Spencer J A, Ryan G, Ronderos-Dumit D, Nicolini U, Rodeck C H
Department of Obstetrics and Gynaecology, University College London Medical School, UK.
Br J Obstet Gynaecol. 1994 Feb;101(2):121-4. doi: 10.1111/j.1471-0528.1994.tb13076.x.
To determine the effect of neuromuscular blockade on fetal heart rate and its variation.
Case control study.
Tertiary referral fetal medicine unit in a London teaching hospital.
Forty women with rhesus iso-immunisation requiring an intravascular fetal blood transfusion between 28 and 34 weeks gestation.
Intravascular injection of pancuronium to the fetus prior to fetal blood transfusion in 20 cases.
Comparison between the group receiving pancuronium and the control group with regard to differences in perceived fetal activity and computer derived numerical indices of fetal heart rate and fetal heart rate variation after fetal blood transfusion.
After transfusion in the control group, there were fewer perceived fetal movements, a small reduction in fetal heart rate but no differences in number of fetal heart rate accelerations or measures of fetal heart rate variation. In the study group, pancuronium produced no change in fetal heart rate despite a virtual abolition of perceived fetal movements and fetal heart rate accelerations. Measures of fetal heart rate variation were reduced by 60%. Comparison of the pre- to post-transfusion changes between the two groups showed significant differences for all fetal heart rate indices.
Fetal activity accounts for more than half the measured variation of the human fetal heart rate.
确定神经肌肉阻滞对胎儿心率及其变异性的影响。
病例对照研究。
伦敦一家教学医院的三级转诊胎儿医学科。
40例妊娠28至34周需要进行胎儿血管内输血的恒河猴血型不合免疫孕妇。
20例在进行胎儿输血前向胎儿血管内注射泮库溴铵。
比较接受泮库溴铵治疗的组与对照组在胎儿输血后感知到的胎儿活动差异，以及计算机得出的胎儿心率和胎儿心率变异性数值指标。
对照组输血后，感知到的胎儿活动减少，胎儿心率略有下降，但胎儿心率加速次数或胎儿心率变异性指标无差异。在研究组中，尽管几乎完全消除了感知到的胎儿活动和胎儿心率加速，但泮库溴铵对胎儿心率没有影响。胎儿心率变异性指标降低了60%。两组输血前后变化的比较显示，所有胎儿心率指标均有显著差异。
胎儿活动占所测人类胎儿心率变异性的一半以上。
