Sheng Zhimin, Mao Junqin, Mei Zhong, Liu Xiang, Liu Jie, Chen Guantao, Lin Kang, Qian Xiaowei
Department of Anesthesiology, Wenling Maternity and Child Health Care Hospital, Taizhou, China.
Department of Anesthesiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China.
Int J Surg. 2025 Aug 1;111(8):5280-5287. doi: 10.1097/JS9.0000000000002602. Epub 2025 Jun 5.
Few studies directly compared the effects of metaraminol and norepinephrine on maternal and neonatal outcomes during cesarean delivery. Moreover, the infusion rates are often based on clinical experience rather than high-quality evidence, leading to non-equivalent dosing. This study aims to validate and compare metaraminol and norepinephrine at their 90% effective dose (ED 90 ) in obstetric anesthesia.
One hundred parturients undergoing cesarean delivery were randomly assigned to receive either 2.00 μg/kg/min of metaraminol (Group ME) or 0.10 μg/kg/min of norepinephrine (Group NE) to prevent spinal anesthesia-induced hypotension (SAIH). The primary outcomes were neonatal umbilical arterial (UA) pH and incidence of SAIH. Secondary outcomes included hemodynamic changes during the first 15 minutes, maternal adverse events, and additional neonatal outcome parameters.
Among the 94 participants who completed the study, the UA pH in Group ME [mean: 7.298; 95% confidence interval (CI): 7.255-7.341] was non-inferior to that in Group NE (mean: 7.296; 95% CI: 7.255-7.337), with a mean difference of 0.003 (95% CI: - 0.017 to 0.023), which is within the predefined non-inferiority margin of 0.02 pH units (non-inferiority P = 0.012). The incidence of SAIH was 13.0% in Group ME and 8.3% in Group NE (P = 0.701). No significant differences were observed in hypertension, bradycardia, nausea, and vomiting. Systolic blood pressure (SBP) measurements were comparable between the groups during the first 15 minutes. Additionally, Group NE had a higher heart rate (HR) than Group ME at most time points. Neonatal outcomes were comparable except for a higher UA pO 2 in Group ME.
Prophylactic infusion of metaraminol at 2.00 μg/kg/min is non-inferior to norepinephrine at 0.10 μg/kg/min in terms of neonatal outcomes, as assessed by umbilical arterial pH. Our findings further support the use of metaraminol as a suitable vasopressor in obstetric anesthesia for low-risk populations.
很少有研究直接比较间羟胺和去甲肾上腺素在剖宫产术中对母体和新生儿结局的影响。此外，输注速率通常基于临床经验而非高质量证据，导致剂量不等效。本研究旨在验证并比较间羟胺和去甲肾上腺素在产科麻醉中90%有效剂量（ED90）时的效果。
100例行剖宫产术的产妇被随机分配接受2.00μg/kg/min的间羟胺（ME组）或0.10μg/kg/min的去甲肾上腺素（NE组），以预防脊麻引起的低血压（SAIH）。主要结局为新生儿脐动脉（UA）pH值和SAIH的发生率。次要结局包括最初15分钟内的血流动力学变化、母体不良事件以及其他新生儿结局参数。
在完成研究的94名参与者中，ME组的UA pH值（均值：7.298；95%置信区间[CI]：7.255 - 7.341）不劣于NE组（均值：7.296；95%CI：7.255 - 7.337），平均差值为0.003（95%CI： - 0.017至0.023），在预先定义的非劣效性界值0.02个pH单位范围内（非劣效性P = 0.012）。ME组SAIH的发生率为13.0%，NE组为8.3%（P = 0.701）。在高血压、心动过缓、恶心和呕吐方面未观察到显著差异。两组在最初15分钟内的收缩压（SBP）测量值相当。此外，在大多数时间点，NE组的心率（HR）高于ME组。除ME组的UA pO2较高外，新生儿结局相当。
以脐动脉pH值评估，预防性输注2.00μg/kg/min的间羟胺在新生儿结局方面不劣于0.10μg/kg/min的去甲肾上腺素。我们的研究结果进一步支持在产科麻醉中，对于低风险人群使用间羟胺作为合适的血管升压药。
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