Effects of low-dose norepinephrine on neonates undergoing cesarean section under combined spinal-epidural anesthesia

doi:10.3877/cma.j.issn.1673-5250.2023.06.015

Objective

To investigate effects of low-dose norepinephrine on the oxygen uptake rate (ERO2) and blood gas parameters of neonates undergoing cesarean section under combined spinal-epidural anesthesia (CSEA).

Methods

From April 2018 to March 2021, a total of 98 pregnant women who were admitted to Huai′an First People′s Hospital were selected in the study. They were divided into study group (n=49) and control group (n=49) by random number table. Both groups were treated with 6% hydroxyethyl starch (130/0.4) after opening the venous channel, and the pre-expansion time was 20 min at a drip rate of 10 mL/ (kg·h). The control group did not use any vasoactive drugs after successful anesthesia puncture, and study group used a micro pump to infuse 100 μg norepinephrine after successful anesthesia puncture, the infusion time was 1 min. Rapid increase in blood pressure within 1min after medication, with a shorter duration. By retrospective analysis, the following indexes of parturient and delivery newborn were compared between two groups. ①The general conditions during the operation (intraoperative urine volume, total intraoperative fluid infusion volume, intraoperative blood loss, additional vasoactive drugs) were compared between two groups. ②The ERO₂, 1 min Apgar score, blood gas parameters [partial pressure of carbon dioxide (PaCO₂), pulse oxygen saturation (SaO₂) and partial pressure of oxygen (PaO₂)] of two groups of newborns were compared. ③The occurrence of adverse reactions were compared. ④The conditions of neonatal pressurized oxygen and tracheal intubation were compared between the two groups. The procedure followed in this study conforms to the ethical standards formulated by the Ethics Committee of Huai′an First People′s Hospital and was approved by the Committee (Approval No.YX-2021-156-01). Informed consents were obtained from patients.

Results

① There were no significant differences in general clinical data such as delivery age, gestational age and preoperative body mass index (BMI) between two groups (P>0.05). ②There were no statistically significant differences between two groups in the amount of urine, the total amount of intraoperative fluid infusion, and the amount of intraoperative blood loss between two groups (P>0.05). The proportion of additional vasoactive drugs in study group was lower than that in control group (P<0.05). ③There were no significant differences in ERO₂, PaCO₂, SaO₂, PaO₂ between two groups (P>0.05). There were no significant differences in 1 min Apgar score after birth between two groups (P>0.05). ④There was no significant difference in the incidence of adverse reactions between two groups (P>0.05). ⑤There was no need for tracheal intubation in two groups of newborns, and there was no significant difference in the number of neonatal pressurized oxygen administration between two groups (P>0.05).

Conclusions

Low-dose norepinephrine has no obvious effects on oxygen intake and blood gas parameters of newborns delivered by cesarean section under CDSA, which can reduce the proportion of vasoactive drugs, and is safe and reliable.

Key words: Norepinephrine, Colloidal pre-dilatation, Combined spinal-epidural anesthesia, Cesarean section, Oxygen uptake rate, Blood gas analysis, Infant, newborn

表1 2组剖宫产术分娩产妇的一般临床资料比较

组别	例数	分娩年龄(岁，±s)	分娩孕龄(周，±s)	术前BMI(kg/m²，±s)	ASA分级[例数(%)]
组别	例数	分娩年龄(岁，±s)	分娩孕龄(周，±s)	术前BMI(kg/m²，±s)	Ⅰ级	Ⅱ级
研究组	49	26.9±2.3	39.2±0.7	24.6±1.4	21(42.9)	28(57.1)
对照组	49	26.7±2.2	39.1±0.7	24.5±1.4	19(38.8)	30(61.2)
统计量		t＝0.43	t＝0.91	t＝0.55	χ²＝0.17
P值		0.672	0.364	0.594	0.681

