Nitroglycerin Therapy for Phenylephrine‐Induced Hypertension in Pregnant Ewes
Nitroglycerin Therapy for Phenylephrine‐Induced Hypertension in Pregnant Ewes
复制标题
硝酸甘油治疗妊娠母羊苯肾上腺素诱发的高血压
作者：
J. Craft;E. G. Co;M. Yonekura;R. Gilman
产科情况下，内源性或外源性血管活性胺急剧增加母体血压和减少子宫血流量可能与产妇发病率和死亡率增加，并与胎儿酸中毒和窘迫的发展。我们研究了在输注α-肾上腺素能药物苯肾上腺素时，硝酸甘油在降低母体血压和增加子宫血流量方面的有效性。在苯肾上腺素输注期间，母体血压升高20%，心输出量降低25%，总外周血管阻力升高60%，肺动脉压升高40%，子宫血流量降低50%，胎儿动脉pH值从7.37降至7.30（p < 0.05）。在维持苯丙氨酸输注速率恒定的同时，输注硝酸甘油使母体全身压和肺动脉压迅速恢复至对照值，使总外周阻力降低至对照值以上18%，使心输出量增加至对照值以下12%，使子宫动脉血流量增加至对照值以下30%，胎动脉pH值由7.30升高至7.35（P < 0.05）。可以得出结论，母体高血压导致强烈的α-肾上腺素能刺激可以快速有效地治疗硝酸甘油的静脉输注与子宫动脉血流的部分恢复（20%）向控制。
Obstetrical situations in which endogenous or exogenous vasoactive amines precipitously increase maternal blood pressure and decrease uterine blood flow may be associated with increased maternal morbidity and mortality and with development of fetal acidosis and distress. We examined the effectiveness of nitroglycerin in lowering maternal blood pressure and increasing uterine blood flow during the infusion of the alpha-adrenergic agent phenylephrine. During the phenylephrine infusion maternal blood pressure increased 20%, cardiac output decreased 25%, total peripheral vascular resistance increased 60%, pulmonary arterial pressure increased 40%, uterine blood flow decreased 50%, and fetal arterial pH decreased from 7.37 to 7.30 (p < 0.05). While maintaining the phenylephrine infusion at a constant rate, the infusion of nitroglycerin rapidly returned maternal systemic pressure and pulmonary arterial pressure to control values, decreased total peripheral resistance to 18% above control, increased cardiac output to 12% below control, increased uterine artery blood flow to 30% below control, and increased the fetal arterial pH from 7.30 to 7.35 (p < 0.05). It is concluded that maternal hypertension resulting from intense alpha-adrenergic stimulation may be treated rapidly and effectively by the intravenous infusion of nitroglycerin with a partial restoration (20%) of uterine artery blood flow toward control.