非急诊剖宫产和新生儿酸血症期间预防性输注苯肾上腺素与根据需要使用血管加压药栓治疗的对比：一项回顾性队列研究（2016-2021年）

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia Pub Date : 2024-08-22 DOI:10.1016/j.ijoa.2024.104253

Victor Rabkin , Barak Cohen , Anat Lavie , Boris Aptekman , Chaim Greenberger , Idit Matot , Carolyn F. Weiniger

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引用次数: 0

摘要

导言：预防性使用血管加压素可降低剖宫产过程中的脊柱低血压，但血管加压素对新生儿酸血症的影响仍不确定。我们研究了非急诊剖宫产情况下新生儿酸血症的发生率，并比较了预防性输注苯肾上腺素与苯肾上腺素栓剂治疗病例的结果。方法经伦理批准的回顾性队列研究，比较了在脊髓麻醉下进行的非急诊剖宫产病例（2016 年至 2021 年），接受预防性输注苯肾上腺素或根据需要栓剂治疗的病例。pH值或血压数据缺失的记录被排除在外。自变量为预防性注射苯肾上腺素，这是2018年根据国际建议实施的一项策略。主要结果是新生儿酸血症，定义为脐动脉 pH < 7.1。次要结果是产妇低血压，定义为至少一次收缩压（SBP）测量值低于 100 mmHg 或低于 80% 基线。结果共有 4392 例患者纳入最终分析；1318 例（30.0%）接受了预防性输注苯肾上腺素。接受预防性苯肾上腺素治疗的新生儿中有 28 例（2.1%）出现新生儿酸血症（脐动脉 pH 值为 7.1），而接受按需注入苯肾上腺素治疗的新生儿中有 50 例（1.6%）出现新生儿酸血症（p = 0.188）。预防性输注苯肾上腺素与新生儿酸血症的发生无关（aOR 0.83；95% CI 0.52 至 1.33，p = 0.435）。当定义为 SBP < 100 mmHg 时，预防性输注苯肾上腺素与脊柱低血压发生率降低有关（OR 0.47; 95% CI 0.37 to 0.57; p <0.001），当低血压定义为低于基线 SBP 的 80% 或 90% 时，结果类似。

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

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.

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来源期刊

International journal of obstetric anesthesia 医学-妇产科学

CiteScore

4.70

自引率

7.10%

发文量

285

审稿时长

58 days

期刊介绍： The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.