A dose-response meta-analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective cesarean delivery
A dose-response meta-analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective cesarean delivery
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DOI：
10.1213/01.ane.0000096183.49619.fc
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发表时间：
2004-02-01
影响因子：
5.7
通讯作者：
Gin, T
中科院分区：
文献类型：
--
作者：
Lee, A;Kee, WDN;Gin, T
我们系统地回顾了现有的研究，以确定预防性静脉注射麻黄碱预防腰麻剖宫产术期间低血压的剂量反应特征。我们检索了MEDLINE、EMBASE、科克伦对照试验中心登记处和已发表文章的参考列表中获得的随机对照试验（RCT）或队列研究，其中两种或多种不同剂量的预防性静脉注射麻黄碱用于预防剖宫产脊髓麻醉期间的低血压。发现了4项RCT和1项队列研究（共n = 390）。在低血压的RCT汇总中存在显著的剂量-反应关系（斜率= -0.0128; 95%置信区间[CI]，-0.0213至-0.0044），高血压（斜率= 0.0563; 95% CI，0.0235至0.0892）和脐动脉pH值（斜率= -0.03; 95% CI，-0.05至0.00）。麻黄素预防低血压的效果不明显。在14 mg时，需要治疗的数量仅为7.6（95% CI，4.8-21.1），这与需要伤害的数量相同（7.6; 95% CI，3.7-23.4）。在较大剂量下，引起高血压的可能性实际上大于防止低血压的可能性，并且脐动脉pH值也略有下降。
We systematically reviewed available studies to determine the dose-response characteristics of prophylactic IV ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. We searched for randomized controlled trials (RCTs) or cohort studies obtained through MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and reference lists of published articles-in which two or more different doses of prophylactic IV ephedrine were used to prevent hypotension during spinal anesthesia for cesarean delivery. Four RCTs and one cohort study were found (total n = 390). There was a significant dose-response relationship in the RCTs pooled for hypotension (slope = -0.0128; 95% confidence interval [CI], -0.0213 to -0.0044), hypertension (slope = 0.0563; 95% CI, 0.0235 to 0.0892), and umbilical arterial pH (slope = -0.03; 95% CI, -0.05 to 0.00). The efficacy of ephedrine for preventing hypotension was small. At 14 mg, the number-needed-to-treat was only 7.6 (95% CI, 4.8-21.1), and this was the same as the number-needed-to-harm (7.6; 95% CI, 3.7-23.4). At larger doses, the likelihood of causing hypertension was actually more than that of preventing hypotension, and there was also a minor decrease in umbilical arterial pH.