Matsuda Chie, Hayashi Shusaku, Kinouchi Keiko
Department of Anesthesia and Intensive Care, Research Institute for Maternal and Child Helath, Izumi 594-1101.
Masui. 2013 Apr;62(4):390-4.
Rapid and transient uterine relaxation is sometimes required for fetal distress or difficult delivery due to uterine hyperactivity during cesarean section. For its rapid onset and short duration, intravenous nitroglycerin (NTG) is commonly used for this purpose. But its suitable dose is unclear.
We evaluated the effect of NTG 200 microg on uterine relaxation in 14 parturients who required rapid uterine relaxation during cesarean delivery from October 2010 to March 2011. We assessed the softness of the uterus, maternal hemodynamic changes after NTG administration, blood loss, uterine contraction after delivery, and Apgar scores.
Obstetricians graded the uterus as "moderately soft" in 9, and "very soft" in 5 patients, respectively. Uterine contraction after delivery was good with intravenous oxytocin or dinoprost. Blood loss was acceptable. Six patients exhibited moderate but transient hypotension, and in two of which blood pressure was immediately restored with phenylephrine 100 microg. Four patients complained of nausea and 1 patient complained of headache, but all of which were transient. Median Apgar scores at 1 and 5 minutes were 8.0 and 8.5, respectively.
This study indicated that an intravenous administration of NTG 200 microg was effective for rapid uterine relaxation during cesarean delivery.
剖宫产时，有时因子宫活动亢进导致胎儿窘迫或难产，需要子宫快速短暂松弛。静脉注射硝酸甘油（NTG）起效迅速、作用时间短，常用于此目的。但其合适剂量尚不清楚。
2010年10月至2011年3月期间，我们评估了200微克NTG对14例剖宫产时需要子宫快速松弛的产妇子宫松弛的效果。我们评估了子宫的柔软度、NTG给药后产妇的血流动力学变化、失血量、产后子宫收缩及阿氏评分。
产科医生将9例患者的子宫评为“中度柔软”，5例评为“非常柔软”。静脉注射缩宫素或地诺前列素后，产后子宫收缩良好。失血量可接受。6例患者出现中度但短暂的低血压，其中2例静脉注射100微克去氧肾上腺素后血压立即恢复。4例患者主诉恶心，1例主诉头痛，但均为短暂症状。1分钟和5分钟时阿氏评分中位数分别为8.0和8.5。
本研究表明，剖宫产时静脉注射200微克NTG对子宫快速松弛有效。
