مقایسه اثر فنیل‌افرین و افدرین بر نوزاد در درمان هیپوتانسیون ناشی از بی‌حسی نخاعی در زنان باردار کاندید سزارین

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه بیهوشی، دانشکده پزشکی ، دانشگاه علوم پزشکی ایران، تهران، ایران.

2 استادیار گروه بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران

3 دستیار گروه بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران.

چکیده

مقدمه: یکی از روش‌های مورد استفاده در سزارین، بی‌حسی نخاعی است که این بیهوشی نقش عمده‌ای در عمل سزارین دارد. یکی از عوارض بی‌حسی نخاعی، افت فشارخون می‌باشد. مطالعه حاضر با هدف بررسی مقایسه اثر فنیل‌افرین و افدرین در درمان هایپوتنشن ناشی از بی‌حسی نخاعی در زنان باردار کاندید سزارین انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی تصادفی دو‌سو‌کور در سال 97-1396 بر روی 74 زن باردار سالم کاندید عمل جراحی سزارین انتخابی تحت بی‌حسی نخاعی مراجعه‌کننده به بیمارستان فیروزگر تهران انجام شد. بیماران به‌طور تصادفی در دو گروه فنیل‌افرین یا افدرین قرار گرفتند. بیماران فنیل‌افرین یا افدرین را بلافاصله پس از افت فشارخون به‌دنبال بی‌حسی نخاعی دریافت کردند. طی جراحی متغیرهای همودینامیک شامل فشارخون سیستولیک، دیاستولیک و ضربان قلب هر 5 دقیقه اندازه‌گیری شد و بعد از خروج نوزاد، گازهای خون شریانی بندناف نوزاد تحت آنالیز قرار گرفت و همچنین آپگار نوزاد در دقایق 1 و 5 ثبت شدند. تجزیه و تحلیل داده‌ها با استفاده از نرم افزار آماریSPSS (نسخه 21) و آزمون تحلیل اندازه‌های تکراری انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته­ها: بین فشارخون سیستولیک بیماران در دو گروه طی جراحی تفاوت معناداری وجود نداشت (05/0<p). فشار‌خون دیاستولیک بیماران طی جراحی در دقایق 5، 10، 15، 20، 25 و 30 بعد از خروج نوزاد، در گروه فنیل‌افرین به‌طور معناداری کمتر از گروه افدرین بود (05/0>p). ضربان قلب بیماران طی جراحی به استثنای دقایق قبل از بی‌حسی نخاعی، 6 دقیقه بعد از بی‌حسی نخاعی، 40 و 45 بعد از خروج نوزاد در گروه فنیل‌افرین به‌طور معناداری کمتر از گروه افدرین بود (05/0>p). آپگار نوزادان در دقیقه 1 در گروه فنیل‌افرین به‌طور معناداری بیشتر از گروه افدرین بود (05/0>p). بین نمره آپگار نوزادان در دو گروه در دقیقه 5 تفاوت معناداری وجود نداشت (05/0<p). بین میزان pH نوزادان در بیماران دو گروه تفاوت معناداری وجود نداشت.
نتیجه­گیری: هر دو داروی افدرین و فنیل‌افرین جهت درمان هیپوتانسیون ناشی از بی‌حسی نخاعی در زنان باردار کاندید سزارین،  بدون اختلاف مشخصی در کنترل فشارخون سیستمیک و با کمترین تأثیر بر آپگار نوزاد، قابل استفاده می‌باشند.

کلیدواژه‌ها


عنوان مقاله [English]

Comparison of the effect of phenylephrine and ephedrine on the neonate in treatment of hypotension due to spinal anesthesia in pregnant women candidate for cesarean section

نویسندگان [English]

