瑞芬太尼用于腰麻-硬膜外联合麻醉剖宫产术中卡前列素引起的不良反应
Remifentanil for Carboprost-Induced Adverse Reactions During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia.
作者信息
Wei Chang-Na, Chang Xiang-Yang, Dong Jin-Hua, Zhou Qing-He
机构信息
Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China.
Department of Obstetrics, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China.
出版信息
Front Pharmacol. 2020 Jun 30;11:980. doi: 10.3389/fphar.2020.00980. eCollection 2020.
PURPOSE
Carboprost may induce adverse reactions when used to treat postpartum hemorrhage. We aimed to explore the effects of intravenous infusion of low-dose remifentanil to prevent such reactions.
METHODS
We enrolled parturient patients scheduled for elective cesarean section. Anesthesiologist administered combined spinal epidurals at the L3/4 interspace, with 0.5% hyperbaric bupivacaine subarachnoid space injections (1.5-2.5 ml). We randomly divided parturient patients, administered carboprost during surgery, into the remifentanil group (group R) and the control group (group C). Patients in group R received an intravenous target-controlled infusion of remifentanil (target effect-site concentration, 1.5 ng/ml) simultaneously with a carboprost tromethamine injection (250 µg). Patients in group C received a normal saline infusion with carboprost. We recorded and analyzed the incidence of carboprost-related adverse reactions (vomiting, nausea, chest congestion, flushing, hypertension, tachycardia, cough, and shivering), and assessed patient comfort using a numerical rating scale ([NRS], on which 0 was very uncomfortable and 10 was very comfortable).
RESULTS
After applying inclusion and exclusion criteria, we conducted statistical analysis of the data from 70 women. The incidence of vomiting was significantly lower in group R than in group C (14.3 51.4%, < 0.01); and the incidence of nausea, chest congestion, facial flushing, and hypertension were significantly lower in group R than in group C (all < 0.01). Furthermore, the patients' comfort scores were significantly higher in group R than in group C (8.0 ± 1.8 3.6 ± 2.1, < 0.01).
CONCLUSION
Our results demonstrate that an intravenous low-dose remifentanil infusion can effectively prevent carboprost-related adverse reactions during cesarean delivery under combined spinal and epidural anesthesia.
CLINICAL TRIAL REGISTRATION
We pre-registered this study at http://www.chictr.org.cn/showproj.aspx?proj=27707 (ChiCTR1800016292).
目的
卡前列素用于治疗产后出血时可能会引发不良反应。我们旨在探讨静脉输注低剂量瑞芬太尼预防此类反应的效果。
方法
我们纳入了计划行择期剖宫产的产妇。麻醉医生于L3/4椎间隙行腰硬联合麻醉，蛛网膜下腔注射0.5%的高比重布比卡因（1.5 - 2.5毫升）。我们将手术期间使用卡前列素的产妇随机分为瑞芬太尼组（R组）和对照组（C组）。R组患者在注射卡前列甲酯（250微克）的同时接受瑞芬太尼静脉靶控输注（靶效应室浓度为1.5纳克/毫升）。C组患者接受卡前列素与生理盐水混合输注。我们记录并分析了卡前列素相关不良反应（呕吐、恶心、胸闷、潮红、高血压、心动过速、咳嗽和寒战）的发生率，并使用数字评分量表（NRS，0表示非常不舒服，10表示非常舒服）评估患者的舒适度。
结果
应用纳入和排除标准后，我们对70名女性的数据进行了统计分析。R组呕吐发生率显著低于C组（14.3%对51.4%，P<0.01）；R组恶心、胸闷、面部潮红和高血压的发生率均显著低于C组（均P<0.01）。此外，R组患者的舒适度评分显著高于C组（8.0±1.8对3.6±2.1，P<0.01）。
结论
我们的结果表明，在腰硬联合麻醉下行剖宫产时，静脉输注低剂量瑞芬太尼可有效预防卡前列素相关不良反应。
临床试验注册
我们在http://www.chictr.org.cn/showproj.aspx?proj=27707（ChiCTR1800016292）预先注册了本研究。
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