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預防性注射昂丹司瓊和/或持續輸注去氧腎上腺素可使脊麻下擇期剖宮產術中產婦低血壓發生率降低50%:雙盲、隨機、安慰劑對照試驗


- 2018年3月14日07時26分
- 科學文摘 / 麻醉MedicalGroup

麻醉MedicalGroup

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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


背景與目的

據報導,預防性注射昂丹司瓊或去氧腎上腺素對在脊髓麻醉(SA)下行剖宮產的產婦發生低血壓具有保護作用。本研究假設昂丹司瓊可以改善血流動力學反應,尤其是聯合去氧腎上腺素輸注。

方 法

這項前瞻性,雙盲,隨機,安慰劑對照的研究包括265名擬在SA下進行擇期剖宮產分娩的健康孕婦。將孕婦隨機分為4組,安慰劑組(對照組C)、SA誘導前靜脈注射8mg昂丹司瓊組(0組)、輸注去氧腎上腺素(50mcg/min)組(P組)和昂當司瓊聯合去氧腎上腺素組(OP組)。在16個時間點評估產婦數量、產科情況、手術時間和麻醉參數。所評估的麻醉參量包括血壓、心率、血氧飽和度、噁心、嘔吐、心電圖改變、皮膚潮紅、不適或瘙癢以及血管加壓藥的需求。

結 果

與對照組相比,低血壓產婦數量(對照組50.8%,O組44.6%,P組20.9%,OP組25.0%)(P = 0.0001),每例產婦收縮期低血壓的時間點百分比(P = 0.0001)(對照組17.4%,O組8.7%,P組2.1%,OP組6.7%)以及需要補充大劑量麻黃鹼 (P = 0.003)、苯腎上腺素(P = 0.017)或阿托品(P


= 0.0001)的患者人數差異均有統計學意義。

預防性注射昂丹司瓊和/或持續輸注去氧腎上腺素可使脊麻下擇期剖宮產術中產婦低血壓發生率降低50%:雙盲、隨機、安慰劑對照試驗圖片

結 論

與安慰劑相比,50μg/ min的去氧腎上腺素輸注可降低產婦低血壓50%的發生率,但是目前輸注苯腎上腺素仍然不是常規。

原始文獻摘要

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:. 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%.

摘要翻譯:王子君 來源:罌粟花

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