Li Yuan, Shuai Bingxing, Huang Han
Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital of Sichuan University, Sichuan University, Chengdu, China.
Department of Medical Affairs, West China Hospital, Sichuan University, Chengdu, China.
Front Pharmacol. 2023 Sep 19;14:1247214. doi: 10.3389/fphar.2023.1247214. eCollection 2023.
In this study, we aimed to evaluate the potential dose-response relationship between prophylactic norepinephrine (NE) infusion rates and the risks of hypotension during cesarean section following spinal anesthesia. Randomized controlled trials with two or more NE doses for post-spinal hypotension prophylaxis during cesarean section were systematically searched in the MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and US Clinical Trials Registry databases until 31 July 2022. The primary outcome was the relative risk of maternal hypotension with different NE regimens (infusion rates or bolus doses). Secondary outcomes included the relative risks of maternal and fetal adverse events with different NE regimens. Ten studies with 1,144 parturients were included for final analysis using restricted cubic splines and random-effects dose-response meta-analysis models. A significant dose-response relationship existed between NE infusion rates and the relative risks of maternal hypotension. Every 0.01 μg/kg/min increment in the NE infusion rate was associated with a 14% decrease in the incidence of post-spinal hypotension. ED and ED of NE infusion rates for post-spinal hypotension prophylaxis were estimated to be 0.046 (95% CI from 0.032 to 0.085) and 0.2 (95% CI from 0.14 to 0.37) μg/kg/min, respectively. However, a higher NE infusion rate was associated with a higher incidence of maternal hypertension. An increased NE infusion rate was associated with a decreased incidence of post-spinal hypotension but an increased incidence of hypertension. Therefore, 0.07 μg/kg/min was recommended as the initial NE infusion rate for clinical practice, as it was associated with the lowest risk of physician intervention for unstable hemodynamics after spinal anesthesia for cesarean delivery. (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=349934), identifier (CRD42022349934).
在本研究中，我们旨在评估剖宫产脊髓麻醉后预防性输注去甲肾上腺素（NE）的速率与低血压风险之间潜在的剂量反应关系。在MEDLINE、Embase、Web of Science、Cochrane对照试验中央注册库和美国临床试验注册库数据库中系统检索截至2022年7月31日的剖宫产脊髓麻醉后使用两种或更多NE剂量预防低血压的随机对照试验。主要结局是不同NE方案（输注速率或推注剂量）下产妇低血压的相对风险。次要结局包括不同NE方案下产妇和胎儿不良事件的相对风险。纳入10项研究共1144名产妇，使用受限立方样条和随机效应剂量反应荟萃分析模型进行最终分析。NE输注速率与产妇低血压的相对风险之间存在显著的剂量反应关系。NE输注速率每增加0.01μg/kg/min，脊髓麻醉后低血压的发生率降低14%。预防脊髓麻醉后低血压的NE输注速率的有效剂量和有效剂量分别估计为0.046（95%CI为0.032至0.085）和0.2（95%CI为0.14至0.37）μg/kg/min。然而，较高的NE输注速率与产妇高血压的较高发生率相关。NE输注速率增加与脊髓麻醉后低血压发生率降低但高血压发生率增加相关。因此，推荐0.07μg/kg/min作为临床实践中NE的初始输注速率，因为它与剖宫产脊髓麻醉后血流动力学不稳定时医生干预的最低风险相关。（https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=349934），标识符（CRD42022349934）
