|
分娩镇痛及剖宫产围麻醉期促子宫收缩药物的应用及影响
|
Abstract:
在自然分娩及剖宫产术的围术期中,子宫收缩药物的应用日益广泛,其目的是用于预防和治疗产后出血(PPH)。无论是在自然分娩过程中还是在剖宫产过程中,麻醉医生均扮演着不可或缺的角色,他们的深度参与要求对这一类药物有深入的理解与掌握。鉴于此,本文旨在系统性地探讨子宫收缩药物(缩宫素、卡贝缩宫素、欣母沛、米索前列醇、卡孕栓、马来酸麦角新碱)的最新临床应用进展(具体包括药物分类、作用机制、剂量用法、在预防或治疗子宫收缩乏力中的应用、对血流动力学的影响以及其他不良反应),从而为麻醉科医师及相关医疗人员提供有价值的参考。
The use of uterotonics is becoming increasingly widespread in the perioperative period of both natural delivery and cesarean section for the purpose of preventing and treating postpartum hemorrhage (PPH). Anesthesiologists play an indispensable role both during spontaneous delivery and cesarean section, and their deep involvement requires an in-depth understanding and mastery of this class of drugs. In light of this, the present paper aims to systematically explore the latest clinical advancements in the use of uterotonics (including Oxytocin, Carbetocin, Hemabate, Misoprostol, Carboprost, and Ergonovine Maleate), including their classification, mechanism of action, dosage and administration, application in preventing or treating uterine atony, effects on hemodynamics, and other adverse reactions. This will provide valuable reference information for anesthesiologists and related healthcare professionals.
[1] | 沈小雅, 陈娟娟. 缩宫素的药理与用药规范[J]. 中华产科急救电子杂志, 2018, 7(4): 253-256. |
[2] | Robinson, C., Schumann, R., Zhang, P. and Young, R.C. (2003) Oxytocin-Induced Desensitization of the Oxytocin Receptor. American Journal of Obstetrics and Gynecology, 188, 497-502. https://doi.org/10.1067/mob.2003.22 |
[3] | 李健和, 曹俊华, 周冬初, 易利丹, 彭六保. 长效催产素受体激动剂卡贝缩宫素的药理作用与临床应用[J]. 中国新药与临床杂志, 2012, 31(3): 134-138. |
[4] | Gallos, I.D., Williams, H.M., Price, M.J., Merriel, A., Gee, H., Lissauer, D., et al. (2018) Uterotonic Agents for Preventing Postpartum Haemorrhage: A Network Meta-analysis. Cochrane Database of Systematic Reviews, 4, CD011689. https://doi.org/10.1002/14651858.cd011689.pub2 |
[5] | Chen, Y., Jiang, W., Zhao, Y., Sun, D., Zhang, X., Wu, F., et al. (2021) Prostaglandins for Postpartum Hemorrhage: Pharmacology, Application, and Current Opinion. Pharmacology, 106, 477-487. https://doi.org/10.1159/000516631 |
[6] | 金秀云. 米索前列醇在妇产科应用进展[J]. 医药导报, 2011, 30(2): 227-228. |
[7] | 吴海霞. 应用米索前列醇治疗产后出血的效果及作用机制探究[J]. 中国继续医学教育, 2018, 10(13): 90-92. |
[8] | 杨孜, 段华, 金力. 卡前列甲酯临床应用专家共识(2020年版) [J]. 中国实用妇科与产科杂志, 2020, 36(11): 1091-1097. |
[9] | 李涛, 卫蔷, 吴琳 等. 马来酸麦角新碱注射液预防阴道分娩产后出血的多中心临床研究[J]. 四川大学学报(医学版), 2022, 53(2): 316-320. |
[10] | 罗钰, 杨堃, 陈华梅, 杨文燕. 氨甲环酸应用于凶险型前置胎盘剖宫产术中的有效性及安全性[J]. 西部医学, 2020, 32(11): 1612-1615. |
[11] | Balki, M., Ronayne, M., Davies, S., Fallah, S., Kingdom, J., Windrim, R., et al. (2006) Minimum Oxytocin Dose Requirement after Cesarean Delivery for Labor Arrest. Obstetrics & Gynecology, 107, 45-50. https://doi.org/10.1097/01.aog.0000191529.52596.c0 |
[12] | 高申山, 陈友伟. 剖宫产术中缩宫素使用的研究进展[J]. 临床麻醉学杂志, 2017, 33(12): 1231-1234. |
[13] | Heesen, M., Carvalho, B., Carvalho, J.C.A., Duvekot, J.J., Dyer, R.A., Lucas, D.N., et al. (2019) International Consensus Statement on the Use of Uterotonic Agents during Caesarean Section. Anaesthesia, 74, 1305-1319. https://doi.org/10.1111/anae.14757 |
[14] | Joseph, J., George, S., Daniel, M. and Ranjan, R. (2020) A Randomised Double-Blind Trial of Minimal Bolus Doses of Oxytocin for Elective Caesarean Section under Spinal Anaesthesia: Optimal or Not? Indian Journal of Anaesthesia, 64, 960-964. https://doi.org/10.4103/ija.ija_377_20 |
