催产素在剖宫产术中的合理应用PPT课件.ppt

OT受体孕末期达到高峰，比非孕期高80倍，比孕早期高12倍，发作后mRNA，雌激素使子宫对催产素的敏感性增加，而孕激素则使之降低在非孕期及早、中孕期作用弱，在妊娠末期尤其在分娩期作用强 缩宫素+受体与G蛋白偶联→激活磷脂酶C→促进磷酸肌醇的生成→↑胞质中Ca2+→子宫收缩↑。 催产素作用迅速，用药后2～3分钟即起作用，但持续时间短，仅20～30分钟。 催产素促使腺泡周围的肌上皮细胞收缩，有利于乳汁的排出。 催产素直接的血管平滑肌松弛效应可降低全身血管阻力，导致低血压、心动过速 催产素与心肌催产素受体结合，可直接影响房室传导以及心肌细胞复极，导致心动过速 Background. ECG changes, similar to those seen during myocardial ischaemia, together with symptoms of chest pain, are common during Caesarean section (CS). We hypothesized that oxytocin administration has cardiovascular effects leading to these symptoms and ECG changes. Methods. Forty women undergoing elective CS under spinal anaesthesia were given an i.v. bolus of either 10 IU of oxytocin (Group OXY-CS, n?20) or 0.2 mg of methylergometrine (Group MET-CS, n?20), in a double-blind, randomized fashion after delivery. Ten healthy, nonpregnant, non-anaesthetized women were used as normal controls (Group OXY-NC, n?10) and were given 10 IU of oxytocin i.v. Twelve-lead ECG, on-line, computerized vectorcardiography (VCG), and invasive arterial pressure were recorded. Results. Oxytocin produced a significant increase in heart rate, t28 (SD 4) and t52 (3) beats min21 [mean (SEM); P,0.001], decreases in mean arterial pressure, 233 (2) and 230 (3) mm Hg (P,0.001), and increases in the spatial ST-change vector magnitude (STC-VM), t77 (12) and t114 (8) mV (P,0.001), in CS patients and controls, respectively. Symptoms of chest pain and subjective discomfort were simultaneously present. Methylergometrine produced mild hypertension and no significant ECG changes. Conclusions. Oxytocin administered as an i.v. bolus of 10 IU induces chest pain, transient profound tachycardia, hypotension, and concomitant signs of myocardial ischaemia according to marked ECG and STC-VM changes. The effects are related to oxytocin administration and not to pregnancy, surgical procedure, delivery, or sympathetic block from spinal anaesthesia. 存在分歧、经验主义、模糊不清 the de行择期剖宫产时，5 IU催产素（1IU/min）即达到“天花板效应”，再增加剂量也不能增强子宫收缩或减少出血 cre