Department of Anesthesiology and Intensive Care, Institution of Clinical Sciences Lund, Lund University, and Skåne University Hospital, Lund, Sweden.
Department of Obstetrics and Gynecology, Institution of Clinical Sciences Malmö, Lund University, and Skåne University Hospital, Malmö, Sweden.
J Matern Fetal Neonatal Med. 2023 Dec;36(1):2208252. doi: 10.1080/14767058.2023.2208252.
Oxytocin is routinely administered after delivery for prophylaxis and treatment of postpartum hemorrhage, but it is associated with considerable cardiovascular side-effects. Carbetocin, a synthetic oxytocin analogue, has a myometrial contraction effect of 60 min when given IV, compared with 16 min for oxytocin.
To investigate whether there are differences in cardiovascular effects between oxytocin and carbetocin up to 1 h after treatment.
Sixty-one healthy pregnant women undergoing elective cesarean section in spinal anesthesia were randomized to receive an IV bolus of either five units (8.3 µg) of oxytocin or 100 µg of carbetocin after delivery of the baby. Heart rate (HR), mean arterial blood pressure, ECG ST index, oxygen saturation (SaO), and photoplethysmographic digital pulse wave analysis variables were recorded before and at 1, 5, 20, and 60 min after drug administration. Vasopressor use, uterine tonus, total bleeding, and need for additional uterotonics were also assessed. Repeated measurement ANOVA was used for statistical analyses.
The drugs had equal vasodilatory and hypotensive effects. Oxytocin, but not carbetocin, caused a decrease in HR at 1 min and a sustained decrease in cardiac left ventricular ejection time. Aggregate vasopressor use was higher in the carbetocin group. Neither drug caused any change in ST index, SaO, or subjective cardiac symptoms. Uterine tonus, need for additional uterotonics, or total bleeding did not differ significantly between the groups.
Single doses of oxytocin and carbetocin had similar dilatory effects on vascular tonus, where the difference in aggregate vasopressor use can be attributed to a more persistent hypotensive effect of carbetocin. A transient negative chronotropic and sustained negative inotropic effect occurred after oxytocin. Neither drug showed any alarmingly adverse effects. Differences in drug effects may be attributed to differences in oxytocin and vasopressin receptor signaling pathways.
缩宫素常规用于产后出血的预防和治疗，但它与相当多的心血管副作用有关。卡贝缩宫素是一种合成的催产素类似物，静脉注射时子宫收缩作用持续 60 分钟，而催产素持续 16 分钟。
研究缩宫素和卡贝缩宫素在给药后 1 小时内的心血管效应是否存在差异。
61 例择期行椎管内麻醉剖宫产的健康孕妇，随机分为两组，分娩后分别静脉注射 5 单位（8.3µg）缩宫素或 100µg 卡贝缩宫素。记录给药前及给药后 1、5、20、60 分钟的心率（HR）、平均动脉血压、心电图 ST 指数、氧饱和度（SaO）和光电容积脉搏波分析变量。还评估了血管加压药的使用、子宫张力、总出血量和对额外子宫收缩剂的需求。采用重复测量方差分析进行统计学分析。
两种药物均具有同等的血管扩张和降压作用。缩宫素而非卡贝缩宫素在 1 分钟时引起心率下降，并持续降低心脏左心室射血时间。卡贝缩宫素组的综合血管加压药使用量较高。两种药物均未引起 ST 指数、SaO 或主观心脏症状的任何变化。子宫张力、对额外子宫收缩剂的需求或总出血量在两组间无显著差异。
单次剂量的缩宫素和卡贝缩宫素对血管张力具有相似的扩张作用，而综合血管加压药使用量的差异可归因于卡贝缩宫素更持久的降压作用。使用缩宫素后会出现短暂的负性变时作用和持续的负性变力作用。两种药物均未显示出任何明显的不良作用。药物作用的差异可能归因于催产素和血管加压素受体信号通路的差异。