[15] | Robinson, d., Basso, M., Chan, C., Duckitt, K. and Lett, R. (2022) Guideline No. 431: Postpartum Hemorrhage and Hemorrhagic Shock. Journal of Obstetrics and Gynaecology Canada, 44, 1293-1310.e1. https://doi.org/10.1016/j.jogc.2022.10.002 |
[16] | Bekkenes, M.E., Fagerland, M.W., Solberg, O.G., Aaberge, L., Klingenberg, O., Norseth, J., et al. (2022) Exploring Cardiac Effects after Oxytocin 2.5 IU or Carbetocin 100 Mug: A Randomised Controlled Trial in Women Undergoing Planned Caesarean Delivery. European Journal of Anaesthesiology, 39, 928-938. https://doi.org/10.1097/eja.0000000000001763 |
[17] | Langesæter, E., Rosseland, L.A. and Stubhaug, A. (2009) Haemodynamic Effects of Repeated Doses of Oxytocin during Caesarean Delivery in Healthy Parturients. British Journal of Anaesthesia, 103, 260-262. https://doi.org/10.1093/bja/aep137 |
[18] | 尹泓, 夏瑞, 毛庆军, 等. 小剂量去氧肾上腺素对缩宫素致剖宫产术患者心血管反应的影响[J]. 中华麻醉学杂志, 2010, 30(5): 630-631. |
[19] | Moran, C., Ni Bhuinneain, M., Geary, M., Cunningham, S., McKenna, P. and Gardiner, J. (2001) Myocardial Ischaemia in Normal Patients Undergoing Elective Caesarean Section: A Peripartum Assessment. Anaesthesia, 56, 1051-1058. https://doi.org/10.1046/j.1365-2044.2001.02271.x |
[20] | Miyoshi, Y., Kaneko, S., Suga, S., Koga, M., Sugimi, S., Yamashita, H., et al. (2020) Comparison of the Benefits and Hemodynamic Side Effects of Oxytocin between Intravenous Infusion with and without Bolus Injection during Caesarean Section. Journal of Obstetrics and Gynaecology, 41, 557-561. https://doi.org/10.1080/01443615.2020.1780421 |
[21] | Guimarães, D., Windels, A., Fernandes, P. and Chumela, T. (2023) Atrial Fibrillation after a Bolus of Oxytocin during an Urgent Caesarean Section. Anaesthesia Reports, 11, e12214. https://doi.org/10.1002/anr3.12214 |
[22] | McDonagh, F., Carvalho, J.C.A., Abdulla, S., Cordovani, D., Downey, K., Ye, X.Y., et al. (2022) Carbetocin Vs. Oxytocin at Elective Caesarean Delivery: A Double‐Blind, Randomised, Controlled, Non‐Inferiority Trial of Low‐ and High‐dose Regimens. Anaesthesia, 77, 892-900. https://doi.org/10.1111/anae.15714 |
[23] | Cordovani, D., Balki, M., Farine, D., Seaward, G. and Carvalho, J.C.A. (2012) Carbetocin at Elective Cesarean Delivery: A Randomized Controlled Trial to Determine the Effective Dose. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 59, 751-757. https://doi.org/10.1007/s12630-012-9728-2 |
[24] | Anandakrishnan, S., Balki, M., Farine, D., Seaward, G. and Carvalho, J.C.A. (2013) Carbetocin at Elective Cesarean Delivery: A Randomized Controlled Trial to Determine the Effective Dose, Part 2. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 60, 1054-1060. https://doi.org/10.1007/s12630-013-0028-2 |
[25] | Tabl, S., Balki, M., Downey, K., Tomlinson, G., Farine, D., Seaward, G., et al. (2018) Uterotonics in Elective Caesarean Delivery: A Randomised Non‐Inferiority Study Comparing Carbetocin 20 μg and 100 μg. Anaesthesia, 74, 190-196. https://doi.org/10.1111/anae.14480 |
[26] | Bahr, M.H., Abdelaal Ahmed Mahmoud M Alkhatip, A., Ahmed, A.G., Elgamel, A.F., Abdelkader, M. and Hussein, H.A. (2023) Hemodynamic Effects of Oxytocin and Carbetocin during Elective Cesarean Section in Preeclamptic Patients under Spinal Anesthesia: A Randomized Double-Blind Controlled Study. Anesthesiology and Pain Medicine, 13, e128782. https://doi.org/10.5812/aapm-128782 |
[27] | Rosseland, L.A., Hauge, T.H., Grindheim, G., Stubhaug, A. and Langesæter, E. (2013) Changes in Blood Pressure and Cardiac Output during Cesarean Delivery: The Effects of Oxytocin and Carbetocin Compared with Placebo. Anesthesiology, 119, 541-551. https://doi.org/10.1097/aln.0b013e31829416dd |
