苯肾上腺素和去甲肾上腺素治疗择期剖宫产术中椎管内麻醉后低血压的随机对照试验
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A randomised controlled trial of phenylephrine and noradrenaline boluses for treatment of postspinal hypotension during elective caesarean section
摘要
苯肾上腺素是目前选择性剖宫产术中首选的升压药，但它会引起反射性心动过缓。去甲肾上腺素，一种有效的a-激动剂和弱的b-激动剂，心动过缓发生率较低。但是关于两者比较的资料有限。这项双盲随机对照试验比较了100ug苯肾上腺素和5ug去甲肾上腺素用于单胎妊娠妇女择期剖腹产术中椎管内麻醉后低血压的疗效。低血压定义为收缩压下降超过基础血压的20%，或绝对值<100mmhg。本研究纳入了90名孕妇。主要结果是母亲心动过缓<60次/分。心动过缓的发生率（37.8%用苯肾上腺素，22.2%用去甲肾上腺素；P=0.167），低血压发作次数，治疗第一次低血压发作或反应性高血压所需的剂量无差异。苯肾上腺素组的总用药量较高（P=0.01）。使用苯肾上腺素与去甲肾上腺素治疗后1分钟的母亲心率无显著性差异（p=0.034，认为p<0.01具有统计学意义）。苯肾上腺素组脐动脉PH值高于去甲肾上腺素组（p=0.034）。总之，两种血管升压药均能逆转脊麻后低血压，但在母亲心动过缓方面无统计学差异。然而，鉴于使用去甲肾上腺素时脐动脉ph较低，有必要进一步研究其胎盘转移和胎儿代谢的影响。
原始文献摘要
M. Mohta A. Garg,G. T. Chilkoti.et,al. A randomised controlled trial of phenylephrine and noradrenaline boluses for treatment of postspinal hypotension during elective caesarean section[J]Anaesthesia 2019 Jul;74(7) DOI：10.1111/anae.14675
Phenylephrine is currently the vasopressor of choice during elective caesarean section, but it can cause reflex bradycardia. Noradrenaline, a potent a-agonist and weak b-agonist, may be associated with a lower incidence of bradycardia. However, comparative information is limited. This double-blind randomised controlled trial compared the effects of 100 lg phenylephrine and 5 lg noradrenaline administered as boluses for the treatment of postspinal hypotension during elective caesarean section in women with an uncomplicated singleton pregnancy. Hypotension was defined as a decrease of ≥ 20% from baseline systolic arterial pressure,or an absolute value < 100 mmHg. Ninety women were included in the study. The primary outcome was the incidence of maternal bradycardia < 60 beats.min-1. There was no difference in the incidence of bradycardia(37.8% with phenylephrine vs. 22.2% with noradrenaline; p = 0.167), number of hypotensive episodes, number of boluses required to treat the first hypotensive episode or reactive hypertension. The total number of boluses used was higher in the phenylephrine group (p = 0.01). Maternal heart rate at 1 min after vasopressor administration was non-significantly lower using phenylephrine vs. noradrenaline (p = 0.034, considering p < 0.01 as statistically significant). The umbilical artery pH was higher using phenylephrine than with noradrenaline (p = 0.034). In conclusion, both vasopressors reversed postspinal hypotension without a statistically significant difference in maternal bradycardia. However, in view of the lower umbilical artery pH when using noradrenaline, further research is warranted to study its placental transfer and fetal metabolic effects.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