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Comparative Dose–Response Study on the Infusion of Norepinephrine Combined with Crystalloid Coload versus Colloid Coload for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery
Drug Design, Development and Therapy ( IF 4.8 ) Pub Date : 2022-08-06 , DOI: 10.2147/dddt.s378453
Wei-Dong Jin 1 , Jun-Qin Mao 2 , Jie Liu 2 , Gang Liang 2 , Chao Jiang 2 , Zhi-Min Sheng 2
Affiliation  

Background: Although the optimal infusion dose of norepinephrine combined with crystalloid coload for preventing spinal anesthesia-induced hypotension (SAIH) for cesarean delivery has been established, the infusion regimen of norepinephrine combined with colloid coload has not been fully quantified. The objective of this study was to compare and determine the median effective dose (ED50) and 90% effective dose (ED90) of norepinephrine infusion combined with crystalloid coload versus colloid coload for preventing SAIH during cesarean delivery.
Methods: Two hundred parturients were randomly assigned to receive norepinephrine infusion at 0.02, 0.04, 0.06, 0.08, or 0.10 μg/kg/min in combination with 10 mL/kg crystalloid coload or colloid coload to prevent SAIH. The study period was defined as the interval from the commencement of intrathecal injection to delivery of the neonate. The primary outcome was non-occurrence of hypotension, defined as systolic blood pressure (SBP) less than 80% of the baseline before delivery. The ED50 and ED90 of norepinephrine infusion dose were determined using probit regression analysis. By calculating the 95% confidence intervals (CIs) of relative median potency to determine whether the prophylactic infusion of norepinephrine requirement was different between the two groups.
Results: The derived ED50 and ED90 of norepinephrine infusion combined with crystalloid coload were 0.030 (95% CIs 0.020 to 0.038) and 0.097 (95% CIs 0.072 to 0.157) μg/kg/min, respectively. The ED50 and ED90 of norepinephrine infusion combined with colloid coload were 0.021 (95% CIs 0.013 to 0.029) and 0.070 (95% CIs 0.053 to 0.107) μg/kg/min, respectively. The estimate of relative median potency for norepinephrine between the two groups was 1.37 (95% CIs 0.94 to 2.23).
Conclusion: Under the conditions of this study, 10 mL/kg colloid coload reduced the dose of prophylactic norepinephrine infusion by approximately 30% in parturients during spinal anesthesia for cesarean delivery compared with the crystalloid coload.



中文翻译:

去甲肾上腺素输注联合晶体液与胶体液预防剖宫产脊髓麻醉低血压的剂量反应比较研究

背景:虽然已经确立了去甲肾上腺素联合晶体液共载预防剖宫产脊髓麻醉性低血压(SAIH)的最佳输注剂量,但去甲肾上腺素联合胶体共载的输注方案尚未完全量化。本研究的目的是比较和确定去甲肾上腺素输注联合晶体共载与胶体共载在剖宫产期间预防 SAIH的中位有效剂量 (ED 50 ) 和 90% 有效剂量 (ED 90 )。
方法:200 名产妇被随机分配接受 0.02、0.04、0.06、0.08 或 0.10 μg/kg/min 的去甲肾上腺素输注联合 10 mL/kg 晶体液或胶体液以预防 SAIH。研究期定义为从鞘内注射开始到新生儿分娩的时间间隔。主要结果是未发生低血压,定义为分娩前收缩压 (SBP) 低于基线的 80%。使用概率回归分析确定去甲肾上腺素输注剂量的ED 50和ED 90。通过计算相对中位效力的 95% 置信区间 (CIs) 来确定两组之间预防性输注去甲肾上腺素的需求是否不同。
结果:去甲肾上腺素输注联合晶体共载量的衍生 ED 50和 ED 90分别为 0.030(95% CI 0.020 至 0.038)和 0.097(95% CI 0.072 至 0.157)μg/kg/min。去甲肾上腺素输注联合胶体共载量的 ED 50和 ED 90分别为 0.021(95% CI 0.013 至 0.029)和 0.070(95% CI 0.053 至 0.107)μg/kg/min。两组间去甲肾上腺素的相对中位效价估计值为 1.37(95% CI 为 0.94 至 2.23)。
结论:在本研究条件下,与晶体液共载量相比,10 mL/kg 胶体共载量可使剖宫产腰麻分娩产妇预防性去甲肾上腺素输注剂量减少约 30%。

更新日期:2022-08-05
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