Page 59 - CASA Bulletin of Anesthesiology 2022; 9(5)
P. 59
Vol. 9, No 5, 2022
缩宫素是治疗产科宫缩乏力的首选,其加强子宫收缩、迅速关闭子宫肌层创面的血窦、阻断
血流的效果确切,但缩宫素有其固有的副作用,通过直接(包括反射)作用或间接作用可导致产
妇显著短暂的低血压、心动过速和/或心律失常,缩宫素还有直接抑制心脏收缩力及导致冠脉痉挛
的作用。对于心肺功能较差的产妇无相应的代偿性反应,尤其对于肺动脉高压者,往往会导致体
肺压力倒置,出现肺高压危象。同时胎儿的娩出和缩宫素的应用,子宫血窦内的血液回流至体循
环,回心血量骤然增加,右心难以承受前负荷的突然增加,会即刻出现右心衰竭。
缩宫素的心血管副作用同剂量相关,目前研究认为,以<5U/次缓慢滴注,或以一定剂量稀释
后静脉滴注,对血流动力学影响较轻。
参考文献
[1] CANOBBIO MM, WARNES CA, ABOULHOSN J, et al. Management of pregnancy in patients with complex
congenital heart disease: a scientific statement for healthcare professionals from the American Heart
Association [J]. Cirulation, 2017, 135(8):e50-e87
[2] 王艳双,刘亚光,车昊,等.妊娠合并肺动脉高压患者行剖宫产围手术期稳定血流动力学麻醉干预与性激
素水平的研究 [J].心肺血管病杂志,2017,36 (2):114-118
[3] 车昊,赵丽云.妊娠合并艾森门格综合征行剖宫产手术的麻醉管理 1 例 [J].麻醉安全与质控,2017,1
(5):257-259
[4] HOPKINS MK, GOLDSTEIN SA, WARD CC, et al. Evaluation and management of maternal congenital heart
disease: a review [J]. Obstet Gynecol Surv, 2018, 73(2):116-124
[5] CORREALE M, D'AMATO N, D'AGOSTINO C, et al. Eisenmenger,s syndrome in pregnancy[J].J Cardiovasc
Med (Hagerstown), 2013, 14(5):384-387
[6] TROIANO NH, WITCHER PM. Maternal mortality and morbidity in the United States:classification, causes,
preventability, and critical care obstetric implications[J]. J Perinat Neonatal Nurs, 2018, 32(3):222-231
[7] HEMNES AR, KIELY DG, COCKRILL BA, et al. Statement on pregnancy in pulmonary hypertension from the
Pulmonary Vascular Research Institute [J]. Pulm Circ, 2015, 5(3):435-465
[8] GUGLIELMINOTTI J, LANDAU R, FRIEDMAN AM, et al. Pulmonary hypertension during pregnancy in New
York State, 2003-2014 [J]. Matern Child Health J, 2019, 23(2):277-284
[9] VITULO P, BERETTA M, MARTUCCI G, et al. Challenge of pregnancy in patients with pre-capillary
pulmonary hypertension: veno-arterial extracorporeal membrane oxygenation as an innovative support for
delivery [J]. J CardiothoracVascAnesth, 2017, 31(6):2152-2155
[10] FRANCO V, RYAN JJ, MCLAUGHLIN VV. Pulmonary hypertension in women [J]. Heart Failure Clinics,
2019, 15(1):137-145
P a g e 58 | 66