Miller Suzanne L, Loose Jan M, Jenkin Graham, Wallace Euan M
Monash Immunology and Stem Cell Laboratories, Monash University, VIC, Australia.
Am J Obstet Gynecol. 2009 Jan;200(1):102.e1-7. doi: 10.1016/j.ajog.2008.08.029. Epub 2008 Oct 9.
This study examined whether the type-5 phosphodiesterase inhibitor sildenafil citrate (Viagra; Pfizer, New York, NY) could increase uterine blood flow in intrauterine growth restriction (IUGR), thereby improving fetal oxygenation and well being.
In fetal sheep, we induced IUGR at 105-110 days (0.7 gestation) using single umbilical artery ligation (SUAL). In SUAL and control animals, we measured uterine blood flow (UBF) and blood gases before and after sildenafil administration.
SUAL fetuses were hypoxemic compared with controls. Following sildenafil, UBF was significantly decreased in both SUAL and control ewes for approximately 40 minutes. In response to sildenafil, pO(2) was decreased in SUAL and control fetuses and both groups displayed significant hypotension and tachycardia. At postmortem SUAL fetal body weight was significantly reduced by 23% compared with controls.
Sildenafil does not improve UBF or fetal well being in SUAL-induced IUGR pregnancies and should be used with caution in IUGR and healthy pregnancies because of its detrimental effects on uteroplacental perfusion and on the fetus.
本研究旨在探讨5型磷酸二酯酶抑制剂枸橼酸西地那非（万艾可；辉瑞公司，纽约州纽约市）是否能增加宫内生长受限（IUGR）孕妇的子宫血流量，从而改善胎儿氧合及健康状况。
在胎羊中，于妊娠105 - 110天（妊娠0.7期）采用单脐动脉结扎术（SUAL）诱导IUGR。在接受SUAL手术的动物和对照动物中，我们在给予西地那非前后测量子宫血流量（UBF）和血气。
与对照组相比，接受SUAL手术的胎儿存在低氧血症。给予西地那非后，SUAL组和对照组母羊的UBF均显著下降约40分钟。对西地那非的反应中，SUAL组和对照组胎儿的pO₂均下降，且两组均出现显著低血压和心动过速。尸检时，与对照组相比，接受SUAL手术的胎儿体重显著降低23%。
在SUAL诱导的IUGR妊娠中，西地那非不能改善UBF或胎儿健康状况，鉴于其对子宫胎盘灌注和胎儿有不利影响，在IUGR妊娠和健康妊娠中应谨慎使用。
