Which vasopressor should be used to treat hypotension during magnesium sulfate infusion and epidural anesthesia?
Which vasopressor should be used to treat hypotension during magnesium sulfate infusion and epidural anesthesia?
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硫酸镁输注和硬膜外麻醉期间应使用哪种血管升压药治疗低血压？
DOI：
10.1097/00000542-199207000-00015
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发表时间：
1992
期刊：
影响因子：
8.8
通讯作者：
Chatterjee,P
中科院分区：
文献类型：
--
作者：
Sipes,SL;Chestnut,DH;VincentJr,RD;DeBruyn,CS;Bleuer,SA;Chatterjee,P
麻黄碱恢复和/或保护实验动物子宫血流和胎儿健康。相反，α 1-肾上腺素能激动剂使子宫血流和胎儿状况恶化。我们以前证明，硫酸镁（MgSO 4）减弱苯乙哌啶对妊娠母羊子宫血管阻力的不利影响。因此，我们进行了这项研究，以确定是否麻黄碱或苯丙氨酸更好地恢复和保护子宫血流和胎儿氧合在硬膜外麻醉诱导的低血压高镁妊娠母羊。12只长期仪器化的妊娠母羊各自用于三个实验：1）麻黄碱，2）苯丙氨酸，和3）生理盐水（NS）-对照。对于每个实验，方案如下：1）在时间零点，开始静脉输注MgSO 4; 2）在150分钟时，用2%利多卡因达到硬膜外麻醉的胸水平; 3）165 min时开始静脉滴注麻黄碱、苯肾上腺素或NS，持续195 min。硬膜外麻醉均匀地降低母体平均动脉压（MAP），心率、心输出量、子宫血流量和胎儿PO 2。麻黄碱和苯丙氨酸均使母体MAP恢复至基线水平，与实验设计的预期一致。麻黄碱显着增加心输出量和子宫血流量相比，NS-控制，但苯肾上腺素没有。与NS-对照组相比，苯丙氨酸显著增加子宫血管阻力，但麻黄碱没有。因此，胎儿pH值和PO 2显着更大的麻黄碱输液过程中比NS-对照输液。在麻黄碱输注期间，胎儿pH值稳定，但在苯丙氨酸输注期间继续下降。（250字处删节）
Ephedrine restores and/or protects uterine blood flow and fetal well-being in laboratory animals. In contrast, alpha 1-adrenergic agonists worsen uterine blood flow and fetal condition. We previously demonstrated that magnesium sulfate (MgSO4) attenuates the detrimental effects of phenylephrine on uterine vascular resistance in gravid ewes. Therefore, we performed this study to determine whether ephedrine or phenylephrine better restores and protects uterine blood flow and fetal oxygenation during epidural anesthesia-induced hypotension in hypermagnesemic gravid ewes. Twelve chronically instrumented gravid ewes were each used for three experiments: 1) ephedrine, 2) phenylephrine, and 3) normal saline (NS)-control. For each experiment the protocol was as follows: 1) at time zero, intravenous infusion of MgSO4 was begun; 2) at 150 min a thoracic level of epidural anesthesia was achieved with 2% lidocaine; and 3) at 165 min, an intravenous infusion of ephedrine, phenylephrine, or NS was begun and continued through 195 min. Epidural anesthesia uniformly decreased maternal mean arterial blood pressure (MAP), heart rate, cardiac output, uterine blood flow, and fetal PO2 in each of the three groups. Both ephedrine and phenylephrine restored maternal MAP to baseline, as expected from the experimental design. Ephedrine significantly increased cardiac output and uterine blood flow when compared with NS-control, but phenylephrine did not. Phenylephrine significantly increased uterine vascular resistance when compared with NS-control, but ephedrine did not. As a result, fetal pH and PO2 were significantly greater during ephedrine infusion than during infusion of NS-control. Fetal pH was stable during ephedrine infusion, but it continued to decrease during phenylephrine infusion.(ABSTRACT TRUNCATED AT 250 WORDS)