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潍坊女孩想代孕:预防性输注去氧肾上腺素和麻
文章来源:http://www.gjnsjt.cn  发布日期:2019-05-16

  

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  The Effect of Prophylactic Phenylephrine and Ephedrine Infusions on Umbilical Artery Blood pH in Women With Preeclampsia Undergoing Cesarean Delivery With Spinal Anesthesia: A Randomized, Double-Blind Trial

  

  背景与目的:蛛网膜下腔麻醉下行剖腹产时低血压发生率高。当用于预防或治疗健康女性的低血压时,去氧肾上腺素使脐血动脉pH值升高的程度大于麻黄碱。我们假设,与麻黄素相比,去氧肾上腺素会使在蛛网膜下腔麻醉下行剖宫产的先兆子痫孕妇的脐动脉血pH值升高更多。

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  方法:本研究是一项随机双盲临床试验。在西北医学院普伦蒂斯妇女医院进行剖宫产分娩的非先兆子痫妇女随机接受去氧肾上腺素或麻黄碱的预防性输注,以维持收缩压>基线的80%。蛛网膜下腔麻醉由重比重0.75%布比卡因12mg,芬太尼15μg,吗啡150μg组成。主要结果是脐动脉血液pH值,次要结果为脐动脉血碱剩余。

  结果:有110名妇女参加了该研究,其中每组54人被纳入分析。分别有74和72名婴儿在麻黄素组和去氧肾上腺素组。脐动脉pH值去氧肾上腺素:麻黄碱比值为1.002(95%置信区间[CI],0.997-1.007)。麻黄碱组7.20 [0.10]和去氧肾上腺素组7.22 [0.07]的平均[标准偏差]脐动脉pH值差异无统计学意义(平均差-0.02,95%CI差为-0.06?0.07; P=0.38)。麻黄素组中位数(第一,第三四分位数)脐动脉血碱剩余分别为-3.4mEq / L(-5.7?-2.0mEq / L),去氧肾上腺素组为-2.8mEq / L(-4.6?-2.2mEq / L)(差异为-0.6mEq / L,差异95%CI为-1.6?0.3mEq / L; P=0.10)。对胎龄和婴儿性别进行调整时,脐动脉pH值在组间无差异。经镁治疗或重度子痫前期患者脐动脉pH值分层无显著差异。

  结论:我们无法证明与麻黄碱相比去氧肾上腺素对脐动脉pH值的有益作用。我们的研究结果表明,与用麻黄素相比,去氧肾上腺素用于预防先兆子痫妇女接受蛛网膜下腔麻醉下剖宫产分娩引起的低血压时,在改善新生儿酸碱状态时可能不具有临床上重要的优势。

  The Effect of Prophylactic Phenylephrine and Ephedrine Infusions on Umbilical Artery Blood pH in Women With Preeclampsia Undergoing Cesarean Delivery With Spinal Anesthesia: A Randomized,Double-Blind Trial;Anesth Analg. Sep 25,2017. doi: 10.1213/ANE.0000000000002524.

  Background:Spinal anesthesia for cesarean delivery is associated with a high incidence of hypotension. Phenylephrine results in higher umbilical artery pH than ephedrine when used to prevent or treat hypotension in healthy women. We hypothesized that phenylephrine compared to ephedrine would result in higher umbilical artery pH in women with preeclampsia undergoing cesarean delivery with spinal anesthesia.

  Methods: This study was a randomized double-blind clinical trial. Nonlaboring women with preeclampsia scheduled for cesarean delivery with spinal anesthesia at Prentice Women's Hospital of Northwestern Medicine were randomized to receive prophylactic infusions of phenylephrine or ephedrine titrated to maintain systolic blood pressure >80% of baseline. Spinal anesthesia consisted of hyperbaric 0.75% bupivacaine 12 mg, fentanyl 15 μg, and morphine 150 μg. The primary outcome was umbilical arterial blood pH and the secondary outcome was umbilical artery base excess.

  Results:One hundred ten women were enrolled in the study and 54 per group were included in the analysis. There were 74 and 72 infants delivered in the ephedrine and phenylephrine groups, respectively. The phenylephrine:ephedrine ratio for umbilical artery pH was 1.002 (95% confidence interval [CI], 0.997-1.007). Mean [standard deviation] umbilical artery pH was not different between the ephedrine 7.20 [0.10] and phenylephrine 7.22 [0.07] groups (mean difference -0.02, 95% CI of the difference -0.06 to 0.07; P=.38). Median (first, third quartiles) umbilical artery base excess was -3.4 mEq/L (-5.7 to -2.0 mEq/L) in the ephedrine group and -2.8 mEq/L (-4.6 to -2.2mEq/L) in the phenylephrine group (difference -0.6 mEq/L, 95% CI of the difference -1.6 to 0.3 mEq/L; P=.10). When adjusted for gestational age and infant gender, umbilical artery pH did not differ between groups. There were also no differences in the umbilical artery pH stratified by magnesium therapy or by the severity of preeclampsia.

  Conclusion:We were unable to demonstrate a beneficial effect of phenylephrine on umbilical artery pH compared with ephedrine. Our findings suggest that phenylephrine may not have a clinically important advantage compared with ephedrine with regard to improved neonatal acid-base status when used to prevent spinal anesthesia-induced hypotension in women with preeclampsia undergoing cesarean delivery.

  

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