目的:腰麻仍是子痫前期患者剖宫产术中首选的麻醉方式。我们调查了剖宫产期间脊髓麻醉下产妇低血压的发生率,通过比较去甲肾上腺素与生理盐水的不同预防性输注率。
方法:我们随机分配了180例先兆子痫患者(每组45例),年龄在18-45岁之间进行剖宫产,以0剂量(生理盐水组)接受四种预防性去甲肾上腺素输注之一,0.025(0.025组),0.05(0.05组),或脊髓麻醉后0.075(0.075组)µg/kg/min。主要终点是产妇低血压的发生率(收缩压<基线的80%)。
结果:不同预防性输注去甲肾上腺素的比率降低了产妇低血压的发生率(26.7%,15.6%,和6.7%)与生理盐水(37.8%)相比,呈显着下降趋势(p=0.002)。随着去甲肾上腺素输注剂量的增加,收缩压控制(中位性能误差;中位绝对性能误差)与基线的偏差(p<0.001;p<0.001)和需要抢救去甲肾上腺素(p=0.020)呈显著下降趋势.预防性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,分别。
结论:预防性输注去甲肾上腺素,与没有预防措施相比,能有效降低先兆子痫患者剖宫产术中低血压的发生率,不会增加母亲或新生儿的其他不良事件。
背景:临床试验标识号NCT04556370。
OBJECTIVE: 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.
METHODS: 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).
RESULTS: 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.
CONCLUSIONS: 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.
BACKGROUND: Clinical trials.gov identifier number NCT04556370.