剖宫产臀位分娩时硬膜外麻醉下的子宫松弛

Ezra Yossef, Wade Carol, Rolbin Stephen H, Farine Dan

Departments of Obstetrics and Gynecology and of Anesthesiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

J Reprod Med. 2002 Jul;47(7):555-8.

OBJECTIVE

To assess the safety and efficacy of ritodrine and nitroglycerin for uterine relaxation during cesarean section with a breech-presenting fetus, performed under nongeneral anesthesia.

STUDY DESIGN

A retrospective review of all breech singletons delivered by cesarean section under epidural anaesthesia in a two-year period. The study groups consisted of those who received ritodrine and those who received nitroglycerin. A group who received no relaxant served as a comparison group. The interval from uterine incision to delivery was recorded, and comparisons for potential complications of the medications included maternal changes in pulse and blood pressure, blood loss, and changes in hemoglobin and hematocrit. Fetal outcomes that were evaluated included five-minute Apgar score, cord pH and any recorded birth trauma. Statistical significance was set at P = .05. The Student t test, Yates's correlation for chi 2, Fisher's exact test and ANOVA were used as appropriate.

RESULTS

The three groups had similar demographic characteristics. There was no significant difference in the uterine incision to delivery interval between the groups. In three cases the uterine incision to delivery interval was prolonged (> 5 minutes) in the nitroglycerin group, six cases in the ritodrine group and three in the comparison group (P = .002). There was no case of serious maternal morbidity or mortality, and no patient required a blood transfusion. The three groups had similar estimated blood loss, changes in maternal heart rate and systolic blood pressure intraoperatively and fall in hemoglobin and hematocrit 24 hours postoperatively. Neonatal outcome was similar among the three groups, and there was no case of neonatal birth trauma or intrapartum death. Cord blood analysis was similar in the three groups. One of the seven infants weighing < 1,500 g died within one hour of birth.

CONCLUSION

Ritodrine and nitroglycerine are safe agents for use at cesarean breech delivery with epidural anesthesia and may be considered for uterine relaxation when a traumatic delivery is anticipated or encountered. Our results do not support the use of these tocolytics for "routine" cesarean breech delivery.

目的

评估利托君和硝酸甘油在非全身麻醉下剖宫产分娩臀位胎儿时用于子宫松弛的安全性和有效性。

研究设计

对两年内硬膜外麻醉下剖宫产分娩的所有单胎臀位进行回顾性研究。研究组包括接受利托君的患者和接受硝酸甘油的患者。未接受松弛剂的一组作为对照组。记录子宫切开至分娩的间隔时间，并比较药物的潜在并发症，包括产妇脉搏和血压的变化、失血情况以及血红蛋白和血细胞比容的变化。评估的胎儿结局包括5分钟阿氏评分、脐血pH值以及任何记录的出生创伤。统计学显著性设定为P = 0.05。根据情况适当使用学生t检验、Yates卡方相关性检验、Fisher精确检验和方差分析。

结果

三组具有相似的人口统计学特征。各组之间子宫切开至分娩的间隔时间无显著差异。硝酸甘油组有3例子宫切开至分娩的间隔时间延长（>5分钟），利托君组有6例，对照组有3例（P = 0.002）。无严重产妇发病或死亡病例，也无患者需要输血。三组的估计失血量、术中产妇心率和收缩压变化以及术后24小时血红蛋白和血细胞比容下降情况相似。三组的新生儿结局相似，无新生儿出生创伤或产时死亡病例。三组的脐血分析结果相似。7名体重<1500 g婴儿中有1名在出生后1小时内死亡。