结晶体和合体共同负载与北上腺素预防在剖腹产期间脊椎后麻醉低血压的结合:一个随机的顺序分配剂量发现研究
Yi Chen1, Xiangzhao Xu2, Rui Qin1
1Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
Frontiers in medicine
|September 19, 2023
概括
使用结晶体或基乙烯粉辅助加载的液体加载不会改变在剖腹产期间预防低血压所需的北上腺素有效剂量. 这两种类型的液体在维持血液动力学稳定性方面同样有效.
科学领域:
- 麻醉学 麻醉学
- 产科 产科 产科 产科 产科
- 药理学 药理学是指药理学的学科.
背景情况:
- 在剖腹产期间,通过维持血管内体积和组织输液,预防脊柱后麻醉的低血压至关重要.
- 脊髓麻醉的交感阻塞可能导致低血压,需要进行干预,例如共同加载液体和血管压缩剂输液.
- 与预防性血管压缩剂一起确定最佳的流体策略是管理这种患者群体血液动力学的关键.
研究的目的:
- 为了比较水晶化物与基乙烯粉共同负载对预防性北上腺素的有效剂量所需的效果,以防止剖腹产期间脊椎后麻醉的低血压.
- 为了识别与不同液体共载策略相结合时,上腺素输注的ED90 (有效剂量90%).
主要方法:
- 一项随机顺序分配剂量检测研究,涉及80名在脊髓麻醉下进行剖腹产的患者.
- 患者接受了10毫升/千克的晶体化物或6%的基乙烯粉 (130/0.4) 联合加载,并与预防性诺亚上腺素输液相结合.
- 使用上下序列方法调整诺亚上腺注量,以确定预防低血压的ED90 (SBP <80%的基线).
主要成果:
- 预防性上腺素输注的ED90在晶体组 (0.063μg使用同位素回归) 和基乙粉组 (0.062μg使用同位素回归) 之间是相似的.
- 实验室回归分析也显示了两个流体组之间对诺尔上腺素的可比ED90值.
- 二次结局,包括低血压发病率,心肌梗塞,高血压,阿帕格得分和动脉血液气体值,在两组之间没有显著差异.
结论:
- 作为辅助剂的6%基乙 (130/0.4) 作为辅助剂,在降低预防性诺亚美因的有效剂量以防止剖腹产期间脊柱后麻醉的低血压时,与晶体辅助剂相比,没有提供额外的好处.
- 在这种情况下,结晶体和基乙烯粉共同负载均同样有效,当与预防性北上腺素输液一起用于这种环境中的血液动力学管理时.
- 结晶体和基乙烯粉之间的选择对共同加载不会影响预防性诺拉皮内林的必要剂量,以防止剖腹产期间的低血压.
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