关注罂粟花，共同学习麻醉学最新文献！
剖宫产术中去氧肾上腺素推注与输注方案对母儿结局影响的系统评价和Meta分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：周菁 编辑：田明德 审校：曹莹
背景：进行了一项系统回顾和荟萃分析，以比较在腰麻或腰-硬联合麻醉下进行剖宫产的产妇中去氧肾上腺素推注与预防性输注对胎儿-母亲结局的影响。
方法：检索了 Medline、Embase、Cochrane 和美国临床注册数据库。 其中包括比较去氧肾上腺素推注（治疗性和预防性）与输注（固定和可变速率）评估各种胎儿-母亲结局的研究。 主要结局是孕产妇低血压的发生率。 次要产妇结局包括反应性高血压、心动过缓、恶心或呕吐的发生率； 次要新生儿结局包括脐动脉 pH 值、氧分压 (paO2)、脐静脉 pH 值、胎儿酸中毒、1 分钟和 5 分钟时的 Apgar 评分。 使用随机效应模型对所有结果进行定量分析。 使用 Cochrane Collaboration R0B 2.0 工具评估偏倚风险。
结果：我们纳入了15项研究，共2153名产妇。在腰麻或腰-硬联合麻醉下剖宫产时，与去氧肾上腺素输注相比，接受苯巴比妥推注的产妇分娩前低血压的发生率显著增加（风险比[RR]，2.34，95%置信区间[CI]，1.72 - 3.18）。与输注组相比，接受去氧肾上腺素推注的产妇中反应性高血压（RR，0.48，95% CI，0.29 - 0.79）和心动过缓（RR，0.57，95% CI，0.41 - 0.79）较不常见;而呕吐（RR，2.15，95% CI，1.53 - 3.03）较常见。两组之间在恶心发生率或任何胎儿结局（脐动脉pH值、PaO2、脐静脉pH值、胎儿酸中毒和1分钟和5分钟的Apgar评分）方面均未观察到统计学显著差异。3项研究存在高偏倚风险。
结论：与治疗性或预防性去氧肾上腺素推注组相比，预防性去氧肾上腺素输注可显著降低在椎管内麻醉接受剖宫产术的产妇的分娩前低血压发生率。所有无高血压疾病或心血管疾病的产妇均可考虑预防性去氧肾上腺素输注，以降低分娩前低血压的风险。需要更多的证据来指导高血压或心血管疾病患者的最佳血流动力学管理。
原始文献来源：Garg,H. , ,V.N.M.R. , Khanna,P. ,& Yalla , B.(2024).Comparison of Phenylephrine Bolus and Infusion Regimens on Maternal and Fetal Outcomes During Cesarean Delivery: A Systematic Review and Meta-Analysis.Anesthesia & Analgesia,139(6),1144-1155.
Comparison of Phenylephrine Bolus and Infusion Regimens on Maternal and Fetal Outcomes During Cesarean Delivery: A Systematic Review and Meta-Analysis
Abstract
Background: A systematic review and meta-analysis was conducted to compare phenylephrine boluses versus prophylactic infusion in parturients undergoing cesarean delivery under spinal or combined spinal-epidural anesthesia on feto-maternal outcomes.
Method:Medline, Embase, Cochrane, and US Clinical registry databases were searched.Studies comparing phenylephrine boluses (both therapeutic and prophylactic) with infusion (both fixed- and variable-rate) assessing various feto-maternal outcomes were included. The primary outcome was the incidence of maternal hypotension. Secondary maternal outcomes included the incidence of reactive hypertension, bradycardia, nausea, or vomiting; secondary neonatal outcomes included umbilical arterial pH, partial pressure of oxygen (paO2), umbilical venous pH, fetal acidosis, Apgar Scores at 1 and 5 minutes. All outcomes were quantitatively analyzed using the random effects model. Risk of bias was assessed using the Cochrane Collaboration R0B 2.0 tool.
Results:A prophylactic phenylephrine infusion significantly reduces the incidence of predelivery hypotension in parturients undergoing cesarean delivery under neuraxial anesthesia in comparison to the therapeutic or prophylactic phenylephrine bolus group. A prophylactic phenylephrine infusion may be considered in all parturients without preexisting hypertensive disorder or cardiovascular disorders to reduce the risk of predelivery hypotension. More evidence is needed to guide optimal hemodynamic management for patients with hypertensive or cardiovascular disorders.
Conclusion:A prophylactic phenylephrine infusion significantly reduces the incidence of predelivery hypotension in parturients undergoing cesarean delivery under neuraxial anesthesia in comparison to the therapeutic or prophylactic phenylephrine bolus group. A prophylactic phenylephrine infusion may be considered in all parturients without preexisting hypertensive disorder or cardiovascular disorders to reduce the risk of predelivery hypotension. More evidence is needed to guide optimal hemodynamic management for patients with hypertensive or cardiovascular disorders.