  • Alireza Pournajafian 1
  • Faranak Rokhtabnak 1
  • Mohamadreza Ghodrati 1
  • Alireza Kholdebarin 2
  • Ali Hassani 3
  • Abdolreza Dayani 3
1 Associate professor, Department of Anesthesia, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
2 Assistant professor, Department of Anesthesia, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
3 Resident, Department of Anesthesia, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: One of the methods used in cesarean section is spinal anesthesia that have major role in cesarean section. One complication of spinal anesthesia is hypotension. This study was performed with aim to compare the effects of phenylephrine and ephedrine in the treatment of hypotension due to spinal anesthesia in pregnant women who are candidates for cesarean section.
Methods: This randomized, double-blind, clinical trial study was performed on 74 healthy pregnant women candidate for ceasarian section under spinal anesthesia who referred to Firoozgar hospital in Tehran in 2017-2018. Patients were randomly assigned to two groups: phenylephrine or ephedrine. Patients received phenylephrine or ephedrine immediately after hypotension due to spinal anesthesia. During the surgery, hemodynamic variables including systolic, diastolic blood pressure and heart rate were measured every 5 minutes. After the removal of the baby, the umbilical cord blood gases were analyzed; first and fifth minutes Apgar score were recorded. Data were analyzed by SPSS software (version 21) and Repeated measures ANOVA. P<0.05 was considered statistically significant.
Results: There was no significant difference between systolic blood pressure in two groups during surgery (P>0.05). The diastolic blood pressure during surgery at 5, 10, 15, 20, 25 and 30 minutes after the removal of the baby was significantly less in the phenylephrine group than Ephedrine group (P<0.05). Heart rate of patients during surgery except minutes before spinal anesthesia, 6 min after spinal anesthesia, 40 and 45 after the removal of the newborn was significantly less in the phenylephrine group than ephedrine group (P<0.05). First minute Apgar score was significantly higher in phenylephrine group than the ephedrine group (P<0.05). Fifth minute Apgar score was not significantly different between the two groups (P >0.05). There was no significant difference in the PH of newborns in two groups (P>0.05).
Conclusion: Both ephedrin and phenylephrine can be used in treatment of hypotension due to spinal anesthesia in pregnant women candidate for caesarean section, without any significant differences in control of systemic blood pressure and minimum effect on Apgar score.           

کلیدواژه‌ها [English]

