【罂粟摘要】去甲肾上腺素输注或束腿用于预防择期剖宫产腰麻后低血压：一项随机、双盲、安慰剂对照试验
去甲肾上腺素输注或束腿用于预防择期剖宫产腰麻后低血压：一项随机、双盲、安慰剂对照试验
贵州医科大学 高鸿教授课题组
翻译：唐剑 编辑：佟睿 审校：曹莹
去甲肾上腺素兼具α和β受体激动活性，目前的研究已证实其可有效地预防与治疗腰麻后低血压。但输液泵的匮乏制约了血管活性药物在医疗资源贫瘠国家的应用。已有研究证明双下肢束腿可有效预防腰麻后低血压，但因缺乏确凿的高质量证据并没有被广泛应用。因此，本研究进行了一项随机双盲对照试验，比较预防性输注去甲肾上腺素和束腿在减少择期剖宫产手术腰麻后低血压的发生率方面的疗效研究。
纳入标椎：年龄在19至40岁之间、单胎择期剖宫产的患者。排除标椎：妊娠高血压疾病、术前合并高血压、心脏或脑血管疾病、BMI>35，胎儿异常、静脉通路困难或不同意脊髓麻醉的患者被排除在研究之外。最终144名产妇纳入研究，随机分为三组：去甲肾上腺素输注组(NE组)、束腿组(LW组)和对照组(C组)。NE组以0.05ug/kg/min的速度输注甲肾上腺素，C组和LW组以相同的速度输注0.9%生理盐水。LW组由两名接受过培训的手术室人员将患者的双腿抬高45度，从跖骨到腹股沟对双下肢使用弹性绷带进行紧密缠裹，另外两组采用绷带宽松裹腿。术中低血压定义为SBP下降>基线的20%，三组均使用7.5微克去甲肾上腺素治疗，必要时每2分钟重复一次，直到SBP恢复到基线值。术中高血压(定义为SBP>基线的25%)通过停止去甲肾上腺素输注来处理。主要评价指标是低血压的发生率。次要评价指标是性能误差测量、高血压、心动过缓和新生儿抢救发生率。
与对照组相比，NE与LW组腰麻后低血压发生率显著降低（P=0.021）。胎儿娩出后低血压发生率LW组低于对照组，NE组无低血压发生。去甲肾上腺素输注的平均剂量为166±10ug。性能误差计算显示，输注去甲肾上腺素后，收缩压维持在接近基线水平。
观点
与单纯输注生理盐水相比，输注去甲肾上腺素与双下肢束腿均可降低择期剖宫产腰麻后低血压发生率。
原始文献来源：
Sundararajan M, Ravindran C, Ponnusamy R, Murugesan R. Prophylactic norepinephrine infusion or leg wrapping for postspinal hypotension in elective caesarean delivery: A randomised, double-blind, placebo-controlled trial. Eur J Anaesthesiol. 2020 Sep;37(9):803-809.
BACKGROUND: Because of its alpha and beta agonist properties, norepinephrine infusion is currently being studied for the prevention of spinal hypotension during caesarean delivery. Vasopressor infusions are not always possible if there is an unavailability of infusion pumps. Leg wrapping with crepe bandage is an effective technique for prevention of postspinal hypotension and could be useful in resource-poor settings.
OBJECTIVE: The aim of this study was to compare the incidence of hypotension with norepinephrine infusion or leg wrapping with a control group in women undergoing caesarean delivery with spinal anaesthesia.
DESIGN: Randomised, double-blind, controlled trial.
SETTING: Single centre, tertiary level institute, India.Study period 3 April 2018 to 31 March 2019.
PATIENTS: One hundred and forty-four women aged 19 to 40 years with a singleton pregnancy.
INTERVENTION: In group Leg Wrapping, crepe bandage was applied tightly from metatarsus to groin. Group Norepinephrine and the control group received sham leg wrapping. In group Norepinephrine, the women received a norepinephrine infusion according to their body weight, while group Leg Wrapping and the control group received a 0.9% normal saline infusion at a similar rate. All three groups received a 500 ml co-load of Ringer's solution over 15 min. Noninvasive SBP was monitored every 2 min until delivery, and every 5 min thereafter. Any hypotensive event (SBP < 20% of baseline) was treated with an intravenous bolus of norepinephrine (7.5 μg).
MAIN OUTCOME MEASURES:The primary outcome was the incidence of hypotension. The secondary outcomes were performance error measurements, and the incidences of hypertension, bradycardia, norepinephrine rescue bolus and neonatal outcomes.
RESULTS: The incidences of hypotension were significantly lower in the norepinephrine infusion group and the leg wrapping groups than the control group (P values 0.021 for both). Performance error calculations showed that SBP was maintained closer to baseline with the norepinephrine infusion.
CONCLUSION: Norepinephrine infusion and leg wrapping can both reduce the incidence of postspinal hypotension during elective caesarean delivery compared with saline infusion alone.
译者注：翻译时省略了不重要的摘要内容，可能译序与原摘要有不同。