【罂粟摘要】间羟胺预防剖宫产术中脊麻性低血压的随机双盲剂量依赖性研究
间羟胺预防剖宫产术中脊麻性低血压的随机双盲剂量依赖性研究
贵州医科大学 高鸿教授课题组
翻译：吴学艳 编辑：佟睿 审校：曹莹
在剖宫产术中预防性使用血管活性药物是一种合理的选择，而间羟胺是产科术中最常用的血管升压药之一；然而，间羟胺的量效关系尚未完全确定，最佳使用剂量尚不清楚。因此，本研究旨在确定间羟胺用于预防腰硬联合麻醉在择期剖宫产患者中引起低血压的半数有效剂量(ED50)和90%有效剂量(ED90)。
纳入117例单胎妊娠产妇，随机分为5组，蛛网膜下腔注入布比卡因10mg + 舒芬太尼5μg，各组麻醉后即刻分别以0、0.25、1.0、1.75、2.5μg/kg/m in间羟胺恒速输注间羟胺，有效预防剂量定义为脊麻后至胎儿娩出期间无低血压发生，用Probit回归方法计算预防性输注间羟胺的ED50和ED90值，记录脊髓麻醉特点及不良反应。
以体重为基础恒速输注间羟胺的ED50和ED90值分别为0.64 (95% CI, 0.04～1.00)μg/kg/min和2.00 (95% CI, 1.58～2.95) μg/kg/min；五组低血压的发生率随着间羟胺输注速率的增加而降低(趋势检验，p<0.001)。0～0.25μg/kg/m in组低血压发生率相似，但明显高于其他组;1.0组与1.75μg/kg/min组低血压发生率相似，但高于2.5组；2.5μg/kg/min组反应性高血压的发生率明显高于其他组。医生干预0、0.25及2.5μg/kg/m in组比1.0、1.75μg/kg/m in组更频繁(校正后p<0.001)；新生儿结局无差异，包括新生儿Apgar评分和脐动脉血pH值。
综上所述，研究比较了四种不同预防剂量间羟胺预防剖宫产术中脊麻引起低血压的效果，预防腰麻引起低血压的间羟胺ED50和ED90值分别为0.64 μg/kg/min和2.00 μg/kg/min；这一发现可能有助于指导临床工作及进一步研究。
Xiao F,Xu WP,Yao HQ,etal.A Randomized Double-Blinded Dose-dependent Study of Metaraminol for Preventing Spinal-Induced Hypotension in Caesarean Delivery.Front Pharmacol 2021;12.
A Randomized Double-Blinded Dose-dependent Study of Metaraminol for Preventing Spinal-Induced Hypotension in Caesarean Delivery
Purpose:Prophylactic infusion of a vasopressor is preferred as a rational choice in clinical practice in Cesarean delivery. Metaraminol is one of most common vasopressors used in obstetric clinical practice. However, the dose-response of metaraminol has not been fully determined and the optimal infusion dose is unknown. Therefore, this study aimed to determine the median effective dose (ED50) and 90% effective dose (ED90) of weightbased fixed-rate metaraminol infusions for preventing spinal-anesthesia-induced hypotension in patients having combined spinal-epidural anesthesia for elective Caesarean delivery.
Methods:One hundred and seventeen patients with singleton pregnancies were enrolled and randomly allocated into one of five groups in this study. Patients received prophylactic metaraminol infusion at a fixed rate of 0, 0.25, 1.0, 1.75 or 2.5 μg/kg/min in each group immediately after induction with intrathecal 10 mg of hyperbaric bupivacaine mixed with 5 μg of sufentanil. An effective prophylactic dose was defined as no occurrence of hypotension during the period of spinal introduction and neonatal delivery. Values for ED50 and ED90 of prophylactic infusion of metaraminol were calculated using probit regression. Characteristics of spinal anesthesia and side effects were recorded.
Results:The ED50 and ED90 values of weight-based fixed rate of metaraminol infusion were 0.64 (95% CI, 0.04–1.00) μg/kg/min and 2.00 (95% CI, 1.58–2.95) μg/kg/min respectively. The incidence of hypotension decreased with an increased infusion rate of metaraminol in the five groups (test for trend, p < 0.001). The incidence of hypotension was similar between group 0 and 0.25, but significant higher than other groups; the incidence of hypotension was also similar between group 1.0 and 1.75, but higher than group 2.5. The incidence of reactive hypertension was significantly higher in group 2.5 compared to the other groups. Physician interventions were more frequent in group 0,0.25 and 2.5 than in group 1.0 and 1.75 (adjusted p < 0.001). No difference was found in neonatal outcomes, including Apgar score and pH value of the umbilical artery.
Conclusion:In summary, we have compared four different prophylactic weight-based
infusion doses of metaraminol for preventing post-spinal hypotension in Cesarean delivery.The ED50 and ED90 values of metaraminol infusion for preventing spinal anesthesiainduced hypotension were 0.64 μg/kg/min and 2.00 μg/kg/min, respectively. This finding may be helpful for guiding clinical practice and further research.
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