  • Apgar
  • Ephedrine
  • Hypotension
  • Phenylephrine
  • Spinal anesthesia
  1. Rollins M, Lucero J. Overview of anesthetic considerations for Cesarean delivery. Br Med Bull 2012; 101:105-25.
  2. Tsen LC. Anesthesia for cesarean delivery. In: Chestnut DH, Polley LS, Wong CA, Tsen LC, editors. Chestnut’s obstetric anesthesia: principles and practice. 4nd ed. Philadelphia; 2009. Elsevier. p. 521-573.
  3. Fettes PD, Jansson JR, Wildsmith JA. Failed spinal anaesthesia: mechanisms, management, and prevention. Br J Anaesth 2009; 102(6):739-48.
  4. Riley ET, Cohen SE, Macario A, Desai JB, Ratner EF. Spinal versus epidural anesthesia for cesarean section: a comparison of time efficiency, costs, charges, and complications. Anesth Analg 1995; 80(4):709-12.
  5. Chooi C, Cox JJ, Lumb RS, Middleton P, Chemali M, Emmett RS, et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2017; 8:CD002251.
  6. Allen TK, George RB, White WD, Muir HA, Habib AS. A double-blind, placebo-controlled trial of four fixed rate infusion regimens of phenylephrine for hemodynamic support during spinal anesthesia for cesarean delivery. Anesth Analg 2010; 111(5):1221-9.
  7. Smiley RM. Burden of proof. Anesthesiology 2009; 111(3):470-2.
  8. Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992; 76(6):906-16.
  9. Mercier FJ, Bonnet MP, De la Dorie A, Moufouki M, Banu F, Hanaf A, et al. [Spinal anaesthesia for caesarean section: fluid loading, vasopressors and hypotension]. Ann Fr Anesth Reanim 2007; 26(7-8):688-93.
  10. Jackson R, Reid JA, Thorburn J. Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. Br J Anaesth 1995; 75(3):262-5.
  11. Burns SM, Cowan CM, Wilkes RG. Prevention and management of hypotension during spinal anaesthesia for elective caesarean section: a survey of practice. Anaesthesia 2001; 56(8):794-8.
  12. Ralston DH, Shnider SM, DeLorimier AA. Effects of equipotent ephedrine, metaraminol, mephentermine, and methoxamine on uterine blood flow in the pregnant ewe. Anesthesiology 1974; 40(4):354-70.
  13. Kluger MT. Ephedrine may predispose to arrhythmias in obstetric anaesthesia. Anaesth Intensive Care 2000; 28(3):336.
  14. Ngan Kee WD, Khaw KS, Tan PE, Ng FF, Karmakar MK. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology 2009; 111(3):506-12.
  15. Clyburn P. Spinal anaesthesia for caesarean section: time for re‐appraisal? Anaesthesia 2005; 60(7):633-5.
  16. Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2002; 94(4):920-6.
  17. Ngan Kee WD. Prevention of maternal hypotension after regional anaesthesia for caesarean section. Curr Opin Anaesthesiol 2010; 23(3):304-9.
  18. Thomas DG, Robson SC, Redfern N, Hughes D, Boys RJ. Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for caesarean section. Br J Anaesth 1996; 76(1):61-5.
  19. Dyer RA, Reed AR, van Dyk D, Arcache MJ, Hodges O, Lombard CJ, et al. Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. Anesthesiology 2009; 111(4):753-65.
  20. Cooper DW, Carpenter M, Mowbray P, Desira WR, Ryall DM, Kokri MS. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia form cesarean delivery. Anesthesiology 2002; 97(6):1582-90.
  21. Magalhães E, Govêia CS, de Araújo Ladeira LC, Nascimento BG, Kluthcouski SM. Ephedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus. Rev Bras Anesthesiol 2009; 59(1):11-20.
  22. Vincent JC. Principles of anesthesiology: general and regional anesthesia. 3nd ed. Philadelphia: Lea &​ Febiger; 1993. p. 1541-1545.
  23. Rooke GA, Freund PR, Jacobson AF. Hemodynamic response and change in organ blood volume during spinal anesthesia in eldery men with cardiac disease. Anesth Analg 1997; 85(1): 99-105
  24. Lynn FM. Nurse Anesthesia Pocket Guide. 3nd ed. Jones & Bartlett Learning 2016.
  25. Greene NM. Physiology of Spinal Anesthesia. 3nd ed. Williams & Wilkins; 1981.
  26. Atashkhoyi S, Fardiazar Z, Hatami Marandi P, Torab R. Comparison the effect of ephedrine and phenylephrine in treatment of hypotension after spinal anesthesia during cesarean section. Open Journal of Obstetrics and Gynecology 2012; 2(3):192-196.
  27. Dua D, Jadliwala R, Gondalia D, Parmar V, Jain A. Comparison of bolus phenylephrine, ephedrine and mephentermine for maintenance of arterial pressure during spinal anaesthesia in caesarean section. Int J Pharm Sci Res 2014; 5(6):2412-17.
  28. Mohta M, Aggarwal M, Sethi AK, Harisinghani P, Guleria K. Randomized double-blind comparison of ephedrine and phenylephrine for management of post-spinal hypotension in potential fetal compromise. Int J Obstet Anesth 2016; 27:32-40.
  29. Soxhuku-Isufi A, Shpata V, Sula H. Maternal and Neonatal Effects of Vasopressors Used for Treating Hypotension after Spinal Anesthesia for Caesarean Section: A Randomized Controlled Study. Open Access Maced J Med Sci 2016; 4(1):54-58.
  30. Alereza Amiri H, Banihashem N, Naziri F, Rabiee M, Ghasemi A, Shirkhani Z, et al. The Effects of Phenylephrine and Ephedrine on Maternal Hemodynamic Changes and Neonatal Acid-Base Status during Spinal Anesthesia for Cesarean Delivery. J Mazandaran Univ Med Sci 2013; 23(107):117-124.
  31. Mohta M, Duggal S, Chilkoti GT. Randomised double‐blind comparison of bolus phenylephrine or ephedrine for treatment of hypotension in women with pre‐eclampsia undergoing caesarean section. Anaesthesia 2018; 73(7):839-846.
  32. Abedinzadeh MR, Noorian C, Kheire S, Nejat Z. Pharmacutical effects of ephedrine, atropine and mucosal phenilephrin on hemodynamic alterations of women during spinal anesthesia in cesarean section. J Gorgan Uni Med Sci 2012; 13(4):27-34.
  33. Fakhari S, Bile Jani I, Atashkhouei S, Khanbabayi Gol M, Soliemanzadeh S. Comparing the effect of hypotension treatment due to spinal anesthesia with ephedrine or phenylephrine on arterial blood gases and neonatal Apgar score during cesarean delivery in obese mothers: randomized clinical trial. Iran J Obstet Gynecol Infertil 2019; 22(10):12-20.