Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, Ningxia 750004, China.
Clin Pharmacokinet. 2024 Jun;63(6):847-856. doi: 10.1007/s40262-024-01381-4. Epub 2024 Jun 13.
Spinal anesthesia remains the preferred mode of anesthesia for preeclamptic patients during cesarean delivery. We investigated the incidence of maternal hypotension under spinal anesthesia during cesarean delivery, by comparing different prophylactic infusion rates of norepinephrine with normal saline.
We randomly allocated 180 preeclamptic patients (45 in each groups) aged 18-45 scheduled for cesarean delivery to receive one of four prophylactic norepinephrine infusions at doses of 0 (normal saline group), 0.025 (0.025 group), 0.05 (0.05 group), or 0.075 (0.075 group) µg/kg/min following spinal anesthesia. The primary endpoint was the incidence of maternal hypotension (systolic blood pressure < 80% of baseline).
The incidence of maternal hypotension was reduced with different prophylactic infusion rates of norepinephrine (26.7%, 15.6%, and 6.7%) compared with normal saline (37.8%) with a significant decreasing trend (p = 0.002). As the infusion doses of norepinephrine increased, there is a significant decreasing trend in deviation of systolic blood pressure control (median performance error; median absolute performance error) from baseline (p < 0.001; p < 0.001) and need for rescue norepinephrine boluses (p = 0.020). The effective dose 50 and effective dose 90 of prophylactic norepinephrine infusion were - 0.018 (95% confidence interval - 0.074, 0.002) µg/kg/min and 0.065 (95% confidence interval 0.048, 0.108) µg/kg/min, respectively.
Prophylactic infusion of norepinephrine, as compared to no preventive measures, can effectively reduce the incidence of maternal hypotension in preeclamptic patients under spinal anesthesia during cesarean delivery, without increasing other adverse events for either the mother or neonate.
Clinical trials.gov identifier number NCT04556370.
蛛网膜下腔麻醉仍然是子痫前期患者剖宫产时首选的麻醉方式。我们通过比较不同预防剂量去甲肾上腺素与生理盐水的输注率，来研究蛛网膜下腔麻醉下剖宫产产妇低血压的发生率。
我们将 180 例年龄在 18-45 岁之间的子痫前期患者（每组 45 例）随机分为四组，分别接受以下四种预防剂量去甲肾上腺素输注：0（生理盐水组）、0.025（0.025 组）、0.05（0.05 组）或 0.075（0.075 组）µg/kg/min。主要终点是产妇低血压（收缩压<基线的 80%）的发生率。
与生理盐水组（37.8%）相比，不同预防剂量去甲肾上腺素输注（26.7%、15.6%和 6.7%）可降低产妇低血压的发生率，呈显著下降趋势（p=0.002）。随着去甲肾上腺素输注剂量的增加，收缩压控制（中位数性能误差；中位数绝对性能误差）与基线的偏差呈显著下降趋势（p<0.001；p<0.001），需要抢救性去甲肾上腺素推注的次数也呈下降趋势（p=0.020）。预防剂量去甲肾上腺素输注的有效剂量 50 和有效剂量 90 分别为-0.018（95%置信区间-0.074，0.002）µg/kg/min 和 0.065（95%置信区间 0.048，0.108）µg/kg/min。
与无预防措施相比，蛛网膜下腔麻醉下剖宫产时预防性输注去甲肾上腺素可有效降低子痫前期患者低血压的发生率，而不会增加母亲或新生儿的其他不良事件。
Clinicaltrials.gov 标识符号 NCT04556370。
