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银海英, 万里, 黄瀚. 去甲肾上腺素预防双胎产妇腰硬联合麻醉后低血压有效剂量的研究[J]. 四川大学学报(医学版), 2022, 53(5): 880-889. DOI: 10.12182/20220960204
引用本文: 银海英, 万里, 黄瀚. 去甲肾上腺素预防双胎产妇腰硬联合麻醉后低血压有效剂量的研究[J]. 四川大学学报(医学版), 2022, 53(5): 880-889. DOI: 10.12182/20220960204
YIN Hai-ying, Wan Li, HUANG Han. Effective Dose of Prophylactic Norepinephrine for Preventing Hypotension under Combined Spinal and Epidural Anesthesia during Cesarean Section in Singleton Versus Twin Pregnancies[J]. Journal of Sichuan University (Medical Sciences), 2022, 53(5): 880-889. DOI: 10.12182/20220960204
Citation: YIN Hai-ying, Wan Li, HUANG Han. Effective Dose of Prophylactic Norepinephrine for Preventing Hypotension under Combined Spinal and Epidural Anesthesia during Cesarean Section in Singleton Versus Twin Pregnancies[J]. Journal of Sichuan University (Medical Sciences), 2022, 53(5): 880-889. DOI: 10.12182/20220960204

去甲肾上腺素预防双胎产妇腰硬联合麻醉后低血压有效剂量的研究

Effective Dose of Prophylactic Norepinephrine for Preventing Hypotension under Combined Spinal and Epidural Anesthesia during Cesarean Section in Singleton Versus Twin Pregnancies

  • 摘要:
      目的  确定去甲肾上腺素预防双胎产妇腰硬联合麻醉后低血压的90%有效输注剂量(90% effective dose, ED90),并与单胎产妇的ED90进行对比。
      方法  于2020年11月–2021年6月在四川大学华西第二医院,纳入200例拟在腰硬联合麻醉下行剖宫产的产妇,采用随机对照研究,其中单胎、双胎产妇各100例。按随机数字表,产妇被随机分入以下5个组:0.025、0.050、0.075、0.100和0.125 μg/(kg·min)去甲肾上腺素组,每组包含单胎和双胎产妇各20例。在注射腰麻药物同时,开始去甲肾上腺素输注,直至胎儿娩出。主要结局指标为腰硬联合麻醉后至胎儿娩出期间产妇的低血压发生率。对产妇的低血压发生情况进行生存分析(定义未发生低血压为生存)。根据低血压发生率,通过probit回归分析分别推算去甲肾上腺素预防单胎和双胎产妇腰硬联合麻醉下剖宫产中,使90%产妇不发生低血压的去甲肾上腺素输注剂量(即ED90)及其95%置信区间(CI)。
      结果  单胎产妇中、双胎产妇中,基线资料及麻醉手术数据差异无统计学意义(P>0.05)。以0.025、0.050、0.075、0.100和0.125 μg/(kg·min)输注去甲肾上腺素,单胎产妇中低血压发生率分别为50%(10/20)、35% (7/20)、20% (4/20)、10% (2/20)和5%(1/20),ED90为0.100 (95%CI: 0.082~0.130) μg/(kg·min);双胎产妇中,低血压发生率则分别为60%(12/20)、20%(4/20)、20% (4/20)、10% (2/20)和5% (1/20),ED90为0.098 (95%CI: 0.080~0.127) μg/(kg·min)。单胎产妇各剂量组间的生存曲线差异有统计学意义,双胎产妇各剂量组间的生存曲线差异有统计学意义(P<0.05)。单胎产妇、双胎产妇的反应性高血压发生率,均随去甲肾上腺素输注剂量的升高而增加(P<0.05),单胎产妇各剂量组间及双胎产妇各剂量组间,产妇其他不良反应、新生儿结局差异无统计学意义(P>0.05)。各剂量组单双胎产妇间的年龄、身高差异无统计学意义(P>0.05),但产妇的孕周、体质量、体质量指数(BMI)差异有统计学意义(P<0.05)。相同剂量组单、双胎产妇间,低血压、反应性高血压、心动过缓、头晕、恶心呕吐发生率差异无统计学意义(P>0.05)。各剂量组内单双胎产妇间生存曲线差异无统计学意义。单、双胎产妇对去甲肾上腺素的ED90差异无统计学意义。
      结论  去甲肾上腺素预防双胎产妇与单胎产妇腰硬联合麻醉后低血压的ED90差异不明显,临床需考虑孕周、体质量、BMI因素的干扰。

