低剂量雷米芬坦尼尔在预期剖腹产中使用全身麻醉:一项随机对照试验
Clément Chollat1,2, Fabien Tourrel3, Estelle Houivet4
1Service de NéonatoloDepartment of Neonatal Pediatrics, Trousseau Hospital, APHP, Sorbonne Université, 26 Av. du Dr Arnold Netter, 75012, Paris, France. clement.chollat@gmail.com.
Paediatric drugs
|September 15, 2023
概括
在剖腹产期间在带紧之前服用雷米芬坦尼尔对于母亲和早产婴儿来说是安全的. 然而,与标准护理相比,这种方法并没有改善母亲的血液动力学或新生儿适应能力.
科学领域:
- 麻醉学 麻醉学
- 产科 产科 产科 产科 产科
- 新生儿科学 新生儿科学
背景情况:
- 目前的剖腹产整体麻醉方案在带紧后使用阿片类药物.
- 在绳紧之前研究雷米芬坦尼尔的效果可能会优化孕产妇和新生儿的结果.
- 过早出生的新生儿在剖腹产时需要在母亲麻醉期间仔细考虑.
研究的目的:
- 为了测试前带紧的雷米芬坦尼尔是否会减少母亲补充麻醉的需要.
- 为了评估前带紧的Remifentanil对孕产妇血液动力学的影响.
- 为了评估早产婴儿在带紧之前给母亲注射雷米芬坦尼尔后的新生儿适应性.
主要方法:
- 一个第三阶段,双盲,随机,安慰剂对照试验.
- 在怀孕37周之前在全身麻醉下进行剖腹产的分娩妇女被纳入.
- 主要结局:5分钟Apgar分数<7;次要结局包括母亲的血液动力学和新生儿的呼吸状况.
主要成果:
- 在Remifentanil和安慰剂组之间5分钟Apgar分数没有显著差异 (33.3%与44.0%,p=0.45).
- 母亲的血液动力学参数,麻醉时间和累积药物剂量在各组之间没有差异.
- 没有观察到带气体或神经发育/养分数在1至2岁时的差异.
结论:
- 在剖腹产时带紧之前服用低剂量的雷米芬坦尼尔对母亲和早产新生儿是安全的.
- 这项研究没有发现使用前绳紧剂 (remifentanil) 改善孕产妇或新生儿结局.
- 进一步的研究可能会探索在这个人群中优化麻醉的替代策略.
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