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Effect of Weight-Adjusted Phenylephrine, Norepinephrine, and Metaraminol for Elective Cesarean Delivery on Neonatal Acid–Base Status: A Randomized Controlled Trial
Drug Design, Development and Therapy ( IF 4.7 ) Pub Date : 2022-09-21 , DOI: 10.2147/dddt.s381048 Tianyu Liu 1 , Zhiyong Cheng 2 , Shiya Zou 3 , Chao Xu 4 , Shoudong Pan 3 , Huabei Zeng 2 , Yidong Shan 2 , Yi Feng 1 , Hong Zhang 1
Drug Design, Development and Therapy ( IF 4.7 ) Pub Date : 2022-09-21 , DOI: 10.2147/dddt.s381048 Tianyu Liu 1 , Zhiyong Cheng 2 , Shiya Zou 3 , Chao Xu 4 , Shoudong Pan 3 , Huabei Zeng 2 , Yidong Shan 2 , Yi Feng 1 , Hong Zhang 1
Affiliation
Purpose: Many previous trials have compared the effects of different vasoactive drugs on cesarean section patients, but their infusion rate is based on experience rather than high-quality evidence. It is difficult to judge whether the effect of vasoactive drug comes from the better choice or a more appropriate at rates of vasoactive drugs. The effect of vasoactive drugs at the rates of the 90% effective dose needs to be verified and compared.
Patients and Methods: Women undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomized to receive phenylephrine or norepinephrine or metaraminol infusion at the rate that was assumed to be the 90% effective dose. Anesthetic management was standardized and included fluid loading with 10 mL/kg of Ringer. The primary outcome was the umbilical artery pH.
Results: 78 patients were included. The umbilical artery pH was not significantly different among the three groups (phenylephrine group: 7.33 ± 0.03 vs norepinephrine group: 7.33 ± 0.04 vs metaraminol group: 7.33 ± 0.04, P = 0.99). There were no significant differences in the incidence of hypotension, hypertension, bradycardia, and nausea and vomiting among the three groups. The SBP of the phenylephrine group was significantly higher than that of the metaraminol group (adjustive P value = 0.005).
Conclusion: Phenylephrine (0.54 μg/kg/min) or metaraminol (2 μg/kg/min) or norepinephrine (0.08 μg/kg/min) administered to healthy patients with elective cesarean section after spinal anesthesia has no significant effect on the acid-base balance of the fetus.
Keywords: cesarean section, vasoactive drugs, foetal acid-base balance, randomized controlled trial
中文翻译：
体重调整后的去甲肾上腺素、去甲肾上腺素和间胺醇对择期剖宫产对新生儿酸碱状态的影响：一项随机对照试验
目的：之前的许多试验都比较了不同血管活性药物对剖宫产患者的影响，但其输注速度是基于经验而非高质量证据。很难判断血管活性药物的效果是来自更好的选择还是更合适的血管活性药物的使用率。需要验证和比较血管活性药物在 90% 有效剂量率下的作用。
患者和方法：在腰硬联合麻醉下进行择期剖宫产的妇女被随机分配接受去氧肾上腺素或去甲肾上腺素或间胺醇输注，输注速率假定为 90% 有效剂量。麻醉管理是标准化的，包括用 10 mL/kg 的 Ringer 进行液体负荷。主要结果是脐动脉 pH 值。
结果：包括 78 名患者。三组之间的脐动脉pH值无显着差异（去甲肾上腺素组：7.33±0.03 vs 去甲肾上腺素组：7.33 ± 0.04 vs 间胺醇组：7.33 ± 0.04，P = 0.99）。三组间低血压、高血压、心动过缓、恶心呕吐的发生率差异无统计学意义。去氧肾上腺素组的 SBP 显着高于间氨醇组（调整 P 值 = 0.005）。
结论：健康人择期剖宫产腰麻后给予去氧肾上腺素（0.54 μg/kg/min）或间苯二酚（2 μg/kg/min）或去甲肾上腺素（0.08 μg/kg/min）对酸-胎儿的基础平衡。
关键词：剖宫产 血管活性药物 胎儿酸碱平衡 随机对照试验
更新日期：2022-09-20
Patients and Methods: Women undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomized to receive phenylephrine or norepinephrine or metaraminol infusion at the rate that was assumed to be the 90% effective dose. Anesthetic management was standardized and included fluid loading with 10 mL/kg of Ringer. The primary outcome was the umbilical artery pH.
Results: 78 patients were included. The umbilical artery pH was not significantly different among the three groups (phenylephrine group: 7.33 ± 0.03 vs norepinephrine group: 7.33 ± 0.04 vs metaraminol group: 7.33 ± 0.04, P = 0.99). There were no significant differences in the incidence of hypotension, hypertension, bradycardia, and nausea and vomiting among the three groups. The SBP of the phenylephrine group was significantly higher than that of the metaraminol group (adjustive P value = 0.005).
Conclusion: Phenylephrine (0.54 μg/kg/min) or metaraminol (2 μg/kg/min) or norepinephrine (0.08 μg/kg/min) administered to healthy patients with elective cesarean section after spinal anesthesia has no significant effect on the acid-base balance of the fetus.
Keywords: cesarean section, vasoactive drugs, foetal acid-base balance, randomized controlled trial
中文翻译：
体重调整后的去甲肾上腺素、去甲肾上腺素和间胺醇对择期剖宫产对新生儿酸碱状态的影响：一项随机对照试验
目的：之前的许多试验都比较了不同血管活性药物对剖宫产患者的影响，但其输注速度是基于经验而非高质量证据。很难判断血管活性药物的效果是来自更好的选择还是更合适的血管活性药物的使用率。需要验证和比较血管活性药物在 90% 有效剂量率下的作用。
患者和方法：在腰硬联合麻醉下进行择期剖宫产的妇女被随机分配接受去氧肾上腺素或去甲肾上腺素或间胺醇输注，输注速率假定为 90% 有效剂量。麻醉管理是标准化的，包括用 10 mL/kg 的 Ringer 进行液体负荷。主要结果是脐动脉 pH 值。
结果：包括 78 名患者。三组之间的脐动脉pH值无显着差异（去甲肾上腺素组：7.33±0.03 vs 去甲肾上腺素组：7.33 ± 0.04 vs 间胺醇组：7.33 ± 0.04，P = 0.99）。三组间低血压、高血压、心动过缓、恶心呕吐的发生率差异无统计学意义。去氧肾上腺素组的 SBP 显着高于间氨醇组（调整 P 值 = 0.005）。
结论：健康人择期剖宫产腰麻后给予去氧肾上腺素（0.54 μg/kg/min）或间苯二酚（2 μg/kg/min）或去甲肾上腺素（0.08 μg/kg/min）对酸-胎儿的基础平衡。
关键词：剖宫产 血管活性药物 胎儿酸碱平衡 随机对照试验
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