Räsänen J, Alahuhta S, Kangas-Saarela T, Jouppila R, Jouppila P
Department of Obstetrics and Gynaecology, University of Oulu, Oulu, Finland.
Int J Obstet Anesth. 1991 Sep;1(1):3-8. doi: 10.1016/0959-289x(91)90022-i.
The effects of two vasopressors, ephedrine and etilefrine, on blood flow in maternal uterine, fetal umbilical, middle cerebral and renal arteries and on fetal myocardial function were studied by colour Doppler and M-mode echocardiography techniques during spinal anaesthesia for caesarean section. There were 7 healthy pregnant women in each treatment group. The vascular resistance of maternal uterine arteries increased significantly after both of the vasopressors while the vascular resistance of the umbilical artery remained unchanged. Ephedrine decreased the blood velocity waveform indices in the fetal middle cerebral and renal arteries, increased fetal right ventricular contractility and decreased left ventricular inner end-diastolic dimension. Fetal heart rate was unchanged. Etilefrine caused no detectable changes in fetal haemodynamics or in fetal myocardial function. These findings demonstrate that vasopressors administered for the treatment of minor maternal arterial pressure fall produce vasoconstriction in the uterine circulation during spinal anaesthesia, yet healthy fetuses seem to tolerate these haemodynamic alterations well. On the other hand, ephedrine caused changes in fetal myocardial function and in the vascular resistance of fetal middle cerebral and renal arteries, which demonstrates the potential modifying effect of vasoactive drug given to the mother on fetal haemodynamics.
在剖宫产脊髓麻醉期间，应用彩色多普勒和M型超声心动图技术研究了两种血管升压药麻黄碱和乙基肾上腺素对母体子宫动脉、胎儿脐动脉、大脑中动脉和肾动脉血流以及胎儿心肌功能的影响。每个治疗组有7名健康孕妇。两种血管升压药使用后，母体子宫动脉的血管阻力均显著增加，而脐动脉的血管阻力保持不变。麻黄碱降低了胎儿大脑中动脉和肾动脉的血流速度波形指数，增加了胎儿右心室收缩力，并减小了左心室内舒张末期内径。胎儿心率未变。乙基肾上腺素未引起胎儿血流动力学或胎儿心肌功能的可检测变化。这些发现表明，用于治疗母体轻度动脉压下降的血管升压药在脊髓麻醉期间会使子宫循环产生血管收缩，但健康胎儿似乎能很好地耐受这些血流动力学改变。另一方面，麻黄碱引起了胎儿心肌功能以及胎儿大脑中动脉和肾动脉血管阻力的变化，这表明给予母亲的血管活性药物对胎儿血流动力学具有潜在的调节作用。
