苯肾上腺素和去甲肾上腺素预防腰麻下剖宫产患者低血压的比较——一项随机前瞻性研究

IF 0.2 Q4 ANESTHESIOLOGY
Wakhloo Renu, Bhagat Heena, Gandotra Megha, Suri Era
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引用次数: 0

摘要

背景:低血压是剖宫产术后腰麻常见的副作用,发生率高达71%。各种血管加压药物可用于对抗脊柱低血压,每种药物具有不同的药理特征。去甲肾上腺素是目前预防剖宫产患者脊柱性低血压的可行选择之一。目的:比较苯肾上腺素和去甲肾上腺素降低腰麻剖宫产术患者低血压发生率的疗效及其对新生儿预后的影响。比较的主要结局是低血压的发生率(定义为收缩压比基线值下降20%或<90 mmHg)。次要结局是心动过缓、母亲恶心、呕吐的发生率和新生儿结局。方法:选取美国麻醉学会(ASA)分级ⅱ期拟行选择性剖宫产术的单胎足月孕妇80例,随机分为两组,每组40例。P组给予苯肾上腺素50 mcg, N组给予去甲肾上腺素10 mcg,于脊髓麻醉后即刻仰卧后1 min内静脉滴注。对生命参数、不良反应和新生儿结局进行评估和统计分析。结果:术中去甲肾上腺素组平均心率明显高于苯肾上腺素组。两组新生儿预后在外观、脉搏、面部表情、活动、呼吸(Apgar)评分和脐动脉ph值方面相似。结论:在脊髓麻醉下剖宫产术中,去甲肾上腺素与苯肾上腺素在挽救孕产妇低血压方面的疗效相似,无明显的孕产妇或新生儿不良后果,且心动过缓发生率较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of phenylephrine and norepinephrine for prevention of hypotension in patients undergoing cesarean section under spinal anesthesia – A randomized prospective study
Background: Hypotension is a common side effect of spinal anesthesia for cesarean section with incidence of upto 71%. Various vasopressors are available for counteracting spinal hypotension each with different pharmacological profile. Norepinephrine is currently one of the feasible options for prophylaxis of spinal induced hypotension in patients undergoing cesarean section. Aims: To compare efficacy of phenylephrine and norepinephrine for reducing incidence of hypotension in patients undergoing cesarean section under spinal anesthesia and their effect on neonatal outcome. The primary outcome compared was incidence of hypotension (defined as fall in systolic blood pressure of >20% from the baseline value or a value <90 mmHg). The secondary outcomes noted were incidence of bradycardia, nausea, vomiting in the mother, and neonatal outcome. Methodology: A total of 80 singleton full term pregnant patients of American Society of Anesthesiology (ASA) grade II scheduled for elective cesarean section were randomly assigned to 2 groups of 40 patients each. Group P received phenylephrine 50 mcg and Group N received norepinephrine 10 mcg as intravenous bolus over 1 min immediately after the patient had been made supine after giving spinal anesthesia. The vital parameters, adverse effects, and neonatal outcome were assessed and analyzed statistically. Results: Intraoperatively, norepinephrine group had a significantly higher mean heart rate than phenylephrine group. Neonatal outcome was similar in both the groups with respect to appearance, pulse, grimace, activity, and respiration (Apgar) scores and umbilical arterial pH. Conclusions: In cesarean section under spinal anesthesia, norepinephrine efficacy in rescuing maternal hypotension is similar to that of phenylephrine without obvious maternal or neonatal adverse outcomes and with a lower incidence of bradycardia.
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