预防性苯肾上腺素输注与按需血管加压剂推注治疗在非紧急剖宫产分娩和新生儿酸中毒中的应用：一项回顾性队列研究（2016-2021 年）。

Prophylactic phenylephrine infusion versus treatment with vasopressor bolus as needed during non-urgent cesarean delivery and neonatal acidemia: a retrospective cohort study (2016-2021).

机构信息

Department of Anaesthesiology, Intensive Care and Pain Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Department of Anaesthesiology, Intensive Care and Pain Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.

出版信息

Int J Obstet Anesth. 2024 Nov;60:104253. doi: 10.1016/j.ijoa.2024.104253. Epub 2024 Aug 22.

DOI:10.1016/j.ijoa.2024.104253

PMID:39260084

Abstract

INTRODUCTION

Prophylactic vasopressor administration reduces spinal hypotension during cesarean delivery, however the effects of vasopressor administration on neonatal acidemia remain uncertain. We examined the occurrence of neonatal acidemia in the setting of non-urgent cesarean delivery and compared outcomes between cases receiving prophylactic phenylephrine infusion versus cases treated with boluses of phenylephrine.

METHODS

Retrospective cohort study with ethical approval, comparing non-urgent cesarean delivery cases performed under spinal anesthesia (2016 to 2021), receiving either prophylactic phenylephrine infusion or boluses as needed. Data were collected from anesthesia and labor ward electronic medical records. Records with missing pH or missing blood pressure data were excluded. The independent variable was prophylactic phenylephrine administration, a strategy implemented following international recommendations in 2018. The main outcome was neonatal acidemia, defined as umbilical artery pH < 7.1. The secondary outcome was maternal hypotension, defined as at least one systolic blood pressure (SBP) measurement below 100 mmHg or below 80% baseline.

RESULTS

A total of 4392 patients were included in the final analysis; 1318 (30.0%) received prophylactic phenylephrine infusion. Neonatal acidemia (umbilical artery pH < 7.1) occurred in 28 (2.1%) cases receiving prophylactic phenylephrine versus 50 (1.6%) treated with boluses as needed (p = 0.188). Prophylactic phenylephrine infusion was not associated with occurrence of neonatal acidemia (aOR 0.83; 95% CI 0.52 to 1.33, p = 0.435). Prophylactic phenylephrine infusion was associated with a reduced spinal hypotension rate when defined as SBP < 100 mmHg (OR 0.47; 95% CI 0.37 to 0.57; p < 0.001), with similar results when hypotension was defined as a drop below 80% or 90% of baseline SBP.

CONCLUSION

In this pragmatic study, prophylactic phenylephrine infusion was associated with a reduction in maternal spinal hypotension, but not reduced neonatal acidemia.

摘要

引言

预防性血管加压素给药可减少剖宫产术中脊髓低血压，但血管加压素给药对新生儿酸中毒的影响仍不确定。我们研究了在非紧急剖宫产中新生儿酸中毒的发生情况，并比较了接受预防性苯肾上腺素输注与按需给予苯肾上腺素推注的病例之间的结果。

方法

这是一项具有伦理批准的回顾性队列研究，比较了 2016 年至 2021 年期间在脊髓麻醉下进行的非紧急剖宫产病例，这些病例分别接受了预防性苯肾上腺素输注或按需给予苯肾上腺素推注。数据从麻醉和产房电子病历中收集。排除 pH 或血压数据缺失的记录。自变量是预防性苯肾上腺素给药，这是 2018 年根据国际建议实施的策略。主要结局是新生儿酸中毒，定义为脐动脉 pH<7.1。次要结局是产妇低血压，定义为至少有一次收缩压（SBP）测量值低于 100mmHg 或低于基线的 80%。

结果

共有 4392 例患者纳入最终分析，其中 1318 例（30.0%）接受了预防性苯肾上腺素输注。接受预防性苯肾上腺素输注的病例中，有 28 例（2.1%）发生新生儿酸中毒（脐动脉 pH<7.1），而按需给予苯肾上腺素推注的病例中有 50 例（1.6%）（p=0.188）。预防性苯肾上腺素输注与新生儿酸中毒的发生无关（比值比 0.83；95%置信区间 0.52 至 1.33，p=0.435）。当定义为 SBP<100mmHg 时，预防性苯肾上腺素输注与脊髓低血压发生率降低相关（比值比 0.47；95%置信区间 0.37 至 0.57；p<0.001），当低血压定义为 SBP 下降至基线的 80%或 90%以下时，结果类似。