去氧肾上腺素与麻黄碱用于非择期剖宫产脊髓麻醉期间维持血压的随机双盲比较*

Randomised double-blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non-elective Caesarean section*.

作者信息

Ngan Kee W D, Khaw K S, Lau T K, Ng F F, Chui K, Ng K L

机构信息

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.

出版信息

Anaesthesia. 2008 Dec;63(12):1319-26. doi: 10.1111/j.1365-2044.2008.05635.x.

DOI:10.1111/j.1365-2044.2008.05635.x

PMID:19032300

Abstract

In a randomised, double-blinded study, we compared boluses of phenylephrine 100 microg with ephedrine 10 mg for treating hypotension (systolic blood pressure < 100 mmHg) in 204 patients having non-elective Caesarean section under spinal anaesthesia. Umbilical arterial (UA) and venous (UV) pH and base excess were similar between groups. In the ephedrine group, UA lactate concentration was higher (median 2.6 [interquartile range 2.3-3.3] vs 2.4 [1.9-3.0] mmolxl(-1), p = 0.002) and UV lactate concentration was higher (2.5 [2.2-3.2] vs 2.3 [1.9-2.8] mmolxl(-1), p = 0.016) and more patients had nausea or vomiting (12.7% vs 3.9%, p = 0.02). Clinical neonatal outcome was similar. Of the protocol-compliant patients (n = 148), UA Po(2) and UV Po(2) were lower in the phenylephrine group although oxygen content was similar. We conclude that phenylephrine and ephedrine are both suitable vasopressors for use in non-elective Caesarean sections.

摘要

在一项随机双盲研究中，我们比较了100微克去氧肾上腺素推注剂与10毫克麻黄碱对204例在脊髓麻醉下接受非择期剖宫产手术患者低血压（收缩压<100 mmHg）的治疗效果。两组间脐动脉（UA）和静脉（UV）的pH值及碱剩余相似。在麻黄碱组中，UA乳酸浓度较高（中位数2.6[四分位间距2.3 - 3.3]对2.4[1.9 - 3.0]mmol/L，p = 0.002），UV乳酸浓度也较高（2.5[2.2 - 3.2]对2.3[1.9 - 2.8]mmol/L，p = 0.016），且更多患者出现恶心或呕吐（12.7%对3.9%，p = 0.02）。临床新生儿结局相似。在符合方案的患者（n = 148）中，去氧肾上腺素组的UA氧分压和UV氧分压较低，尽管氧含量相似。我们得出结论，去氧肾上腺素和麻黄碱都是适用于非择期剖宫产手术的血管升压药。