去甲肾上腺素输注预防剖宫产术中椎管麻醉后低血压：一项随机剂量探索试验。

Norepinephrine Infusion for Preventing Postspinal Anesthesia Hypotension during Cesarean Delivery: A Randomized Dose-finding Trial.

机构信息

From the Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt (A.M.H., S.M.A., N.A.A., M.K.E., S.R., T.I.R., M.A., M.E.E., K.A.E., A.R.) the Department of Anesthesia and Critical Care Medicine, Beni-Suef University, Beni-Suef, Egypt (H.A.H.).

出版信息

Anesthesiology. 2019 Jan;130(1):55-62. doi: 10.1097/ALN.0000000000002483.

DOI:10.1097/ALN.0000000000002483

PMID:30335625

Abstract

BACKGROUND

Norepinephrine has been recently introduced for prophylaxis against postspinal hypotension during cesarean delivery; however, no data are available regarding its optimum dose. The objective of this study is to compare three infusion rates of norepinephrine for prophylaxis against postspinal hypotension during cesarean delivery.

METHODS

The authors conducted a double-blinded, randomized, controlled study including full-term pregnant women scheduled for cesarean delivery. Norepinephrine infusion was commenced after subarachnoid block. Patients were randomized into three groups, which received norepinephrine with starting infusion rates of 0.025 μg · kg(-1) · min(-1), 0.050 μg · kg(-1) · min(-1), and 0.075 μg · kg(-1) · min(-1). Infusion was stopped when intraoperative hypertension occurred. The primary outcome was the frequency of postspinal hypotension (defined as decreased systolic blood pressure less than 80% of the baseline reading). The three groups were compared according to the following: systolic blood pressure, heart rate, frequency of intraoperative hypertension, frequency of bradycardia, and neonatal outcomes.

RESULTS

Two hundred eighty-four mothers were included in the analysis. The frequency of postspinal hypotension was lower for both the 0.050-μg · kg(-1) · min(-1) dose group (23/93 [24.7%], odds ratio: 0.45 [95% CI: 0.24 to 0.82], P = 0.014) and the 0.075-μg · kg(-1) · min(-1) dose group (25/96 [26.0%], odds ratio: 0.48 [95% CI:0.26 to 0.89], P = 0.022) compared with the 0.025-μg · kg(-1) · min(-1) dose group (40/95 [42.1%]). The two higher-dose groups (the 0.050-μg · kg(-1) · min(-1) group and the 0.075-μg · kg(-1) · min(-1) group) had higher systolic blood pressure and lower heart rate compared with the 0.025 μg · kg(-1) · min(-1) group. The three groups were comparable in the frequency of intraoperative hypertension, incidence of bradycardia, and neonatal outcomes.

CONCLUSIONS

Both the 0.050-μg · kg(-1) · min(-1) and 0.075-μg · kg(-1) · min(-1) norepinephrine infusion rates effectively reduced postspinal hypotension during cesarean delivery compared with the 0.025-μg · kg(-1) · min(-1) infusion rate.

摘要

背景

去甲肾上腺素最近被引入用于预防剖宫产期间脊髓后低血压；然而，关于其最佳剂量的数据尚不清楚。本研究的目的是比较三种去甲肾上腺素输注速率用于预防剖宫产期间脊髓后低血压。

方法

作者进行了一项双盲、随机、对照研究，纳入了计划行剖宫产的足月孕妇。蛛网膜下腔阻滞后开始输注去甲肾上腺素。患者随机分为三组，分别以 0.025μg·kg(-1)·min(-1)、0.050μg·kg(-1)·min(-1)和 0.075μg·kg(-1)·min(-1)的起始输注率输注去甲肾上腺素。当发生术中高血压时停止输注。主要结局是脊髓后低血压的发生频率（定义为收缩压低于基线读数的 80%）。根据以下指标比较三组：收缩压、心率、术中高血压发生率、心动过缓发生率和新生儿结局。

结果

284 名母亲纳入分析。0.050μg·kg(-1)·min(-1)剂量组（23/93[24.7%]，比值比：0.45[95%CI：0.24 至 0.82]，P=0.014）和 0.075μg·kg(-1)·min(-1)剂量组（25/96[26.0%]，比值比：0.48[95%CI：0.26 至 0.89]，P=0.022）的脊髓后低血压发生率均低于 0.025μg·kg(-1)·min(-1)剂量组（40/95[42.1%]）。与 0.025μg·kg(-1)·min(-1)组相比，两个高剂量组（0.050μg·kg(-1)·min(-1)组和 0.075μg·kg(-1)·min(-1)组）的收缩压更高，心率更低。三组在术中高血压发生率、心动过缓发生率和新生儿结局方面无差异。