Wang Tingting, He Qiuli, Zhang Wangping, Zhu Jianjun, Ni Huadong, Yang Rui, Liu Qianying, Xu Longsheng, Yao Ming
The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, P.R. China.
Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314001, P.R. China.
Exp Ther Med. 2020 Mar;19(3):1763-1770. doi: 10.3892/etm.2019.8360. Epub 2019 Dec 20.
Norepinephrine is considered as a potential alternative for blood pressure stabilization during spinal anesthesia for cesarean delivery, as it maintains a better maternal heart rate and cardiac output compared with phenylephrine. However, its use as a bolus dose for hypotension treatment remains largely unexplored. Therefore, the present study investigated the ED and ED of norepinephrine as a bolus for maternal hypotension during cesarean delivery. In the present prospective trial, 42 patients were enrolled for elective delivery under spinal anesthesia. The dose of norepinephrine was decided by the up-and-down sequential allocation method (UDM) with an initial dose of 0.075 µg/kg and a 0.025 µg/kg increment. The 42 patients received a bolus of norepinephrine when systolic blood pressure fell to <80% of baseline. The ED was calculated by the sequential method and the probit regression model. The ED was then calculated using the probit regression model. The ED of norepinephrine, which was determined by the UDM, was 0.067 µg/kg (95% CI, 0.056-0.081). The probit regression model calculated an ED of 0.072 µg/kg (95% CI, 0.056-0.088) and an ED of 0.121 µg/kg (95% CI, 0.1-0.207). In summary, the present results suggested the ED of a bolus norepinephrine for preventing hypotension in elective CD is 0.067 µg/kg (95% CI, 0.056-0.081), with an ED of 0.121 µg/kg (95% CI, 0.1-0.207).
去甲肾上腺素被认为是剖宫产脊髓麻醉期间稳定血压的一种潜在替代药物，因为与去氧肾上腺素相比，它能更好地维持产妇心率和心输出量。然而，其作为低血压治疗的推注剂量的应用在很大程度上仍未得到充分探索。因此，本研究调查了剖宫产期间作为推注药物用于产妇低血压治疗的去甲肾上腺素的有效剂量（ED）和半数有效剂量（ED50）。在本前瞻性试验中，42例患者入选接受脊髓麻醉下的择期分娩。去甲肾上腺素的剂量通过序贯上下分配法（UDM）确定，初始剂量为0.075μg/kg，增量为0.025μg/kg。当收缩压降至基线的<80%时，42例患者接受一次去甲肾上腺素推注。有效剂量通过序贯法和概率回归模型计算。然后使用概率回归模型计算半数有效剂量。通过UDM确定的去甲肾上腺素的有效剂量为0.067μg/kg（95%可信区间，0.056 - 0.081）。概率回归模型计算出的有效剂量为0.072μg/kg（95%可信区间，0.056 - 0.088），半数有效剂量为0.121μg/kg（95%可信区间，0.1 - 0.207）。总之，目前的结果表明，用于择期剖宫产预防低血压的去甲肾上腺素推注有效剂量为0.067μg/kg（95%可信区间，0.056 - 95%可信区间，0.056 - 0.081），半数有效剂量为0.121μg/kg（95%可信区间，0.1 - 0.207）。
