Marcus M A, Vertommen J D, Van Aken H
Department of Anesthesiology, University Hospitals, Katholieke Universiteit, Leuven, Belgium.
Anesth Analg. 1995 May;80(5):949-54. doi: 10.1097/00000539-199505000-00016.
Administration of fluids intravenously prior to spinal and epidural analgesia in obstetrics is required to prevent maternal hypotension and fetal hypoxia. A colloid solution, such as hydroxyethyl starch (HES), might be preferable considering the capacity to stay intravascularly for a longer period. In this study the placental transfer of HES and the hemodynamic effects after infusion were investigated using a chronic maternal-fetal sheep preparation. Either 500 mL HES 10% or 750 mL lactated Ringer's solution (RL) was infused intravenously into the ewe over 30 min. Fetal and maternal blood were assayed for HES, blood gases, and acid-base status before and at regular intervals after infusion. Maternal and fetal cardiovascular variables were recorded continuously for 90 min. After HES infusion, maternal HES levels peaked at 30 min ranging from 6.9 mg/mL to 12.1 mg/mL and declined at 24 h to levels between 0.3 mg/mL and 2.8 mg/mL. Mean fetal HES concentrations remained below 0.3 mg/mL. Infusion of HES decreased hemoglobin (Hb) and plasma viscosity (PV) in the mother. Infusion of RL decreased Hb, but did not change PV. Infusion of HES significantly increased uterine blood flow (UBF), cardiac output (CO), total oxygen-delivery capacity, and uterine artery oxygen delivery. In contrast, infusion of RL did not significantly change these variables. Infusion of HES increases UBF, CO, and uterine and total oxygen-carrying capacity in the pregnant ewe. No significant transplacental transfer of HES was shown.
在产科进行脊髓和硬膜外镇痛之前，需要静脉输注液体以预防产妇低血压和胎儿缺氧。考虑到在血管内停留时间更长的能力，胶体溶液，如羟乙基淀粉（HES）可能更可取。在本研究中，使用慢性母胎绵羊制备方法研究了HES的胎盘转运及输注后的血流动力学效应。将500 mL 10%的HES或750 mL乳酸林格氏液（RL）在30分钟内静脉输注到母羊体内。在输注前及输注后定期检测胎儿和母体血液中的HES、血气和酸碱状态。连续记录母体和胎儿心血管变量90分钟。输注HES后，母体HES水平在30分钟时达到峰值，范围为6.9 mg/mL至12.1 mg/mL，并在24小时时下降至0.3 mg/mL至2.8 mg/mL之间。胎儿平均HES浓度保持在0.3 mg/mL以下。输注HES可降低母体的血红蛋白（Hb）和血浆粘度（PV）。输注RL可降低Hb，但不改变PV。输注HES可显著增加子宫血流量（UBF）、心输出量（CO）、总氧输送能力和子宫动脉氧输送。相比之下，输注RL对这些变量没有显著影响。输注HES可增加妊娠母羊的UBF、CO以及子宫和总携氧能力。未显示HES有明显的胎盘转运。
