间歇使用催产素预处理对人子宫肌层收缩性的影响

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The Effect of Intermittent Oxytocin Pretreatment on Oxytocin-Induced Contractility of Human Myometrium In Vitro

背景

分娩时长期连续使用催产素可诱导催产素受体脱敏，这减弱了子宫肌层对催产素的反应，增加了产后出血的风险。文章比较间歇使用与连续使用催产素用于诱导分娩产生的结果。旨在确定间歇性或连续性使用催产素对子宫肌层后续使用催产素反应性的影响。我们假设了间歇性催产素预处理会导致比连续性催产素预处理更好的后续催产素收缩性。

方  法

该体外研究使用从剖宫产妇女处获得的子宫肌层进行。 分为：（1）对照组（未预处理）; （2）连续使用催产素组（用催产素10­^-5M预处理2小时）；（3）间歇性使用催产素组（每15分钟交替使用催产素10^-5M和生理盐水预处理2小时）。 预处理后，使用10^-10至10^-5 M剂量的催产素进行反应测试并测量收缩参数。主要测量结果是收缩的运动指数（MI=幅度×频率）。

结  果

与连续使用催产素相比，人类子宫肌层对间歇使用催产素的后续反应更加敏感，这很可能是由于催产素受体脱敏的减少或间歇组中受体再敏化的形成。 因此，在分娩期间歇使用催产素给药作为改善子宫催产素反应性的技术。，需要进一步研究，

结  论

与连续使用催产素相比，人类子宫肌层对间歇使用催产素的后续反应更加敏感，这很可能是由于催产素受体脱敏的减少或间歇组中受体再敏化的形成。 因此，在分娩期间歇使用催产素给药作为改善子宫催产素反应性的技术。，需要进一步研究。

原始文献摘要

BACKGROUND:

Prolonged continuous oxytocin administration during labor may induce oxytocin receptor desensitization, which attenuates the response of the myometrium to further oxytocin, increasing the risk of postpartum hemorrhage. The literature comparing pulsatile (intermittent) versus continuous oxytocin administration for induction and augmentation of labor is inconsistent with regard to maternal outcomes. We aimed to determine the effect of intermittent versus continuous oxytocin preexposure on myometrial responsiveness to subsequent oxytocin. We hypothesized that intermittent oxytocin pretreatment would result in superior subsequent oxytocin-induced contractility than continuous oxytocin pretreatment.

METHODS:

This in vitro study was undertaken using myometrium obtained from women undergoing elective cesarean deliveries. Each myometrial strip was mounted in an individual organ bath with physiological salt solution under homeostatic conditions and allocated to one of 3 groups: (1) control (no pretreatment); (2) continuous (pretreatment with oxytocin 10 M for 2 hours); or (3) intermittent (pretreatment with alternating oxytocin 10 M and physiological salt solution every 15 minutes, for 2 hours). After pretreatment, dose-response testing to oxytocin 10 to 10 M was performed and contractile parameters were measured. The primary outcome was motility index (MI, amplitude × frequency) of contractions.

RESULTS:

Eighteen women were recruited, and 86 successful experiments were performed (control n = 29, continuous n = 28, intermittent n = 29). The means (standard errors) of MI (√g·contractions/10 min) in the control, continuous, and intermittent groups were 2.34 (0.09), 1.78 (0.09), and 2.13 (0.11), respectively. The MI was significantly reduced in the continuous group when compared to the control (estimated difference [95% confidence interval {CI}], -0.56 [-0.81 to -0.31]; P < .01) and intermittent group (estimated difference [95% CI], -0.35 [-0.62 to -0.08]; P = .01). There was no significant difference in MI between the intermittent and control group (estimated difference [95% CI], -0.21 [-0.51 to 0.09]; P = .17).

CONCLUSIONS:

Human myometrium remains more responsive to subsequent oxytocin after intermittent compared to continuous exposure to oxytocin, most likely due of reduction in oxytocin receptor desensitization, or facilitation of receptor resensitization in the intermittent group. Hence, intermittent oxytocin administration during labor warrants further investigation as a technique to improve uterine oxytocin responsiveness.

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