LaPorta R F, Arthur G R, Datta S
Department of Anaesthesia, North Shore University Hospital, Manhasset, New York, USA.
Acta Anaesthesiol Scand. 1995 Oct;39(7):901-5. doi: 10.1111/j.1399-6576.1995.tb04195.x.
Maternal and neonatal catecholamine concentrations, following the use of either phenylephrine or ephedrine to treat a drop in maternal blood pressure after spinal anaesthesia for caesarean delivery, were compared. Patients were randomly assigned to one of two groups: Group 1 patients (n = 20) were treated with ephedrine given as 5 mg intravenous bolus injections; Group 2 patients (n = 20) were treated with phenylephrine given as 40 micrograms intravenous bolus injections, for decreases in maternal systolic blood pressure to maintain maternal systolic blood pressure above 100 mmHg. Maternal vein (MV), umbilical vein (UV), and umbilical artery (UA) blood samples were taken at the time of delivery. Samples were analyzed for catecholamine concentrations and blood gas values. Noradrenaline concentrations in UA, UV and MV (at delivery) samples were significantly higher in group 1 compared to group 2; they were 6858 +/- 3689 vs 1674 +/- 944 pg.ml-1 (P < 0.0001), 1265 +/- 758 vs 395 +/- 470 pg.ml-1 (P < 0.001) and 239 +/- 165 vs 103 +/- 93 pg.ml-1 (P < 0.01), respectively. Comparing blood gas values between groups 1 and 2, statistically significant differences were observed in UA pH (7.28 +/- 0.01 and 7.32 +/- 0.01 pH units, P = 0.01), UA pCO2 (7.32 +/- 0.24 and 6.68 +/- 0.21 kPa, P = 0.03), UA base excess (2.2 +/- 0.4 and 0.9 +/- 0.4 mmol.1-1, P = 0.04) and UV base excess (2.0 +/- 0.3 and 0.7 +/- 0.3 mmol.1-1, P = 0.004). No significant differences in maternal characteristics, acid base values, incidence of nausea and vomiting, and Apgar scores were observed between groups. Phenylephrine appears to be as safe and effective as ephedrine in treatment of drop in blood pressure in healthy non-labouring parturients undergoing caesarean delivery. The use of phenylephrine was also associated with significantly lower noradrenaline concentrations in both mother and neonate.
比较了剖宫产脊髓麻醉后使用去氧肾上腺素或麻黄碱治疗产妇血压下降时母婴儿茶酚胺浓度。患者被随机分为两组：第1组患者（n = 20）静脉推注5mg麻黄碱进行治疗；第2组患者（n = 20）静脉推注40微克去氧肾上腺素进行治疗，用于产妇收缩压下降时维持产妇收缩压高于100mmHg。分娩时采集产妇静脉（MV）、脐静脉（UV）和脐动脉（UA）血样。分析血样中的儿茶酚胺浓度和血气值。与第2组相比，第1组UA、UV和MV（分娩时）样本中的去甲肾上腺素浓度显著更高；分别为6858±3689 vs 1674±944 pg.ml-1（P < 0.0001）、1265±758 vs 395±470 pg.ml-1（P < 0.001）和239±165 vs 103±93 pg.ml-1（P < 0.01）。比较第1组和第2组之间的血气值，在UA pH（7.28±0.01和7.32±0.01 pH单位，P = 0.01）、UA pCO2（7.32±0.24和6.68±0.21 kPa，P = 0.03）、UA碱剩余（2.2±0.4和0.9±0.4 mmol.1-1，P = 0.04）和UV碱剩余（2.0±0.3和0.7±0.3 mmol.1-1，P = 0.004）方面观察到统计学显著差异。两组之间在产妇特征、酸碱值、恶心呕吐发生率和阿氏评分方面未观察到显著差异。在治疗接受剖宫产的健康未临产产妇的血压下降方面，去氧肾上腺素似乎与麻黄碱一样安全有效。使用去氧肾上腺素还与母婴体内去甲肾上腺素浓度显著降低有关。
