一项比较预防性输注去甲肾上腺素和麻黄碱以预防脊髓麻醉下择期剖宫产术中产妇脊髓低血压的随机双盲研究：一篇符合CONSORT标准的文章。

A randomized double-blind study comparing prophylactic norepinephrine and ephedrine infusion for preventing maternal spinal hypotension during elective cesarean section under spinal anesthesia: A CONSORT-compliant article.

作者信息

Xu Shiqin, Mao Mao, Zhang Susu, Qian Ruifeng, Shen Xiaofeng, Shen Jinchun, Wang Xian

机构信息

Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital.

Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, P.R. China.

出版信息

Medicine (Baltimore). 2019 Dec;98(51):e18311. doi: 10.1097/MD.0000000000018311.

DOI:10.1097/MD.0000000000018311

PMID:31860981

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6940128/

Abstract

BACKGROUND

Studies have shown the efficacy of norepinephrine in the treatment of maternal hypotension during cesarean section by comparing it to treatment with phenylephrine. However, few studies have compared the efficacy of norepinephrine to ephedrine.

METHODS

Ninety-seven women undergoing elective cesarean section were administered norepinephrine at 4 μg/minute (group N; n = 48) or ephedrine at 4 mg/minute (group E; n = 49) immediately postspinal anesthesia, with an on-off titration to maintain systolic blood pressure (SBP) at 80% to 120% of baseline. A rescue bolus of 8 μg norepinephrine was given whenever SBP reached the predefined lower limit. Our primary outcome was the incidence of tachycardia. Secondary outcomes included the incidence of bradycardia, hypertension, hypotension, severe hypotension, hypotensive episodes, number of rescue top-ups, hemodynamic performance error including median performance error (MDPE), and median absolute performance error (MDAPE). Neonatal Apgar scores and umbilical arterial (UA) blood gas data were also collected.

RESULTS

Women in group N experienced fewer cases of tachycardia (4.2% vs 30.6%, P = .002, odds ratio: 0.11 [95% confidence interval, CI: 0.02-0.47]), a lower standardized heart rate (HR) (70.3 ± 11 vs 75 ± 11, P = .04, difference: 4.7 ± 2.2 [95% CI: 0.24-9.1]), and a lower MDPE for HR (1.3 ± 9.6 vs 8.4 ± 13.5 bpm, P = .003, difference: 3.1 ± 1.8 [95% CI: -0.6-6.7]). In addition, the lowest or the highest HR was lower in group N compared to group E (both P < .05). Meanwhile, the standardized SBP in group N was lower than that in group E (P = .04). For neonates, the UA blood gas showed a higher base excess (BE) and a lower lactate level in group N compared to E (both P < .001). Other hemodynamic variables, maternal, and neonatal outcomes were similar.

CONCLUSION

Infusion of 4 μg/minute norepinephrine presented fewer cases of tachycardia, less fluctuation and a lower HR compared to baseline values, as well as a less stressed fetal status compared to ephedrine infusion at 4 mg/minute. In addition, norepinephrine infusion presented a lower standardized SBP compared to ephedrine.

摘要

背景

研究通过将去甲肾上腺素与去氧肾上腺素治疗进行比较，显示了去甲肾上腺素在剖宫产术中治疗产妇低血压的疗效。然而，很少有研究比较去甲肾上腺素与麻黄碱的疗效。

方法

97例行择期剖宫产的妇女在脊髓麻醉后立即给予4μg/分钟的去甲肾上腺素（N组；n = 48）或4mg/分钟的麻黄碱（E组；n = 49），采用开关滴定法将收缩压（SBP）维持在基线的80%至120%。每当SBP达到预先设定的下限，给予8μg去甲肾上腺素的抢救推注。我们的主要结局是心动过速的发生率。次要结局包括心动过缓、高血压、低血压、严重低血压、低血压发作的发生率、抢救补充次数、包括中位性能误差（MDPE）和中位绝对性能误差（MDAPE）在内的血流动力学性能误差。还收集了新生儿Apgar评分和脐动脉（UA）血气数据。

结果

N组妇女心动过速病例较少（4.2%对30.6%，P = 0.002，优势比：0.11[95%置信区间，CI：0.02 - 0.47]），标准化心率（HR）较低（70.3±11对75±11，P = 0.04，差值：4.7±2.2[95%CI：0.24 - 9.1]），HR的MDPE较低（1.3±9.6对8.4±13.5bpm，P = 0.003，差值：3.1±1.8[95%CI： - 0.6 - 6.7]）。此外，N组的最低或最高HR低于E组（均P < 0.05）。同时，N组的标准化SBP低于E组（P = 0.04）。对于新生儿，与E组相比，N组的UA血气显示碱剩余（BE）较高，乳酸水平较低（均P < 0.001）。其他血流动力学变量、产妇和新生儿结局相似。