【罂粟摘要】不同血管升压药对妊娠晚期大鼠肠系膜上动脉和子宫动脉收缩情况的影响
不同血管升压药对妊娠晚期大鼠肠系膜上动脉和子宫动脉收缩情况的影响
贵州医科大学 高鸿教授课题组
翻译：张中伟 编辑：佟睿 审校：曹莹
椎管内麻醉后血压降低是剖宫产术中最常见的并发症之一。升压药是改善低血压最有效的方法，但这些药物中哪种最适合剖宫产术目前尚不确定。我们评估了升压药对妊娠大鼠子宫动脉和肠系膜上动脉收缩反应的影响，以确定一种既能增加体循环血压，同时对子宫和胎盘循环影响最小的药物。
将来自妊娠大鼠子宫动脉和肠系膜上动脉的分离环状片段置于器官浴中，研究其在几种升压药物的作用下产生的收缩反应。绘制了去甲肾上腺素、去氧肾上腺素、间羟胺和血管加压素的浓度-反应曲线。
根据药物的pEC50测定，肠系膜上动脉对去甲肾上腺素的收缩反应强于子宫动脉(5.617±0.11 vs. 4.493±1.35, p= 0.009)，子宫动脉对间羟胺的收缩反应强于肠系膜上动脉(pEC50: 5.084±0.17 vs. 4.92±0.10, p=0.007)。肠系膜上动脉与子宫动脉的去氧肾上腺素和血管加压素的pEC50无统计学差异。
体外实验表明，去甲肾上腺素对外周血管的收缩作用更强，对子宫动脉收缩作用最小。这些研究支持在使用椎管内麻醉作为剖宫产术的麻醉方法时，去甲肾上腺素为更理想的升压药物。
Tingting Wang， Limei Liao， Xiaohui Tang，et al. Effects of different vasopressors on the contraction of the superior mesenteric artery and uterine artery in rats during late pregnancy.[J].BMC Anesthesiology，(2021) 21:185:1.
Effects of different vasopressors on the
contraction of the superior mesenteric
artery and uterine artery in rats during late pregnancy
Background: Hypotension after neuraxial anaesthesia is one of the most common complications during caesarean section. Vasopressors are the most effective method to improve hypotension, but which of these drugs is best for caesarean section is not clear. We assessed the effects of vasopressors on the contractile response of uterine arteries and superior mesenteric arteries in pregnant rats to identify a drug that increases the blood pressure of the systemic circulation while minimally affecting the uterine and placental circulation.
Methods: Isolated ring segments from the uterine and superior mesenteric arteries of pregnant rats were mounted in organ baths, and the contractile responses to several vasopressor agents were studied. Concentration-response curves for norepinephrine, phenylephrine, metaraminol and vasopressin were constructed.
Results: The contractile response of the mesenteric artery to norepinephrine, as measured by the pEC50 of the drug, was stronger than the uterine artery (5.617 ± 0.11 vs. 4.493 ± 1.35, p= 0.009), and the contractile response of the uterine artery to metaraminol was stronger than the mesenteric artery (pEC50: 5.084 ± 0.17 vs. 4.92 ± 0.10, p=0.007). There was no statistically significant difference in the pEC50 of phenylephrine or vasopressin between the two blood vessels.
Conclusions: In vitro experiments showed that norepinephrine contracts peripheral blood vessels more strongly and had the least effect on uterine artery contraction. These findings support the use of norepinephrine in mothers between the time of neuraxial anaesthesia and the delivery of the foetus.