[28] | Ai, W., Zeng, Y., Ma, Y., Liu, L., Fan, D., Wu, S., et al. (2021) Side‐Effects of Carbetocin to Prevent Postpartum Hemorrhage: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Pharmacology Research & Perspectives, 9, e00745. https://doi.org/10.1002/prp2.745 |
[29] | Harber, C., Levy, D., Chidambaram, S. and Macpherson, M. (2007) Case Report: Life‐Threatening Bronchospasm after Intramuscular Carboprost for Postpartum Haemorrhage. BJOG: An International Journal of Obstetrics & Gynaecology, 114, 366-368. https://doi.org/10.1111/j.1471-0528.2006.01227.x |
[30] | Cooley, D.M., Glosten, B., Roberts, J.R., Eppes, P.D. and Barnes, R.B. (1991) Bronchospasm after Intramuscular 15-Methyl Prostaglandin F2α and Endotracheal Intubation in a Nonasthmatic Patient. Anesthesia & Analgesia, 73, 87-89. https://doi.org/10.1213/00000539-199107000-00016 |
[31] | 沙伟萍, 陈秋媛, 杨庆耿. 右美托咪定联合地佐辛预防剖宫产术中欣母沛不良反应的效果[J]. 中国现代药物应用, 2021, 15(22): 170-172. |
[32] | 姚勤. 不同前列腺素类药物联合缩宫素对瘢痕子宫产妇再次剖宫产产后出血的预防效果[J]. 实用临床医药杂志, 2020, 24(20): 75-78. |
[33] | Quan, Z., Tian, M. and Chi, P. (2016) Large Doses of Uterotonic Drugs Caused Type II Second Degree Sinoatrial Block during Cesarean Section. Int. Journal of Clinical Pharmacology and Therapeutics, 54, 62-64. https://doi.org/10.5414/cp202453 |
[34] | 韩传宝, 刘华, 于力, 等. 欣母沛用于剖宫产术中不良反应的观察[J]. 临床麻醉学杂志, 2008, 24(1): 76-77. |
[35] | Hankins, G.D.V., Berryman, G.K., Scott, R.T. and Hood, D. (1989) Maternal Arterial Desaturation with 15-Methyl Prostaglandin F2 α for Uterine Atony. Obstetric Anesthesia Digest, 9, 16. https://doi.org/10.1097/00132582-198904000-00018 |
[36] | 汪丹, 秦利. 欣母沛治疗产后出血的临床研究[J]. 国外医学(妇幼保健分册), 2004, 15(2): 124-125. |
[37] | 汪胜友, 朱海娟, 金文然, 林武, 方向东. 欣母沛和缩宫素对剖宫产产妇血流动力学影响的比较[J]. 皖南医学院学报, 2019, 38(2): 165-169. |
[38] | Vallera, C., Choi, L.O., Cha, C.M. and Hong, R.W. (2017) Uterotonic Medications: Oxytocin, Methylergonovine, CaRboprost, Misoprostol. Anesthesiology Clinics, 35, 207-219. https://doi.org/10.1016/j.anclin.2017.01.007 |
[39] | Wei, C., Chang, X., Dong, J. and Zhou, Q. (2020) Remifentanil for Carboprost-Induced Adverse Reactions during Cesarean Delivery under Combined Spinal-Epidural Anesthesia. Frontiers in Pharmacology, 11, Article 980. https://doi.org/10.3389/fphar.2020.00980 |
[40] | Hu, B., Zhou, H., Zou, X., Shi, J., Li, X. and Tan, L. (2020) A Comparison of Dexmedetomidine and Midazolam for the Prevention of Postoperative Nausea and Vomiting Caused by Hemabate in Cesarean Delivery: A Randomized Controlled Trial. Drug Design, Development and Therapy, 14, 2127-2133. https://doi.org/10.2147/dddt.s251525 |
[41] | Liu, Y., Chen, H.X., Kang, D.L., et al. (2015) Influence of Dexmedetomidine on Incidence of Adverse Reactions Introduced by Hemabate in Postpartum Hemorrhage during Cesarean Section. International Journal of Clinical and Experimental Medicine, 8, 13776-13782. |
[42] | 赵国胜, 曹秀玲, 王艳双, 白云波. 地佐辛对剖宫产术中卡前列素氨丁三醇不良反应的预防效果及对血流动力学的影响[J]. 中国医药, 2018, 13(8): 1227-1230. |
[43] | (2018) WHO Recommendations: Uterotonics for the Prevention of Postpartum Haemorrhage. |
[44] | 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会. 产后出血预防与处理指南(2023) [J]. 中华妇产科杂志, 2023, 58(6): 401-409. |
[45] | 董魏徵, 董敏, 陈海燕. 米索前列醇对比缩宫素预防产后出血的临床有效性及安全性的Meta分析[J]. 中国药房, 2021, 32(21): 2655-2661. |
[46] | 滕恒芹. 米索前列醇联合缩宫素在宫缩乏力性产后出血中的应用效果[J]. 沈阳药科大学学报, 2021, 38(S1): 49. |
[47] | 杨爱芹. 马来酸麦角新碱联合缩宫素预防前置胎盘产妇剖宫产术后出血的临床效果[J]. 世界复合医学, 2020, 6(9): 174-176. |