Epidural anesthesia worsens uterine blood flow and fetal oxygenation during hemorrhage in gravid ewes.
Epidural anesthesia worsens uterine blood flow and fetal oxygenation during hemorrhage in gravid ewes.
复制标题
硬膜外麻醉会恶化妊娠母羊出血期间的子宫血流和胎儿氧合。
DOI：
10.1097/00000542-199205000-00019
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发表时间：
1992
期刊：
影响因子：
8.8
通讯作者：
Thompson,CS
中科院分区：
文献类型：
--
作者：
VincentJr,RD;Chestnut,DH;Sipes,SL;DeBruyn,CS;Chatterjee,P;Thompson,CS
最近的研究表明，出血前开始的硬膜外麻醉可以改善实验动物的存活率和酸碱状态。然而，对非妊娠动物失血性休克的研究可能不适用于妊娠动物中不太严重的出血。本研究的目的是确定硬膜外麻醉是否改变母羊和胎儿的血流动力学和对妊娠母羊出血的酸碱反应。24个实验在12只计时妊娠0.8至0.9岁之间的慢性仪器化动物身上进行。实验顺序为：1)T=0min：生理盐水500ml静脉滴注；2)T=15min：硬膜外注入0.5%布比卡因(硬膜外组)或生理盐水(对照组)；3)T=30min：硬膜外追加0.5%布比卡因(仅硬膜外组)，麻醉平面低于T10；4)T=45min：产妇出血量20ml/kg超过55min；5)T=110min：母体输血55min以上。在45分钟(即硬膜外注射布比卡因后30分钟)，硬膜外注射布比卡因后，硬膜外注射布比卡因组的中位感觉水平为T9。当时，硬膜外组产妇平均动脉压低于对照组(分别比基线低14+/-2%和比基线高4+/-1%)(P<0.05)。硬膜外组术中产妇平均动脉压、心率、心输出量、子宫血流量、胎儿血氧分压和pH值均显著低于对照组(P<0.05)。
Recent studies suggest that epidural anesthesia initiated before hemorrhage may improve survival and acid-base status in laboratory animals. However, studies of hemorrhagic shock in nonpregnant animals may not be applicable to less severe hemorrhage in pregnant animals. The purpose of this study was to determine whether epidural anesthesia alters maternal and fetal hemodynamic and acid-base responses to hemorrhage in gravid ewes. Twenty-four experiments were performed in twelve chronically instrumented animals between 0.8 and 0.9 of timed gestation. The experimental sequence included: 1) T= 0 min: normal saline 500 ml intravenously; 2) T= 15 min: epidural administration of 0.5% bupivacaine (epidural group) or normal saline (control group); 3) T= 30 min: epidural administration of additional 0.5% bupivacaine (epidural group only) if the sensory level of anesthesia was below T10; 4) T= 45 min: maternal hemorrhage 20 ml/kg over 55 min; and 5) T= 110 min: transfusion of collected maternal blood over 55 min. At 45 min (ie, 30 min after the epidural injection of bupivacaine), epidural bupivacaine resulted in a median sensory level of T9 in the epidural group. At that time, maternal mean arterial pressure was less (P less than 0.05) in the epidural group than in the control group (14+/-2% below baseline versus 4+/-1% above baseline, respectively). Maternal mean arterial pressure, heart rate, cardiac output, and uterine blood flow, and fetal PO2 and pH all were significantly less during hemorrhage (P less than 0.05) in the epidural group than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)