Department of Anesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India.
Department of Obstetrics and Gynecology, University College of Medical Sciences and GTB Hospital, Delhi, India.
Int J Gynaecol Obstet. 2024 Mar;164(3):985-991. doi: 10.1002/ijgo.15138. Epub 2023 Sep 16.
We compared efficacy of weight-based (0.4 IU/kg/h) versus fixed-dose (34 IU/h) oxytocin infusion during cesarean section.
The oxytocin infusion in either group (n = 32 each) was initiated upon cord clamping. Primary outcome measure was adequacy of uterine tone at 4 min after initiating oxytocin infusion. Oxytocin associated side effects were also observed.
Significantly less oxytocin was used with the weight-based versus fixed-dose regimen (16.3 [11.2-22.4] IU vs 20.4 [15.8-26.9] IU; P = 0.036). Incidence of adequate uterine tone was clinically greater but not significantly different with the weight-based versus fixed-dose regimen (81.3% vs 71.9%; P = 0.376). The weight-based regimen was associated with clinically lesser, although not statistically significant need for rescue oxytocin (25% vs 46.9%; P = 0.068) and additional uterotonic (9.4% vs 15.6%; P = 0.708); as well as oxytocin associated side effects (hypotension [34.4% vs 46.9%; P = 0.309], nausea/vomiting [18.8% vs 40.6%; P = 0.055], and ST-T changes [0% vs 3.1%; P = 1.000]).
Weight-based oxytocin was not significantly different from the fixed-dose regimen in terms of uterotonic efficacy or associated side-effects, despite significantly lower doses being used. Use of weight-based oxytocin infusion (0.4 IU/kg/h) can be considered in clinical practice.
Clinical Trial Registry of India (ctri.nic.in, number. CTRI/2021/01/030642).
我们比较了剖宫产时基于体重（0.4IU/kg/h）与固定剂量（34IU/h）催产素输注的疗效。
两组（每组 32 例）均在脐带夹闭时开始输注催产素。主要结局指标为催产素输注开始后 4 分钟时子宫收缩的充分性。还观察了催产素相关的副作用。
与固定剂量方案相比，基于体重的方案使用的催产素明显减少（16.3[11.2-22.4]IU 比 20.4[15.8-26.9]IU；P=0.036）。虽然基于体重的方案与固定剂量方案相比，子宫收缩充分的发生率更高，但无统计学差异（81.3%比 71.9%；P=0.376）。与固定剂量方案相比，基于体重的方案需要使用催产素的几率更小，但无统计学意义（25%比 46.9%；P=0.068），并且需要使用额外的宫缩剂的几率更小（9.4%比 15.6%；P=0.708）；同时，催产素相关的副作用发生率更小（低血压[34.4%比 46.9%；P=0.309]、恶心/呕吐[18.8%比 40.6%；P=0.055]和 ST-T 改变[0%比 3.1%；P=1.000]）。
尽管使用的催产素剂量明显较低，但基于体重的催产素与固定剂量方案在子宫收缩效果或相关副作用方面并无显著差异。在临床实践中，可以考虑使用基于体重的催产素输注（0.4IU/kg/h）。
印度临床试验注册中心（ctri.nic.in，编号 CTRI/2021/01/030642）。