     

    Abstract:
      Objective  To determine and compare the 90% effective dose (ED90) of prophylactic infusion of norepinephrine for preventing hypotension during combined spinal-epidural anesthesia for cesarean section in singleton versus twin pregnancies.
      Methods  A randomized controlled trial was conducted, enrolling 200 pregnant women, 100 of which were of singleton pregnancies while the other 100 were of twin pregnancies, at West China Second University Hospital, Sichuan University between November 3, 2020 and June 2, 2021. All 200 subjects were to have Cesarean section under combined spinal-epidural anesthesia. By using a random number table, they were randomly assigned to five groups, receiving norepinephrine at the infusion dosage of 0.025, 0.050, 0.075, 0.100, and 0.125 μg/(kg·min), with 20 subjects of singleton pregnancy and 20 subjects of twin pregnancy in each group. Norepinephrine infusion started when the anesthesiologist initiated the spinal anesthetic injection and lasted until the delivery of the fetus. The primary outcome measure was the incidence of maternal hypotension during combined spinal-epidural anesthesia, up until the delivery of the fetus. Survival analysis, with survival being defined as not having hypotension, of the incidence of hypotension among the subjects was conducted. Probit regression was used to determine the ED90 of norepinephrine, as well as the corresponding 95% confidence interval (CI), for preventing hypotension during cesarean delivery under combined spinal-epidural anesthesia in women with singleton and twin pregnancies.
      Results  There was no significant difference in the baseline data or the anesthesia and operation data between pregnant women of singleton pregnancy and those of twin pregnancy (P>0.05). In singleton pregnant women receiving 0.025, 0.05, 0.075, 0.1 and 0.125 μg/(kg·min) of norepinephrine, the incidence of hypotension was 50% (10/20), 35% (7/20), 20% (4/20), 10% (2/20) and 5% (1/20), respectively. The estimated ED90 of prophylactic norepinephrine for preventing hypotension during anesthesia was 0.100 (95% CI, 0.082-0.130) μg/(kg·min). In twin pregnant women receiving 0.025, 0.05, 0.075, 0.1 and 0.125 μg/(kg·min) of norepinephrine, the corresponding incidence of hypotension was 60% (12/20), 20% (4/20), 20% (4/20), 10% (2/20) and 5% (1/20). The estimated ED90 of norepinephrine for preventing hypotension during anesthesia was 0.098 (95% CI, 0.080-0.127) μg/(kg·min). Survival analysis showed significant difference in the incidence of hypotension among the five groups receiving different infusion doses in singleton pregnancy subjects, and the same is true of the twin pregnancy subjects (P<0.05). The incidence of reactive hypertension increased with increasing dosage of norepinephrine in both singleton pregnancy subjects and twin pregnancy subjects (P<0.05). There was no significant difference in the incidence of other maternal adverse reaction or in neonatal outcomes in singleton and twin pregnancy subjects receiving different dosage of norepinephrine (P>0.05). The gestational weeks, weight, and BMI were significantly different (P<0.05), while the other characteristics, including age and height, were comparable (P>0.05) between singleton and twin pregnancy subjects receiving norepinephrine at the same dosage. There was no significant difference in the incidence of hypotension, reactive hypertension, bradycardia, nausea and vomiting, and dizziness between singleton and twin pregnancy subjects receiving the same dose (P>0.05). Survival analysis displayed no significant difference in the incidence of hypotension between singleton and twin pregnancy subjects receiving norepinephrine at the same dosage (P>0.05). There was no significant difference in the ED90 of norepinephrine between women with singleton pregnancies and those with twin pregnancies (P>0.05).
      Conclusion  There was no significant difference in the ED90 of norepinephrine for preventing hypotension during combined spinal-epidural anesthesia between women with singleton pregnancy and those with twin pregnancy. Interference of other factors, including gestational age, body mass, and BMI should be considered in clinical practice.

     

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