| Background:Preeclampsia increases risk of placental hypoperfusion and compromises fetoplacental circulation.Herein,we compare equivalent norepinephrine,phenylephrine,and ephedrine for spinal hypotension in preeclamptic parturients.Methods:In this randomized double-blind controlled study,166 preeclamptic spinal hypotension parturients were randomly assigned to receive bolus norepinephrine 4μg（group N;n=56）,phenylephrine 50μg（group P;n=55）or ephedrine 4 mg（group E;n=55）to treat hypotension（systolic blood pressure,SBP<80%baseline）.Primary outcomes were overall SBP and heart rate（HR）until delivery.Secondary outcomes included incidence of tachycardia（HR>120 bpm）,bradycardia（HR<60 bpm）,hypertension（SBP>120%baseline）,number of vasopressor boluses and hypotension episodes,maternal side effects（nausea,vomiting,dizziness and shivering）,and neonatal outcomes（Apgar score;umbilical arterial blood gas and pH）.Results:SBP was similar among groups.The overall HR in group N was higher than that of group P（80.5±12 vs.76.6±6.9 bpm,P=0.04）;however,lower than that of group E（80.5±12 vs.84.9±7.1 bpm,P=0.02）.Consistently,parturients in group N experienced fewer bradycardia compared to group P（3.6%vs.21.8%;relative risk[RR]=0.26,95%confidence interval[CI]=0.07-0.73,P=0.004）and fewer tachycardia compared to group E（16.1%vs.36.4%;RR 0.54,95%CI 0.29-0.90;P=0.02）.In addition,we observed fewer intraoperative nausea and vomiting（5.4%vs20%;RR 0.39,95%CI 0.14-0.90;P=0.02）for mothers,along with lower HCO3-,lactate,and higher pH,base excess（BE）for neonates（P=0.037,<0.001,0.006,and0.003,respectively）in group N compared to group E.No neonate had umbilical artery pH<7.2,and other secondary outcomes were similar among groups.Conclusion:An equipotent bolus norepinephrine shows a similar efficacy,however,a better maternal safety compared to phenylephrine,as well as a better maternal and neonatal safety compared to ephedrine in preeclamptic parturients. |
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