预防性注射昂丹司琼和/或持续输注去氧肾上腺素可使脊麻下择期剖宫产术中产妇低血压发生率降低50％：双盲、随机、安慰剂对照试验
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Reducing by 50% the incidence of maternal hypotension during elective caesarean delivery under spinal anesthesia: Effect of prophylactic ondansetron and/or continuous infusion of phenylephrine - a double-blind, randomized, placebo controlled trial
背景与目的
据报道，预防性注射昂丹司琼或去氧肾上腺素对在脊髓麻醉（SA）下行剖宫产的产妇发生低血压具有保护作用。本研究假设昂丹司琼可以改善血流动力学反应，尤其是联合去氧肾上腺素输注。
方 法
这项前瞻性，双盲，随机，安慰剂对照的研究包括265名拟在SA下进行择期剖宫产分娩的健康孕妇。将孕妇随机分为4组，安慰剂组（对照组C）、SA诱导前静脉注射8mg昂丹司琼组（0组）、输注去氧肾上腺素（50mcg/min）组（P组）和昂当司琼联合去氧肾上腺素组（OP组）。在16个时间点评估产妇数量、产科情况、手术时间和麻醉参数。所评估的麻醉参量包括血压、心率、血氧饱和度、恶心、呕吐、心电图改变、皮肤潮红、不适或瘙痒以及血管加压药的需求。
结 果
与对照组相比，低血压产妇数量（对照组50.8％，O组44.6％，P组20.9％，OP组25.0％）（P = 0.0001），每例产妇收缩期低血压的时间点百分比（P = 0.0001）（对照组17.4％，O组8.7％，P组2.1％，OP组6.7％）以及需要补充大剂量麻黄碱 （P = 0.003）、苯肾上腺素（P = 0.017）或阿托品（P = 0.0001）的患者人数差异均有统计学意义。
结 论
与安慰剂相比，50μg/ min的去氧肾上腺素输注可降低产妇低血压50％的发生率，但是目前输注苯肾上腺素仍然不是常规。
原始文献摘要
Ortiz-GãMez J R, Palacio-Abizanda F J, Morillas-Ramirez F, et al. Reducing by 50% the incidence of maternal hypotension during elective caesarean delivery under spinal anesthesia: Effect of prophylactic ondansetron and/or continuous infusion of phenylephrine - a double-blind, randomized, placebo controlled trial:[J]. Saudi Journal of Anaesthesia, 2017, 11(4):408-414.
BACKGROUND:Prophylactic administrations of ondansetron or phenylephrine have been reported to provide a protective effect against hypotension in women undergoing cesarean delivery under spinal anesthesia (SA). The main hypothesis is that ondansetron improves the hemodynamic response, especially combined with phenylephrine infusion.
METHODS:This prospective, double-blind, randomized, placebo-controlled study included 265 healthy pregnant women scheduled for elective cesarean delivery under SA. Women were randomly allocated into four groups to receive either placebo (control), ondansetron (O) 8 mg intravenously before induction of SA, phenylephrine infusion (50 mcg/min) (P) or ondansetron plus phenylephrine (OP). Demographic, obstetric, intraoperative timing, and anesthetic variables were assessed at 16 time points. Anesthetic variables assessed included blood pressure, heart rate, oxygen saturation, nausea, vomiting, electrocardiographic changes, skin flushing, discomfort or pruritus, and vasopressor requirements.
RESULTS:There were differences (P = 0.0001) in the number of patients with hypotension (50.8% control, 44.6% O, 20.9% P, 25.0% OP), the percentage of time points (P = 0.0001) with systolic hypotension per patient (17.4% control, 8.7% O, 2.1% P, 6.7% OP) and the number of patients requiring supplementary boluses of ephedrine (P = 0.003), phenylephrine (P = 0.017) or atropine (P = 0.0001).
CONCLUSIONS:A 50 μg/min phenylephrine infusion reduces by 50%, the incidence of maternal hypotension compared with placebo, but infusions of phenylephrine are still not routine in our environment. Prophylactic ondansetron 8 mg might be considered in this situation, because it does not reduce the incidence of maternal hypotension but diminishes its severity, reducing the number of hypotensive events per patient by 50%.
麻醉学文献进展分享
联系我们