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氨基酸输注对剖宫产新生儿体温的影响:一项随机对照试验。

Effect of amino acid infusion during cesarean delivery on newborn temperature: a randomized controlled trial.

机构信息

Department of Anesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal.

Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, India.

出版信息

BMC Pregnancy Childbirth. 2021 Mar 31;21(1):267. doi: 10.1186/s12884-021-03734-4.


DOI:10.1186/s12884-021-03734-4
PMID:33789610
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8011173/
Abstract

BACKGROUND: The effect of maternal amino acid (AA) infusion before and during cesarean delivery on neonatal temperature remains unknown. We hypothesized that thermogenic effects of AA metabolism would help maintain body temperature of newborn babies and their mothers. METHODS: Seventy-six parturients scheduled for elective singleton term cesarean delivery were equally randomized to receive intravenous 200 ml of AA or placebo approximately 1 h before subarachnoid block (infusion rate:100 ml/h). The primary outcome was the newborn rectal temperature at 0, 5 and 10 min after birth. The secondary outcomes included the maternal rectal temperature at six time-points: T0 = before starting study solution infusion, T1 = 30 min after starting infusion, T2 = one hour after starting infusion, T3 = during spinal block, T4 = half an hour after spinal block, T5 = at the time of birth and T6 = at the end of infusion, as well as maternal thermal discomfort and shivering episodes. RESULTS: There were no differences in newborn temperature between the two groups at any of the time-points (intervention-time-interaction effect, P = 0.206). The newborn temperature (mean [95%CI] °C) at birth was 37.5 [37.43-37.66] in the AA and 37.4 [37.34-37.55] in the placebo group. It showed a significant (P < 0.001) downward trend at 5 and 10 min after birth (time effect) in both groups. One neonate in the AA and five in the placebo group were hypothermic (temperature < 36.5 °C) (P = 0.20). There was a significant difference in the maternal temperature at all time points between the two groups (Intervention-time interaction effect, P < 0.001). However, after adjustment for multiplicity, the difference was significant only at T6 (P = 0.001). The mean difference [95%CI] in temperature decline from baseline (T0) till the end of infusion (T6) between the two groups was - 0.39 [- 0.55;- 0.22] °C (P < 0.0001). Six mothers receiving placebo and none receiving AA developed hypothermia (temperature < 36 °C) (P = 0.025). Maternal thermal discomfort and shivering episodes were unaffected by AA therapy. CONCLUSIONS: Under the conditions of this study, maternal AA infusion before and during spinal anesthesia for cesarean delivery did not influence the neonatal temperature within 10 min after birth. In addition, the maternal temperature was only maintained at two hours of AA infusion. TRIAL REGISTRATION: ClinicalTrials.government, Identifier NCT02575170 . Registered on 10th April, 2015 - Retrospectively registered.

摘要

背景:在剖宫产手术前和手术期间给予产妇氨基酸(AA)输注对新生儿体温的影响尚不清楚。我们假设 AA 代谢的产热作用有助于维持新生儿及其母亲的体温。

方法:76 名择期行单胎足月剖宫产的产妇被平均随机分为两组,分别在蛛网膜下腔阻滞前约 1 小时接受静脉输注 200ml AA 或安慰剂(输注速度:100ml/h)。主要结局为新生儿出生后 0、5 和 10 分钟时的直肠温度。次要结局包括母亲在六个时间点的直肠温度:T0=开始输注研究溶液前,T1=开始输注后 30 分钟,T2=开始输注后 1 小时,T3=脊髓阻滞期间,T4=脊髓阻滞后半小时,T5=分娩时,T6=输注结束时,以及母亲的热不适和寒战发作情况。

结果:两组在任何时间点的新生儿体温均无差异(干预-时间-交互作用,P=0.206)。AA 组新生儿出生时的体温(平均值[95%CI]℃)为 37.5[37.43-37.66],安慰剂组为 37.4[37.34-37.55]。两组出生后 5 和 10 分钟时(时间效应)体温均呈显著(P<0.001)下降趋势。AA 组有 1 例新生儿和安慰剂组有 5 例新生儿体温过低(<36.5°C)(P=0.20)。两组间所有时间点的母亲体温均有显著差异(干预-时间交互作用,P<0.001)。然而,在调整多重性后,两组仅在 T6 时差异有统计学意义(P=0.001)。两组间从基线(T0)到输注结束(T6)的体温下降平均值[95%CI]为-0.39[-0.55;-0.22]℃(P<0.0001)。6 名接受安慰剂的母亲和 0 名接受 AA 的母亲出现体温过低(<36°C)(P=0.025)。AA 治疗对母亲的热不适和寒战发作无影响。

结论:在本研究条件下,剖宫产手术前和手术期间给予产妇 AA 输注并未影响新生儿出生后 10 分钟内的体温。此外,仅在 AA 输注 2 小时时维持母亲的体温。

试验注册:ClinicalTrials.gov,标识符 NCT02575170。于 2015 年 4 月 10 日注册-回顾性注册。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5cbd/8011173/083ff36831a7/12884_2021_3734_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5cbd/8011173/17cff8b6e05e/12884_2021_3734_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5cbd/8011173/81a1b0ec636e/12884_2021_3734_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5cbd/8011173/083ff36831a7/12884_2021_3734_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5cbd/8011173/17cff8b6e05e/12884_2021_3734_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5cbd/8011173/81a1b0ec636e/12884_2021_3734_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5cbd/8011173/083ff36831a7/12884_2021_3734_Fig3_HTML.jpg

相似文献

[1]
Effect of amino acid infusion during cesarean delivery on newborn temperature: a randomized controlled trial.

BMC Pregnancy Childbirth. 2021-3-31

[2]
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[3]
The effect of combination of warm intravenous fluid infusion and forced air warming versus forced air warming alone on maternal temperature and shivering during cesarian delivery under spinal anesthesia.

Ann Afr Med. 2020

[4]
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[5]
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[6]
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[7]
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[8]
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[10]
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本文引用的文献

[1]
Warming strategies for preventing hypothermia and shivering during cesarean section: A systematic review with network meta-analysis of randomized clinical trials.

Int J Surg. 2019-9-13

[2]
Maintaining normothermia: Why and how?

Semin Fetal Neonatal Med. 2018-3-21

[3]
Inadvertent Perioperative Hypothermia Induced by Spinal Anesthesia for Cesarean Delivery Might Be More Significant Than We Think: Are We Doing Enough to Warm Our Parturients?

Anesth Analg. 2018-1

[4]
Uptake and release of amino acids in the fetal-placental unit in human pregnancies.

PLoS One. 2017-10-5

[5]
Perioperative Amino Acid Infusion for Preventing Hypothermia and Improving Clinical Outcomes During Surgery Under General Anesthesia: A Systematic Review and Meta-analysis.

Anesth Analg. 2017-9

[6]
Intravenous nutrients for preventing inadvertent perioperative hypothermia in adults.

Cochrane Database Syst Rev. 2016-11-22

[7]
Neonatal and Maternal Temperature Regulation During and After Delivery.

Anesth Analg. 2016-7

[8]
Active Warming Utilizing Combined IV Fluid and Forced-Air Warming Decreases Hypothermia and Improves Maternal Comfort During Cesarean Delivery: A Randomized Control Trial.

Anesth Analg. 2016-5

[9]
Perioperative thermoregulation and heat balance.

Lancet. 2016-1-8

[10]
The Effect of patient warming during Caesarean delivery on maternal and neonatal outcomes: a meta-analysis.

Br J Anaesth. 2015-10

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