Phenylephrine Infusion Versus Bolus Regimens During Cesarean Delivery Under Spinal Anesthesia: A Double-Blind Randomized Clinical Trial to Assess Hemodynamic Changes
Phenylephrine Infusion Versus Bolus Regimens During Cesarean Delivery Under Spinal Anesthesia: A Double-Blind Randomized Clinical Trial to Assess Hemodynamic Changes
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DOI：
10.1213/ane.0b013e31826ac3db
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发表时间：
2012-12-01
影响因子：
5.7
通讯作者：
Carvalho, Jose C. A.
中科院分区：
文献类型：
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作者：
Doherty, Anne;Ohashi, Yayoi;Carvalho, Jose C. A.
引言：苯乙哌啶用于预防和治疗剖宫产腰麻期间的低血压。最佳给药方案尚未确定。我们使用了一种非侵入性的心输出量监测器来测试的假设，即一个固定的速率phenylephaline输液方案将导致一个较小的减少，在产妇心输出量，并导致产妇低血压，相比phenylephaline推注regiment.METHODS：这是一个双盲，随机临床试验的妇女进行选择性剖腹产下脊髓麻醉。患者被随机分配到间歇性推注（120 μ g）或固定速率输注（120 μ g/min）的苯丙氨酸。收缩压相对于基线的任何降低均接受治疗。主要结局是使用生物反应技术评估的分娩前心输出量的最大变化。次要结果包括心率的最大变化、低血压和高血压的发生率、恶心/呕吐和心动过缓、苯巴比妥的总剂量、脐带血气和Apgar评分。在每个治疗组随时间的血流动力学曲线进行了比较。两个治疗组之间的心输出量最大变化无显著差异：推注组的心输出量平均（SD）最大变化为1.87（1.68）L/min，输注组为1.9（1.46）L/min（P = 0.94）（平均差异的95%置信区间：-0.84至0.78 L/min）。输注组接受了显著更多的苯乙烷（1740（613）对964（454）μ g）（P < 0.001）。在鞘内注射后的最初6分钟内，与推注组相比，输注组的血压显著降低（P = 0.007）。在其他次要outcomes.CONCLUSION：没有显着差异，以管理苯乙哌啶作为一个输液与推注方案的临床效益。在脊髓注射后的最初几分钟内，推注方案维持母体动脉血压接近基线，但这没有临床益处。输注方案需要更高的去氧肾上腺素总剂量，以在分娩前将母体动脉血压维持在基线水平。（Anesth Analg 2012;115：1343-50）
INTRODUCTION: Phenylephrine is used to prevent and treat hypotension during spinal anesthesia for cesarean delivery. The optimal administration regimen is undetermined. We used a non-invasive cardiac output monitor to test the hypothesis that a fixed-rate phenylephrine infusion regimen would cause a smaller reduction in maternal cardiac output, and result in less maternal hypotension, as compared to a phenylephrine bolus regimen.METHODS: This was a double-blind, randomized clinical trial of women undergoing elective cesarean delivery under spinal anesthesia. Patients were randomized to an intermittent bolus (120) mu g) or a fixed-rate infusion (120 mu g/min) regimen of phenylephrine. Any decrease in systolic blood pressure from baseline was treated. The primary outcome was the maximum change in cardiac output in the predelivery period, assessed using bioreactance technology. Secondary outcomes included the maximum change in heart rate, incidence of hypo- and hypertension, nausea/vomiting and bradycardia, total dose of phenylephrine, umbilical blood gases, and Apgar scores. The hemodynamic profiles over time in each treatment arm were compared.RESULTS: Sixty patients were studied. There was no significant difference in the maximum change in cardiac output between the 2 treatment arms: mean (SD) maximum change in cardiac output in the bolus group was 1.87 (1.68) L/min versus 1.9 (1.46) L/min in the infusion group (P = 0.94) (95% confidence intervals of difference in means: -0.84 to 0.78 L/min). The infusion group received significantly more phenyl ephrine (1740 (613) versus 964 (454) mu g) (P < 0.001). In the initial 6 min after intrathecal injection, there was a significant decrease in blood pressure in the infusion group compared to the bolus group (P = 0.007). There was no significant difference in the other secondary outcomes.CONCLUSION: There were no clinical benefits to administering phenylephrine as an infusion versus a bolus regimen. The bolus regimen maintained maternal arterial blood pressure closer to baseline in the initial minutes after spinal injection but this had no clinical benefits. The infusion regimen required a higher total dose of phenylephrine to maintain maternal arterial blood pressure at baseline during the predelivery period. (Anesth Analg 2012;115:1343-50)