背景:昂丹司琼,选择性5-羟色胺3(5-HT3)受体拮抗剂,已被证明可有效预防选择性剖宫产术的脊髓性低血压。
方法:将138例择期剖宫产产妇随机分为三组。组ONDA4和ONDA8,分别,在100毫升生理盐水中接受4和8毫克的昂丹司琼,脊髓麻醉前用1.7毫升罗哌卡因0.75%和15微克芬太尼,而对照组接受等量生理盐水。到达时记录无创血压和心率,脊髓注射前后,此后每分钟,持续10分钟的时间,以及总剂量的去氧肾上腺素(mcg)或麻黄碱(mg)。脊髓麻醉分别在T4水平和Bromage3量表达到感觉和运动阻滞所需的时间,以及回归到T7水平和Bromage1量表。产妇恶心/呕吐或发抖,脐动脉pH,并记录1分钟和5分钟的新生儿Apgar评分。
结果:两组在收缩压、舒张压,心率(分别为p=0.355,p=0.550,p=0.474),去氧肾上腺素或麻黄碱的剂量,(p=0.920,p=0.142),块达到T4(p=0.889)和Bromage量表3(p=0.269)的时间,或回归到T7(p=0.273)和Bromage量表1(p=0.392),恶心/呕吐的发生率(p=0.898/p=0.365),脐动脉pH(p=0.739),新生儿Apgar评分在1和5分钟(分别为p=0.936和p=0.907)。
结论:我们的结果显示两种不同剂量的昂丹司琼没有显著作用,在预防产妇低血压方面,罗哌卡因腰麻用于剖宫产。
BACKGROUND: Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, has been proven to be effective in the prevention of
spinal-induced hypotension for elective cesarean section.
METHODS: A total of 138 primigravida parturients scheduled for elective cesarean section were randomly assigned to three groups. Groups ONDA4 and ONDA8, respectively, received 4 and 8 mg of ondansetron in 100 mL normal saline, before
spinal anesthesia with 1.7 mL ropivacaine 0.75% and 15 mcg of fentanyl, whereas the CONTROL group received an equal volume of normal saline. Noninvasive blood pressure and heart rate were recorded upon arrival, before and after
spinal injection, and thereafter every minute for a time period of 10 minutes along with total doses of phenylephrine (mcg) or ephedrine (mg). Time required for the
spinal anesthesia to achieve a sensory and motor block at the T4 level and Bromage 3 scale respectively, as well as to regress to the T7 level and a Bromage 1 scale were noted. Maternal nausea/vomiting or shivering, umbilical artery pH, and neonatal Apgar score at 1 and 5 min were also recorded.
RESULTS: There were no differences between groups in systolic, diastolic blood pressure, heart rate (p=0.355, p=0.550, p=0.474 respectively), doses of phenylephrine or ephedrine, (p=0.920, p=0.142 respectively), time for the block to reach T4 (p=0.889) and Bromage scale 3 (p=0.269), or to regress to T7 (p=0.273) and Bromage scale 1 (p=0.392), the incidence of nausea/vomiting (p=0.898/p=0.365), umbilical artery pH (p=0.739), neonatal Apgar score at 1 and 5 min (p=0.936 and p=0.907 respectively).
CONCLUSIONS: Our results showed no significant effect of two different doses of ondansetron, in preventing maternal hypotension, following
spinal anesthesia with ropivacaine for cesarean section.