表1 2组剖宫产术分娩产妇的一般临床资料比较

组别	例数	分娩年龄(岁，±s)	分娩孕龄(周，±s)	术前BMI(kg/m²，±s)	ASA分级[例数(%)]
组别	例数	分娩年龄(岁，±s)	分娩孕龄(周，±s)	术前BMI(kg/m²，±s)	Ⅰ级	Ⅱ级
研究组	49	26.9±2.3	39.2±0.7	24.6±1.4	21(42.9)	28(57.1)
对照组	49	26.7±2.2	39.1±0.7	24.5±1.4	19(38.8)	30(61.2)
统计量		t＝0.43	t＝0.91	t＝0.55	χ²＝0.17
P值		0.672	0.364	0.594	0.681

表2 2组剖宫产术分娩产妇术中情况比较

组别	例数	术中尿量(mL，±s)	术中总输液量(mL，±s)	术中出血量(mL，±s)	追加NE[例数(%)]
研究组	49	372.5±56.7	1 409.7±233.8	426.9±70.2	2(4.1)
对照组	49	374.7±58.3	1 405.7±231.6	423.8±68.6	10(20.4)
统计量		t＝0.19	t＝0.09	t＝0.22	χ²＝6.08
P值		0.854	0.932	0.826	0.014

表2 2组剖宫产术分娩产妇术中情况比较

组别	例数	术中尿量(mL，±s)	术中总输液量(mL，±s)	术中出血量(mL，±s)	追加NE[例数(%)]
研究组	49	372.5±56.7	1 409.7±233.8	426.9±70.2	2(4.1)
对照组	49	374.7±58.3	1 405.7±231.6	423.8±68.6	10(20.4)
统计量		t＝0.19	t＝0.09	t＝0.22	χ²＝6.08
P值		0.854	0.932	0.826	0.014

表3 2组新生儿ERO₂、血气分析、生后1 min Apgar及加压给氧占比比较

组别	例数	ERO₂(%，±s)	PaCO₂(mmHg，±s)	SaO₂(±s)	PaO₂(mmHg，±s)	生后1 min Apgar(分，±s)	加压给氧[例数(%)]
研究组	49	34.1±2.3	42.7±5.7	0.9±0.2	26.34±4.39	9.5±0.3	2(4.1)
对照组	49	34.9±2.4	42.4±5.7	1.0±0.2	26.37±4.35	9.3±0.2	2(4.1)
统计量		t＝1.66	t＝0.21	t＝0.09	t＝0.03	t＝0.78	t＝0.71
P值		0.099	0.836	0.173	0.973	0.440	0.399

表3 2组新生儿ERO₂、血气分析、生后1 min Apgar及加压给氧占比比较

组别	例数	ERO₂(%，±s)	PaCO₂(mmHg，±s)	SaO₂(±s)	PaO₂(mmHg，±s)	生后1 min Apgar(分，±s)	加压给氧[例数(%)]
研究组	49	34.1±2.3	42.7±5.7	0.9±0.2	26.34±4.39	9.5±0.3	2(4.1)
对照组	49	34.9±2.4	42.4±5.7	1.0±0.2	26.37±4.35	9.3±0.2	2(4.1)
统计量		t＝1.66	t＝0.21	t＝0.09	t＝0.03	t＝0.78	t＝0.71
P值		0.099	0.836	0.173	0.973	0.440	0.399

表4 2组剖宫产术分娩产妇不良反应比较[例数(%)]

组别	例数	恶心	呕吐	寒颤	低血压	总发生率
研究组	49	3(6.1)	1(2.0)	1(2.0)	2(4.1)	7(14.3)
对照组	49	2(4.1)	1(2.0)	1(2.0)	1(2.0)	5(10.2)
χ²值		—	—	—	—	0.38
P值		—	—	—	—	0.538

表4 2组剖宫产术分娩产妇不良反应比较[例数(%)]

组别	例数	恶心	呕吐	寒颤	低血压	总发生率
研究组	49	3(6.1)	1(2.0)	1(2.0)	2(4.1)	7(14.3)
对照组	49	2(4.1)	1(2.0)	1(2.0)	1(2.0)	5(10.2)
χ²值		—	—	—	—	0.38
P值		—	—	—	—	0.538

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