Wang Li Ying, Wang Jin, Dong Jin Hua, Ping Ze Peng, Chen Xin Zhong, Wei Chang Na
Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China.
Department of Obstetrics, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China.
Front Pharmacol. 2023 Jul 28;14:1211693. doi: 10.3389/fphar.2023.1211693. eCollection 2023.
An estimate of 90% effective dose (ED90) of oxytocin infusion has already been proved effective in non-laboring parturients. However, the requirements of oxytocin for elderly parturients with prior history of cesarean delivery (CD) may be higher. The aim of this study was to find the optimum oxytocin infusion rate for preventing uterine atony during CD in elderly parturients with prior history of CD. We performed a randomized, double-blinded study in 120 healthy elderly parturients with prior history of CD scheduled for elective CD under combined spinal-epidural (CSE) anesthesia. Participants were treated with oxytocin infusion randomly at the rates of 0, 4, 8, 12, 16, or 20 IU h after the delivery of infants. Following oxytocin administration, a blinded obstetrician evaluated the uterine tone (UT), verbally describing it using numerical scales (0-10: 0, no UT; 10, optimal UT) as either adequate or inadequate at the time intervals of 3, 6, and 9 min. Maternal adverse effects, requirements for additional uterotonic agents, delivery-placenta delivery time (PD), and estimated blood loss (EBL) were recorded. The 50% effective dose (ED50) and 90% effective dose (ED90) of oxytocin infusion were 14.6 IU h (95% confidence interval 12.0-18.4 IU h) and 27.7 IU h (95% confidence interval 22.5-39.4 IU h), respectively. As the rate of infusion was increased in parturients, the rescue oxytocin dose and delivery-PD time were decreased. Parturients who received 0 IU h oxytocin at 3, 6, and 9 min obtained lower UT scores than those who received 16 and 20 IU h oxytocin ( < 0.05, respectively). No significant differences were observed among groups in EBL and maternal adverse effects. The infusion rate of oxytocin at 14.57 and 27.74 IU h produces adequate UT in 50% and 90% of elderly parturients with prior history of CD, respectively. An oxytocin infusion rate of 27.7 IU h is suggested to be the optimal dose for preventing uterine atony during CD in elderly parturients with prior history of cesarean delivery. [https://www.chictr.org.cn/bin/project/edit?pid=62489], Identifier: [ChiCTR2000038891].
催产素输注的90%有效剂量（ED90）估计已被证明对未临产的产妇有效。然而，有剖宫产史（CD）的高龄产妇对催产素的需求量可能更高。本研究的目的是找出有剖宫产史的高龄产妇在剖宫产术中预防宫缩乏力的最佳催产素输注速率。我们对120例计划在腰硬联合麻醉下行择期剖宫产术、有剖宫产史的健康高龄产妇进行了一项随机双盲研究。婴儿娩出后，参与者被随机以0、4、8、12、16或20IU/h的速率输注催产素。给予催产素后，一名不知情的产科医生在3、6和9分钟的时间间隔评估子宫张力（UT），使用数字量表（0 - 10：0表示无子宫张力；10表示最佳子宫张力）口头描述子宫张力是否充足。记录产妇的不良反应、额外宫缩剂的使用需求、胎盘娩出时间（PD）和估计失血量（EBL）。催产素输注的50%有效剂量（ED50）和90%有效剂量（ED90）分别为14.6IU/h（95%置信区间12.0 - 18.4IU/h）和27.7IU/h（95%置信区间22.5 - 39.4IU/h）。随着产妇输注速率的增加，补救性催产素剂量和胎盘娩出时间缩短。在3、6和9分钟接受0IU/h催产素的产妇的子宫张力评分低于接受16和20IU/h催产素的产妇（分别为P<0.05）。各组间在估计失血量和产妇不良反应方面未观察到显著差异。催产素输注速率为14.57和27.74IU/h时，分别能使50%和90%有剖宫产史的高龄产妇产生充足的子宫张力。建议27.7IU/h的催产素输注速率是有剖宫产史的高龄产妇在剖宫产术中预防宫缩乏力的最佳剂量。[https://www.chictr.org.cn/bin/project/edit?pid=62489]，标识符：[ChiCTR2000038891]
