脊髓麻醉下剖宫产术中去甲肾上腺素维持血流动力学及其胎儿结局:系统综述

IF 0.1 Q4 ANESTHESIOLOGY Acta anaesthesiologica Belgica Pub Date : 2023-06-01 DOI:10.56126/74.2.12
S De Deckere, V Saldien, H Coppejans
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引用次数: 0

摘要

背景:脊髓后低血压是轴向麻醉下剖宫产的常见并发症。麻醉师一直在使用不同的血管加压剂来维持血液动力学。最近的研究表明,去甲肾上腺素对产妇血压和心输出量有有益的影响,但对新生儿预后的影响很少。目的:本系统综述总结了剖宫产术中给予去甲肾上腺素后新生儿预后的最新证据,如脐动脉pH值和碱过量。方法:检索PubMed 2010 - 2022年的文献,以新生儿结局为主要终点,以产妇血流动力学为次要终点。共纳入15项随机对照试验。结果:研究使用预防性输注去甲肾上腺素显示正常胎儿血气。无胎儿应激(pH <7、20、底座多余<-6)在研究中被评估。去甲肾上腺素成功维持母体血液动力学。它比苯肾上腺素引起的心动过缓更少,比麻黄碱引起的心动过缓更少。结论:本研究提示,预防性输注去甲肾上腺素是一种安全的血管加压剂,可预防剖宫产术后脊髓后低血压。在最近的研究中没有发现胎儿酸中毒的迹象。
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Hemodynamic maintenance with norepinephrine in caesarean section under spinal anesthesia and its fetal outcome: a systematic review
Background: Postspinal hypotension is a frequent maternal complication in caesarean delivery under neuraxial anesthesia. Anesthesiologists have been using different vasopressors to maintain hemodynamics. Recent studies suggested beneficial effects of norepinephrine on maternal blood pressure and cardiac output, but little evidence exist on the neonatal outcome. Objectives: This systematic review summarises recent evidence on neonatal outcome, such as umbilical arterial pH and base excess, after administration of norepinephrine during caesarean section. Methods: A literature search on PubMed from 2010 to 2022 was performed and every article was reviewed on neonatal outcome, as primary endpoint and on maternal hemodynamics, as secondary endpoint. A total of 15 randomised controlled trials were included. Results: Studies using a prophylactic infusion of norepinephrine show normal fetal blood gases. No evidence of fetal stress (pH < 7,20, base excess < -6) was assessed in the studies. Norepinephrine succeed in maintaining maternal hemodynamics. It is responsible for less bradycardia than phenylephrine and less tachycardia than ephedrine. Conclusion: Our study suggests that norepinephrine, preferably as prophylactic infusion, is a safe vasopressor to prevent postspinal hypotension in caesarean section. No signs of fetal acidosis could be demonstrated in the recent studies.
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来源期刊
CiteScore
0.20
自引率
0.00%
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2
期刊介绍: L’Acta Anaesthesiologica Belgica est le journal de la SBAR, publié 4 fois par an. L’Acta a été publié pour la première fois en 1950. Depuis 1973 l’Acta est publié dans la langue Anglaise, ce qui a été résulté à un rayonnement plus internationaux. Depuis lors l’Acta est devenu un journal à ne pas manquer dans le domaine d’Anesthésie Belge, offrant e.a. les textes du congrès annuel, les Research Meetings, … Vous en trouvez aussi les dates des Research Meetings, du congrès annuel et des autres réunions.
期刊最新文献
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