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剖宫产腰麻下麻黄碱和去氧肾上腺素对胎盘血管阻力的影响

The Effects of Ephedrine and Phenylephrine on Placental Vascular Resistance During Cesarean Section Under Epidual Anesthesia.

作者信息

Guo Ran, Xue Qin, Qian Yanning, Hu Yongming, Tan Jie

机构信息

Department of Anesthesiology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China.

Department of Ultrasound Diagnosis, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China.

出版信息

Cell Biochem Biophys. 2015 Dec;73(3):687-93. doi: 10.1007/s12013-015-0676-7.

Abstract

The purpose of this article is to study the effect of ephedrine and phenylephrine on placental vascular resistance during cesarean section under epidural anesthesia via Doppler ultrasonography. Sixty female subjects, scheduled for elective cesarean section and had an intrathecal injection of bupivacaine, were randomly divided into two groups to receive phenylephrine (50 μg/min) or ephedrine (4 mg/min) via titration to maintain systolic blood pressure at baseline. Doppler ultrasonography was used to measure baseline vascular resistance values prior to administration of anesthesia, and resistance index (RI) and systolic peak velocity/diastolic velocity (S/D) values of umbilical artery and uterine artery were measured at each time point within first 20 min following intrathecal injection. Blood samples were collected from umbilical artery and umbilical vein during delivery to assess the blood gas values. No significant differences in RI and S/D values of umbilical artery and uterine artery after intrathecal injection were found between two groups. RI and S/D values of uterine artery slightly increased in both groups at each time point after anesthesia, but remained within the normal range. No significant differences were observed in blood gas values and the total amount of vasoconstriction drugs between two groups. In contrast to previous reports that used animal models, our study did not show increased placental vascular resistance in patients following phenylephrine (50 μg/min) or ephedrine (4 mg/min) infusion, as well as no significant differences in the effect of either of these two. The discrepancy between the results of human and animal studies may be related to species differences and the mechanism of human placental vascular remodeling.

摘要

本文旨在通过多普勒超声研究硬膜外麻醉下剖宫产术中麻黄碱和去氧肾上腺素对胎盘血管阻力的影响。60例计划行择期剖宫产且鞘内注射布比卡因的女性受试者,被随机分为两组,通过滴定法分别接受去氧肾上腺素(50μg/min)或麻黄碱(4mg/min),以维持收缩压在基线水平。在麻醉给药前,使用多普勒超声测量基线血管阻力值,并在鞘内注射后的前20分钟内的每个时间点测量脐动脉和子宫动脉的阻力指数(RI)以及收缩期峰值速度/舒张期速度(S/D)值。分娩时从脐动脉和脐静脉采集血样以评估血气值。两组鞘内注射后脐动脉和子宫动脉的RI和S/D值无显著差异。两组在麻醉后各时间点子宫动脉的RI和S/D值均略有升高,但仍在正常范围内。两组间血气值和血管收缩药物总量无显著差异。与之前使用动物模型的报道相反,我们的研究未显示在输注去氧肾上腺素(50μg/min)或麻黄碱(4mg/min)后患者的胎盘血管阻力增加,且这两者的效果也无显著差异。人体和动物研究结果的差异可能与物种差异以及人类胎盘血管重塑机制有关。

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