【罂粟摘要】择期剖宫产中催产素的应用：肥胖妇女应用剂量的发现研究
择期剖宫产中催产素的应用：肥胖妇女应用剂量的发现研究
在第三产程预防性使用催产素可以减少产妇失血量，并减少对强宫药物的需求。众所周知，肥胖与子宫无力和产后出血的风险增加有关。目前尚不清楚肥胖女性是否需要更高剂量的催产素才能在产后获得足够的子宫张力。本研究的目的是确定90%的肥胖妇女在择期剖宫产时开始有效子宫收缩所需的催产素推注剂量(ED90)。
我们采用有偏硬币倒置设计法进行了双盲剂量研究。研究对象包括体重指数≥为40 kg·m-2的足月孕妇，在区域麻醉下进行择期剖宫产。有产后出血倾向的孕妇排除在外。在胎儿出生后1分钟内静脉注射催产素。第一名妇女接受0.5IU，催产素剂量按照顺序分配方案给药。主要观察指标是子宫张力满意，产科手术医生在注射催产素2分钟后对其进行评估。次要观察指标包括是否需要解除子宫强直性药物、不良反应和估计失血量。
我们研究了30名女性，她们的平均体重指数(SD)为52.3(7.6)kg·m-2。等张回归得出催产素的ED90为0.75IU (95%CI为0.5~0.93IU)，Dixon-Mood法为0.78IU (95%CI为0.68~0.88IU)。我们的结果表明，体重指数≥为40kg·m-2的女性需要的催产素大约是体重指数小于40kg·m-2的女性的两倍，后者的ED90值为0.35IU(95%可信区间为0.15-0.52IU)。
原始文献来源：E. Peska, M. Balki, C. Maxwell, et al. Oxytocin at elective caesarean delivery: a dose-finding study in women with obesity.[J].Anaesthesia, 2020, Nov 23：doi:10.1111/anae.15322.
Summary
Prophylactic oxytocin administration at the third stage of labour reduces blood loss and the need for additional uterotonic drugs. Obesity is known to be associated with an increased risk of uterine atony and postpartum haemorrhage. It is unknown whether women with obesity require higher doses of oxytocin in order to achieve adequate uterine tone after delivery. The purpose of this study was to establish the bolus dose of oxytocin required to initiate effective uterine contraction in 90% of women with obesity (the ED90) at elective caesarean delivery. We conducted a double-blind dose-finding study using the biased coin up-down design method. Term pregnant women with a BMI ≥ 40 kg·m-2 undergoing elective caesarean delivery under regional anaesthesia were included. Those with conditions predisposing to postpartum haemorrhage were not included. Oxytocin was administered as an intravenous bolus over 1 minute upon delivery of the fetus. With the first woman receiving 0.5 IU, oxytocin doses were administered according to a sequential allocation scheme. The primary outcome measure was satisfactory uterine tone, as assessed by the operating obstetrician 2 minutes after administration of the oxytocin bolus. Secondary outcomes included the need for rescue uterotonic drugs, adverse effects and estimated blood loss. We studied 30 women with a mean (SD) BMI of 52.3 (7.6) kg·m-2. The ED90 for oxytocin was 0.75 IU (95%CI 0.5–0.93 IU) by isotonic regression and 0.78 IU (95%CI 0.68–0.88 IU) by the Dixon and Mood method. Our results suggest that women with a BMI ≥ 40 kg·m-2 require approximately twice as much oxytocin as those with a BMI < 40 kg·m-2, in whom an ED90 of 0.35 IU (95%CI 0.15–0.52 IU) has previously been demonstrated.
翻译：佟睿 编辑：佟睿 审校：曹莹