Dyer R A, Emmanuel A, Adams S C, Lombard C J, Arcache M J, Vorster A, Wong C A, Higgins N, Reed A R, James M F, Joolay Y, Schulein S, van Dyk D
Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
Int J Obstet Anesth. 2018 Feb;33:23-31. doi: 10.1016/j.ijoa.2017.08.001. Epub 2017 Aug 11.
Studies in healthy patients undergoing elective caesarean delivery show that, compared with phenylephrine, ephedrine used to treat spinal hypotension is associated with increased fetal acidosis. This has not been investigated prospectively in women with severe preeclampsia.
Patients with preeclampsia requiring caesarean delivery for a non-reassuring fetal heart tracing were randomised to receive either bolus ephedrine (7.5-15mg) or phenylephrine (50-100µg), to treat spinal hypotension. The primary outcome was umbilical arterial base excess. Secondary outcomes were umbilical arterial and venous pH and lactate concentration, venous base excess, and Apgar scores.
Among 133 women, 64 who required vasopressor treatment were randomised into groups of 32 with similar patient characteristics. Pre-delivery blood pressure changes were similar. There was no difference in mean [standard deviation] umbilical artery base excess (-4.9 [3.7] vs -6.0 [4.6] mmol/L for ephedrine and phenylephrine respectively; P=0.29). Mean umbilical arterial and venous pH and lactate concentrations did not significantly differ between groups (7.25 [0.08] vs 7.22 [0.10], 7.28 [0.07] vs 7.27 [0.10], and 3.41 [2.18] vs 3.28 [2.44] mmol/L respectively). Umbilical venous oxygen tension was higher in the ephedrine group (2.8 [0.7] vs 2.4 [0.62]) kPa, P=0.02). There was no difference in 1- or 5-min Apgar scores, numbers of neonates with 1-min Apgar scores <7 or with a pH <7.2.
In patients with severe preeclampsia and fetal compromise, fetal acid-base status is independent of the use of bolus ephedrine versus phenylephrine to treat spinal hypotension.
对择期剖宫产的健康患者进行的研究表明，与去氧肾上腺素相比，用于治疗脊髓性低血压的麻黄碱会增加胎儿酸中毒的风险。但这尚未在重度子痫前期女性中进行前瞻性研究。
因胎儿心率监护异常而需要剖宫产的子痫前期患者被随机分为两组，分别接受单次静脉注射麻黄碱（7.5 - 15mg）或去氧肾上腺素（50 - 100μg）以治疗脊髓性低血压。主要结局指标为脐动脉碱剩余。次要结局指标包括脐动脉和静脉血pH值及乳酸浓度、静脉碱剩余和阿氏评分。
133名女性中，64名需要血管升压药治疗的患者被随机分为两组，每组32人，两组患者特征相似。分娩前血压变化相似。两组间脐动脉平均[标准差]碱剩余无差异（麻黄碱组为-4.9[3.7]mmol/L，去氧肾上腺素组为-6.0[4.6]mmol/L；P = 0.29）。两组间脐动脉和静脉血pH值及乳酸浓度的均值无显著差异（分别为7.25[0.08]对7.22[0.10]、7.28[0.07]对7.27[0.10]、3.41[2.18]对3.28[2.44]mmol/L）。麻黄碱组脐静脉血氧分压较高（2.8[0.7]对2.4[0.62]kPa，P = 0.02）。1分钟或5分钟阿氏评分、1分钟阿氏评分<7分或pH值<7.2的新生儿数量无差异。
在重度子痫前期且胎儿窘迫的患者中，胎儿酸碱状态与使用单次静脉注射麻黄碱或去氧肾上腺素治疗脊髓性低血压无关。
