新生儿首次呼吸前后脐带动静脉血液氧和二氧化碳变化探索呼吸调控机制的初步报告I—血液氧和二氧化碳分压脐带动静脉差值的组间分析*

doi:10.12047/j.cjap.0099.2021.098

中国应用生理学杂志 ›› 2021, Vol. 37 ›› Issue (1): 1-8.doi: 10.12047/j.cjap.0099.2021.098

• 研究论文 • 下一篇

新生儿首次呼吸前后脐带动静脉血液氧和二氧化碳变化探索呼吸调控机制的初步报告I—血液氧和二氧化碳分压脐带动静脉差值的组间分析^*

刘方¹, 孙兴国, 李启威², 葛万刚¹, 李浩¹, 刘艳玲¹, 慈政^1,3, 陈升平², 宋桂芹², 王桂芝^1,3, 谭晓越¹, 崔闫¹, 张也¹, 朱嘉宝^1,4, 李银俊^1,5, 邓维^1,6, 黄燕^1,7, 马铭欣^1,7, 陈荣^1,7, 邹昱馨^1,8, 台文琦¹, 徐凡¹, 石超¹

1.国家心血管病中心中国医学科学院阜外医院心血管疾病国家重点实验室国家心血管疾病临床医学研究中心,北京协和医学院,北京 100037;
2.国家电网公司北京电力医院,北京 100073;
3.潍坊医学院, 山东潍坊 261053;
4.河北医科大学第二医院,石家庄 050000;
5.兰州市城关区康乐医院,甘肃兰州 730030;
6.重庆医科大学附属康复医院,重庆 400050;
7.辽宁省大连儿童医院,大连 116000;
8.聊城市立医院儿童医院,山东聊城 252000

收稿日期:2020-08-12 修回日期:2021-01-05 发布日期:2021-10-21
通讯作者: ^△Tel：010-88398300;E-mail: xgsun@lundquist.org
基金资助:
^*国家高技术研究发展计划（863计划）课题资助项目（2012AA021009）; 国家自然科学基金医学科学部面上项目（81470204）; 中国康复医疗机构联合重大项目基金（20160102）; 中国医学科学院国家心血管病中心阜外医院科研开发启动基金（2012-YJR02）; 首都临床特色应用研究与成果推广（Z161100000516127）; 北京康复医院2019-2021科技发展专项（2019-003）; 北京协和医学院教学改革项目（2018E-JG07）; 北京协和医学院-国家外国专家局外国专家项目（2015,2016,T2017025,T2018046,G2019001660）; 重庆市卫计委医学科研计划项目（2017MSXM090）; 重庆市科委社会事业与民生保障科技创新专项项目（cstc2017shmsA130063）

Preliminary report on partial pressure changes of oxygen and carbon dioxide in umbilical artery and vein before and after the first breath in Chinese neonates I—The group difference of partial pressure of oxygen and carbon dioxide between umbilical artery and vein in newborns

LIU Fang¹, SUN Xing-guo, LI Qi-wei², GE Wan-gang¹, LI Hao¹, LIU Yan-ling¹, CI Zheng^1,3, CHEN Sheng-ping², SONG Gui-qin², WANG Gui-zhi^1,3, TAN Xiao-yue¹, CUI Yan¹, ZHANG Ye¹, ZHU Jia-bao^1,4, LI Yin-jun^1,5, DENG Wei^1,6, HUANG Yan^1,7, MA Ming-xin^1,7, CHEN Rong^1,7, ZOU Yu-xin^1,8, TAI Wen-qi¹, XU Fan¹, SHI Chao¹

1. Department of Cardiology,Fuwai Hospital,Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/ State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College,Beijing 100037;
2. Electric Power Teaching Hospital of Capital Medical University (Beijing Electric Power Hospital of State Grid Co. of China),Beijing 100073;
3. Weifang Medical University, Weifang 261053;
4. The Second Hospital of Hebei Medical University,Shijiazhuang 050005;
5. Kangle Hospital of Chengguan District, Lanzhou 730030;
6. The Affiliated Rehabilitation Hospital of Chongqing Medical University, Chongqing 400050;
7. Dalian Children's Hospital,Dalian 116000;
8. Liaocheng People's Hospital, Liaocheng 252000, China

Received:2020-08-12 Revised:2021-01-05 Published:2021-10-21

摘要/Abstract

摘要： 目的: 胎儿没有实际上的呼吸,新生儿出生后才开始呼吸,我们假设人的第一次呼吸主要是由于低氧而触发。本研究对流经主动脉体外周化学感受器后的脐带动脉血液氧分压（PuaO₂）变化规律和下限进行分析以探讨新生儿自主呼吸产生机制。方法: 选择签署知情同意书的正常分娩产妇数十例,仅14例新生儿在自主呼吸开始前成功完成脐带动脉或静脉置管。分别进行逐搏取血及顺序血气分析,计算血气指标的平均值、最高值和最低值,统计比较脐带动静脉的异同。结果: 在14例新生儿自主呼吸开始前完成采集脐带动脉（Pua）样本9例,脐带静脉（Puv）样本8例。就PO₂而言,所有9例PuaO₂随时间（心跳次数）呈逐渐降低倾向,直至在自主呼吸产生大约8~10次心跳后Pua挛缩、基本上无法取得足够的血样。PuaO₂平均值是（25.94±6.79,18.04~37.51）mmHg,最高值是（29.11±6.46,23.00~45.90）mmHg,最低值是（21.34±5.54,14.00~33.60）mmHg;但PuaCO₂变化趋势和规律则不够稳定,PuaCO₂平均值是（47.26 ±7.71） mmHg。PuvO₂随时间（心跳次数）虽也呈逐渐降低趋势,但多数还呈现随母亲呼吸节律的规律性交替升降的倾向,特别是母亲吸氧时。所有8例PuvO₂平均值是（53.35±21.35,32.56~100.73）mmHg,最高值是（90.38±48.44,43.40~153.00）mmHg,最低值是（36.96±14.90,24.80~73.80）mmHg;PuvCO₂平均值是（41.04±6.44)mmHg。虽然有着较大的个体差异,但 PuvO₂平均值、最高值和最低值均显著较PuaO₂高（P<0.05）;PuvCO₂虽略低于PuaCO₂,但无显著差异（P>0.05）。结论: 胎儿娩出为新生儿后自主呼吸前PuaO₂随时间（心跳次数）逐渐降低,在达到触发呼吸的阈值时诱发第一次吸气,从而开始自主呼吸。

