- 1.3% to 41.8 +/- 0.8%. The infusion of packed red cells leads to an approximate increase in blood volume of 30%. Heart rate, left ventricular stroke volume, and contractility, as assessed by end-systolic elastance, did not change significantly with transfusion. Left ventricular afterload, as assessed by effective arterial elastance, increased from 11.4 +/- 1.4 to 18.6 +/- 2.8 (P < 0.01) mmHg/ml with transfusion, returning to baseline levels by 60 minutes posttransfusion. During the transfusion, end-diastolic pressure increased from 4.1 +/- 0.4 to 10.6 +/- 0.8 (P < 0.01) mmHg and end-diastolic volume increased from 2.0 +/- 0.3 to 2.9 +/- 0.5 ml/kg. However, by 60 minutes posttransfusion, end-diastolic pressure had returned to baseline levels, whereas end-diastolic volume remained elevated at 3.2 +/- 0.6 ml/kg. We conclude that the persistent increase in end-diastolic volume implies a possible increase in LV diastolic compliance.
我们研究了宫内胎儿血管内输血对贫血胎儿的急性血流动力学影响。采用电导导管技术测量左心室（LV）容积，并对6只妊娠131天（范围为131 - 133天）的贫血绵羊胎儿进行压力 - 容积分析。尸检时胎儿平均体重为3,795 +/- 166克。在12分钟内输入120毫升母体浓缩红细胞（速率为2.6 +/- 0.1毫升/千克/分钟），使血细胞比容从22.5 +/- 1.3%增加到41.8 +/- 0.8%。输注浓缩红细胞导致血容量增加约30%。输血后，心率、左心室每搏输出量以及通过收缩末期弹性评估的收缩性均无显著变化。通过有效动脉弹性评估的左心室后负荷在输血后从11.4 +/- 1.4增加到18.6 +/- 2.8（P < 0.01）mmHg/ml，并在输血后60分钟恢复到基线水平。输血期间，舒张末期压力从4.1 +/- 0.4增加到10.6 +/- 0.8（P < 0.01）mmHg，舒张末期容积从2.0 +/- 0.3增加到2.9 +/- 0.5毫升/千克。然而，输血后60分钟时，舒张末期压力已恢复到基线水平，而舒张末期容积仍升高至3.2 +/- 0.6毫升/千克。我们得出结论，舒张末期容积的持续增加意味着左心室舒张顺应性可能增加。
