Pielet B W, Socol M L, MacGregor S N, Dooley S L, Minogue J
Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois.
Am J Obstet Gynecol. 1988 Sep;159(3):640-3. doi: 10.1016/s0002-9378(88)80025-5.
Because of recurrent needle dislodgement secondary to fetal movement, we have altered our intravascular transfusion technique by replacing maternal premedication (meperidine and diazepam [group 1]) with fetal intravascular infusion of pancuronium bromide (Pavulon [group 2]), a nondepolarizing neuromuscular blocking agent. Baseline fetal heart rate, number of accelerations, and variability were assessed before and after transfusion in both groups. Whereas there were no changes after transfusion in the former group, those fetuses who received pancuronium bromide demonstrated a dramatic abolishment of accelerations and decrease in variability, with the heart rate pattern often appearing "sinusoidal-like." These alterations in fetal heart rate were temporary changes that reverted to normal once the fetus "awakened" from the neuromuscular blockade. We speculate that these changes in fetal heart rate are secondary to the interaction of the reported hypertensive and vagolytic effects of pancuronium bromide.
由于胎儿活动导致反复出现针头移位，我们改变了血管内输血技术，用非去极化神经肌肉阻滞剂溴化潘库溴铵（潘龙[第2组]）进行胎儿血管内输注，取代了母体术前用药（哌替啶和地西泮[第1组]）。两组均在输血前后评估基线胎儿心率、加速次数和变异性。前一组输血后无变化，而接受溴化潘库溴铵的胎儿加速明显消失，变异性降低，心率模式常呈“正弦样”。胎儿心率的这些改变是暂时的，一旦胎儿从神经肌肉阻滞中“苏醒”，就会恢复正常。我们推测，胎儿心率的这些变化继发于溴化潘库溴铵所报道的高血压和抗迷走神经作用的相互作用。