关键词: 新生儿出生后呼吸前, 脐带动脉和脐带静脉连续逐搏取血, 血液气体分析, 脐带动脉血氧分压, 呼吸调节控制信号

Abstract: Objective: The fetus has no actual respiration, and the newborn begins to breathe after birth. We assume that the first breath dominantly generated by hypoxia. In this study, the changes and lowest limit of blood oxygen partial pressureof umbilical artery (PuaO₂) after chemoreceptor were analyzed to explore the mechanism of neonatal spontaneous breathing. Methods: With signed consent form by all fetal parents before birth, 14 newborns successfully completed the umbilical artery or vein catheterization and drawn blood according to the heartbeat. All blood samples analyzed by blood gas analyzer,calculated and analyzed the similarities and differences between umbilical vein(Puv) and umbilical artery(Pua). Results: Although we completed 14 newborns, there were only 9 cases of umbilical artery samples and 8 cases of umbilical vein samples were collected. Only 3 cases collected both Pua and Puv blood samples at the same time (see serial paper II). PuaO₂ in gradually decreased with time (heartbeat frequency), until Pua contracted after spontaneous breathing produced about 8~10 heartbeats, and then could not get enough blood samples. Only 3 newborns were able to take blood samples after spontaneous breathing for 8~10 heartbeats, and their PuaO₂ were jumped to 186.0, 137.0 and 93.8 mmHg respectively. The mean value of PuaO₂ was (25.94±6.79, 18.04~37.51)mmHg, the highest value was (29.11±6.46, 23.00~45.90)mmHg, and the lowest value was (21.34±5.54, 14.00~33.60)mmHg. Although PuvO₂ decreased gradually with time (heartbeat) too, most of them also showed the tendency of alternately rising and falling with the regularity of mother's respiration. The mean value of PuvO₂ was (53.35±21.35, 32.56~100.73)mmHg, the highest value was (90.38±48.44, 43.40~153.00)mmHg, and the lowest value was (36.96±14.90, 24.80~73.80)mmHg. Although there were large individual differences, the mean, highest and lowest values of PuvO₂ were significantly higher than those of PuaO₂ (P<0.05); although PuvCO₂ slightly lower than PuaCO₂, it was no significant difference (P>0.05). Conclusion: PuaO₂decreases gradually with time before spontaneous breathing after the delivered fetus as a newborn, and it induces the first inhalation to start spontaneous breathing when it reaches the threshold of triggering breathing.

Key words: newborn after birth before breathing, umbilical artery and umbilical vein take blood continuously, blood gas analysis, umbilical arterial oxygen partial pressure, respiratory regulation control signal

中图分类号:

R332

刘方, 孙兴国, 李启威, 葛万刚, 李浩, 刘艳玲, 慈政, 陈升平, 宋桂芹, 王桂芝, 谭晓越, 崔闫, 张也, 朱嘉宝, 李银俊, 邓维, 黄燕, 马铭欣, 陈荣, 邹昱馨, 台文琦, 徐凡, 石超. 新生儿首次呼吸前后脐带动静脉血液氧和二氧化碳变化探索呼吸调控机制的初步报告I—血液氧和二氧化碳分压脐带动静脉差值的组间分析^*[J]. 中国应用生理学杂志, 2021, 37(1): 1-8.

LIU Fang, SUN Xing-guo, LI Qi-wei, GE Wan-gang, LI Hao, LIU Yan-ling, CI Zheng, CHEN Sheng-ping, SONG Gui-qin, WANG Gui-zhi, TAN Xiao-yue, CUI Yan, ZHANG Ye, ZHU Jia-bao, LI Yin-jun, DENG Wei, HUANG Yan, MA Ming-xin, CHEN Rong, ZOU Yu-xin, TAI Wen-qi, XU Fan, SHI Chao. Preliminary report on partial pressure changes of oxygen and carbon dioxide in umbilical artery and vein before and after the first breath in Chinese neonates I—The group difference of partial pressure of oxygen and carbon dioxide between umbilical artery and vein in newborns[J]. CJAP, 2021, 37(1): 1-8.

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新生儿首次呼吸前后脐带动静脉血液氧和二氧化碳变化探索呼吸调控机制的初步报告I—血液氧和二氧化碳分压脐带动静脉差值的组间分析^*

Preliminary report on partial pressure changes of oxygen and carbon dioxide in umbilical artery and vein before and after the first breath in Chinese neonates I—The group difference of partial pressure of oxygen and carbon dioxide between umbilical artery and vein in newborns

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