The history of tocolysis
The history of tocolysis
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DOI：
10.1016/s1470-0328(03)00051-x
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发表时间：
2003-04-01
影响因子：
5.8
通讯作者：
Keirse, MJNC
中科院分区：
文献类型：
--
作者：
Keirse, MJNC
1950年，世界卫生组织（WHO）将早产定义为出生体重2500 g或以下，1961年定义为胎龄小于37周。这两个时期标志着人们越来越认识到出生时胎龄的重要性以及如何影响胎龄，而分娩力描记术的发展也促进了胎龄的重要性，因为分娩力描记术可以半客观地测量子宫收缩力。沿着而来的是，人们对能够控制子宫收缩力的药物越来越感兴趣，这种药物超越了早期的激素和胃肠道痉挛剂的经典方法。因此，20世纪60年代初，人们对尼利德林、异氧舒普林和奥西那林等药物产生了很大的研究兴趣，这些药物可以抑制子宫收缩，作为其许多β-激动剂特性之一。随后，将使用两种方法将平衡转移到子宫功能上，而不是对其他身体功能的影响。一种是在这些药物的基础上添加钙拮抗剂和β受体阻滞剂，希望这些药物能抑制子宫以外的活动。另一个是寻找同类药物，与其他受体相比，具有更大的子宫特异性和更高的选择性结合子宫。这两种方法都没有完全实现人们对它们的期望，但它们导致了大量抑制子宫收缩力的药物的可用性。随着蜀葵素作为子宫收缩调节剂的出现以及抑制其生物合成的能力，人们又尝试了另一系列抑制子宫活动的方法。这些药物包括阿司匹林、水杨酸钠、氟芬那酸、舒林酸和吲哚美辛，但有些药物显然是基于对子宫前列腺素合成如何受到影响的不充分理解。与此同时，一群其他的代理人来来去去，往往不止一次，证明了临床医生在试图解决一个知之甚少的问题时的独创性。有些，如松弛素和乙醇，出现和消失。其他药物，如钙拮抗剂，作为保护剂进入现场，防止其他药物的非子宫效应，去了，并以自己的权利重新进入现场。还有一些，如硫酸镁，来了，徘徊，并被认为对早产有影响，而不依赖于影响子宫收缩力。1964年，Mosler从希腊词干“tau okappaozeta”和“lambda upsilonepsiloniotanu”中创造了“tocolysis”一词，以概括所有这些独创性。
In 1950, the World Health Organisation (WHO) defined prematurity as a birthweight of 2500 g or less and in 1961 as a gestational age of less than 37 weeks. The time in between marks an era in which there was growing recognition of the importance of gestational age at birth and how to influence it. The latter was facilitated too by the development of tocography, which permitted some semi-objective measurement of uterine contractility. Along with it, came a growing interest in agents that could control uterine contractility beyond the earlier classical approaches of hormones and gastrointestinal spasmolytics. Hence, the early 1960s saw much research-interest in agents, such as nylidrine, isoxsuprine, and orciprenaline that could suppress uterine contractility as one of their many beta-agonist properties. Subsequently, two approaches would be used to shift the balance towards uterine function over and above the influence on other bodily functions. One consisted of supplementing these drugs with agents, such as calcium antagonists and beta-receptor blockers that were hoped to suppress non-uterine actions. The other was a search for drugs in the same class with greater uterospecificity and more selective binding to uterine as opposed to other receptors. Neither of these approaches has ever fully fulfilled the hopes that were pinned on them, but they resulted in the availability of a large number of agents to suppress uterine contractility. The advent of prostaglandins as regulators of uterine contractility and the ability to suppress their biosynthesis saw another range of attempts to suppress uterine activity. They included aspirin, sodium salicylate, flufenamic acid, sulindac and indomethacin, but some were clearly based on a defective understanding of how uterine prostaglandin synthesis can be influenced. In the meantime, a fluffy of other agents came and went, often more than once, testifying to the ingenuity of clinicians in trying to solve a problem that is poorly understood. Some, such as relaxin and ethanol, came and disappeared. Others, such as calcium antagonists, entered the scene as protectors against the non-uterine effects of other agents, went, and re-entered the scene in their own right. Still others, such as magnesium sulphate, came, lingered around, and became credited with effects in preterm labour that do not depend on affecting uterine contractility. Amidst this all arose the term tocolysis, coined in 1964 by Mosler from the Greek stems 'tau okappaozeta' and 'lambda upsilonepsiloniotanu', to epitomise all of this ingenuity.