Department of Anaesthesia, Changning Maternity and Infant Health Hospital, Shanghai, 200050, China.
Department of Anesthesiology and Perioperative Medicine, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9# Jinsui Road, Guangzhou, 510623, China.
BMC Anesthesiol. 2021 Jun 30;21(1):185. doi: 10.1186/s12871-021-01395-6.
Hypotension after neuraxial anaesthesia is one of the most common complications during caesarean section. Vasopressors are the most effective method to improve hypotension, but which of these drugs is best for caesarean section is not clear. We assessed the effects of vasopressors on the contractile response of uterine arteries and superior mesenteric arteries in pregnant rats to identify a drug that increases the blood pressure of the systemic circulation while minimally affecting the uterine and placental circulation.
Isolated ring segments from the uterine and superior mesenteric arteries of pregnant rats were mounted in organ baths, and the contractile responses to several vasopressor agents were studied. Concentration-response curves for norepinephrine, phenylephrine, metaraminol and vasopressin were constructed.
The contractile response of the mesenteric artery to norepinephrine, as measured by the pEC50 of the drug, was stronger than the uterine artery (5.617 ± 0.11 vs. 4.493 ± 1.35, p = 0.009), and the contractile response of the uterine artery to metaraminol was stronger than the mesenteric artery (pEC50: 5.084 ± 0.17 vs. 4.92 ± 0.10, p = 0.007). There was no statistically significant difference in the pEC50 of phenylephrine or vasopressin between the two blood vessels.
In vitro experiments showed that norepinephrine contracts peripheral blood vessels more strongly and had the least effect on uterine artery contraction. These findings support the use of norepinephrine in mothers between the time of neuraxial anaesthesia and the delivery of the foetus.
椎管内麻醉后低血压是剖宫产术中最常见的并发症之一。血管加压药是改善低血压最有效的方法,但哪种药物最适合剖宫产尚不清楚。我们评估了血管加压药对怀孕大鼠子宫动脉和肠系膜上动脉收缩反应的影响,以确定一种既能增加全身循环血压又能最小化对子宫和胎盘循环影响的药物。
将怀孕大鼠的子宫和肠系膜上动脉环段置于器官浴中,研究几种血管加压剂对其的收缩反应。构建去甲肾上腺素、苯肾上腺素、间羟胺和血管加压素的浓度-反应曲线。
肠系膜动脉对去甲肾上腺素的收缩反应(以药物的 pEC50 衡量)强于子宫动脉(5.617 ± 0.11 对 4.493 ± 1.35,p = 0.009),而子宫动脉对间羟胺的收缩反应强于肠系膜动脉(pEC50:5.084 ± 0.17 对 4.92 ± 0.10,p = 0.007)。两种血管之间的苯肾上腺素或血管加压素的 pEC50 无统计学差异。
体外实验表明,去甲肾上腺素对周围血管的收缩作用更强,对子宫动脉收缩的影响最小。这些发现支持在椎管内麻醉和胎儿分娩之间的母亲使用去甲肾上腺素。