| Objective:Preeclampsia,which happens20weeks after pregnancy, with hypertension and proteinuria as main clinical features, accompanies with multiple organ failure and leads to convulsion, coma even death. Currently, causes and pathomechanism of preeclampsia are still a serious problem in perinatology. Changs in protein expression of placenta tissue during preeclampsia is a key role for this disease progression.Nowadays, preeclampsia is devided into two phases. The first phase is non-clinical symptoms period. Mian features of this period are heteroplasia of placenta tissue leads to ischemia and hypoxia of placenta tissue, then plenty of toxic substances are released to maternal circulation. There are no clinical symptoms during this period. The second phase is clinical symptoms period.Chief manifestations are hypertesion, renal damage, proteinuria, even HELLP syndrome (hemolysis, increased hepatic enzymes, low platelet coumt), eclampsia and other organs damages.Placenta is a special organ in pregnancy because of its impact on fetus growth and maternal health. Thus, the pathology condition of placenta is associated with fetal growth restriction and preeclampsia. More and more studies proved that placenta implantation dysfunction and proinflammatory cytokines production are critical factor for preeclampsia pathogenesis. The mechanism focus on hypoxia of placenta and generation of anti-angiogenic factors such as sEng, VEGF and PIGFwhich are released from placenta tissue, result in preeclampsia.Furthermore, any pain and nervous feeling can cause convulsion and even threat to maternal and child’s life for severe preeclampsia patients. Pregnancy termination is only effective way to save patients’ lives. Inhalation anesthesia is ideal choice for pregnancy termination surgery and sevoflurane is the best of all anesthesia drugs which are used in gynecologic surgery. Because it has low blood gas distribution ratio, rapid induced anesthesia and revival, extensive metabolism in body and no influence for Apgar evaluation of the newborn.The potential medical applications of sevoflurane in gynaecology and obstetrics are exciting. In this research we use sevoflurane to incubate placenta tissue from severe preeclampsia patients to observe how the sEng expresses.Our research is made of two parts.Part One:Impact of sevoflurane on sEng expression of placenta tissue and peripheral blood which are collected from severe preeclampsia patients.Severe preeclampsia is one kind of preeclampsia, is main cause of maternal and child deaths. This part of study focus on severe preeclampsia patients’placenta isolation and sEng expression of placenta after sevoflurane incubation to find out connection between sevoflurane and sEng.PurposeELIS A tests level of sEng in peripheral blood and umbilical cord blood from severe preeclampsia patients compared with nomal controls. ELISA tests level of sEng in placenta tissue from severe preeclampsia patients with sevoflurane incubation or not. The effect of sevoflurane on expression of sEng offers a new idea for therapy and surgery anesthesia of preeclampsia patients.Method1. Object:48severe preeclampsia patients who undergo cesarean operation from June2012to Jan2013in Women’s Hospital School of Medicine Zhejiang University. Diagnostic criteria is refered to 《Weems Obstetrics》 including no past medical history of hypertension, heart attack, kidney disease, diabetes and hyperthyoidism.2.1hr-1MAC-sevoflurane is incubatedwith placentaafter24hr-culture,then test level of sEng of placenta with sevoflurane incubation or not by ELISA.Results1. Level of sEng from umbilical cord blood is higher than that from peripheral blood. 2. Level of sEng from sevoflurane is incubated placenta is lower that without sevoflurane incubation.ConclusionsEng is the major factor of preeclampsia, but sEng expression from sevoflurane is incubated placenta is lower, indicating that sevoflurane may alleviate clinical symptoms of preeclampsia.Part Two:Impact of sevoflurane on skelemin expression of trophoblastic cells isolated from placenta tissue which are collected from severe preeclampsia patients by immunblotting.PurposeMany studies demonstrated that expression of skelemin-9in placenta tissue from preeclampsia patients is markedly higher than that from the healthy, but related mechanism is rarely reported. Therefore, influence of sevoflurane on skelemin-9expression of severe preeclampsia patients’ placenta tissue arouses our interest.Method1.Objects:40severe preeclampsia patients who undergo cesarean operation and20normal pregnant woman who have nomal delivery from August2012to May2013in Women’s Hospital School of Medicine Zhejiang University. Then we collect all placenta tissue from total60parturients2. Healthy pregnant women are labeled Group A, the others are devided into two groups named B and C. Group B is incubated with37℃5%CO2-95%O2meanwhile group C with37℃5%CO2-95%O2-sevoflurane.3. We test expressions of cytoskelemin-9from3groups, and observe expression variation of severe preeclampsia patients’ placenta under sevoflurane incubation.ResultsExpression of skelemin-9in severe preeclampsia patients’ placenta is much higher than normal ones’. However the level of skelemin-9in sevoflurane incubated group is lower than without sevoflurane group, but higher than normal group.Conclusion 1. skelemin-9is upregulated in severe preeclampsia patients’ placenta compared to normal pregnant women.2. Sevoflurane can reduce expression level of skelemin-9in severe preeclampsia patients. |
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