FETAL CARDIAC EFFECTS OF ORAL RITODRINE TOCOLYSIS
FETAL CARDIAC EFFECTS OF ORAL RITODRINE TOCOLYSIS
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DOI：
10.1055/s-2007-994567
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发表时间：
1994-03-01
影响因子：
2
通讯作者：
HOSKINS, IA
中科院分区：
文献类型：
--
作者：
FRIEDMAN, DM;BLACKSTONE, J;HOSKINS, IA
β-交感神经刺激性口服利托君可引起母体心动过速和低血压，并可能穿过胎盘。一种新的超声心动图技术已经被开发出来，以探索胎儿和胎盘利托君的影响。将76名健康的历史对照组与16名患者的18项研究进行比较，同时接受稳定的利托君治疗，分别在基线和服药后30分钟进行测量。收集的数据包括母亲的脉搏和血压(BP)、胎儿大脑和脐带多普勒波形以及胎儿心率。从二维M型超声获得了一种新的评价胎儿心肌收缩能力的指标--综合室壁缩短分数。母体脉搏和血压、胎心率和心脏大小、所有多普勒指数均正常，无明显的剂量-反应效应。在对照组中，随着胎龄的增加，合并的室壁缩短分数下降(合并的室壁缩短分数=-0.27，估计胎龄+49；r=0.27；P<或等于-0.02；估计的标准差，11%)。然而，在利托君患者中，72%的患者合并心室短轴缩短率异常降低。正常人的平均指数为43+/-5%，而利托君患者仅为31%。我们得出结论，有早产史或口服利托君，或两者兼有，与缩短率降低有关。由于胎盘阻力、脑缺氧、胎心率或心脏大小(前负荷)没有变化，那么较低的短轴缩短率可能是由于胎儿全身血管阻力(BP)增加或心肌收缩能力降低所致。
The beta-sympathomimetic oral tocolytic ritodrine can cause maternal tachycardia and hypotension, and may cross the placenta. A new echocardiographic technique has been developed to explore fetal and placental ritodrine effects. Values in 76 healthy historic controls were compared to 18 studies in 16 patients performed while receiving stable oral ritodrine therapy, measured both at baseline and 30 minutes after a dose. Data collected included maternal pulse and blood pressure (BP), fetal cerebral and umbilical Doppler waveforms, and fetal heart rate. A new index of fetal myocardial contractility, combined ventricular shortening fraction, was derived from two-dimensionally directed M-mode. Maternal pulse and BP, fetal heart rate and heart size, and all Doppler indices were normal, without demonstrable dose-response effects. In the control subjects, combined ventricular shortening fraction fell with increasing gestational age (combined ventricular shortening fraction = -0.27 estimated gestational age + 49; r = 0.27; P less-than-or-equal-to 0.02; standard error of the estimate, 11%). However, combined ventricular shortening fraction in ritodrine patients was abnormally decreased in 72% of cases. The mean index in normal subjects was 43 +/- 5%, but in ritodrine patients it was only 31%. We conclude that a history of premature labor or oral ritodrine, or both, is associated with reduced shortening fraction. Since there was no change in placental resistance, cerebral hypoxia, fetal heart rate, or heart size (preload), then low shortening fraction may be due to increased fetal systemic vascular resistance (BP) or decreased myocardial contractility.