Ngan Kee W D, Lee A
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
Anaesthesia. 2003 Feb;58(2):125-30. doi: 10.1046/j.1365-2044.2003.02888.x.
We have investigated the factors predicting umbilical arterial pH (UA pH) and standard base excess (UA BE) in 337 consecutive elective Caesarean sections performed under spinal anaesthesia. Multiple linear regression analysis was performed with UA pH and UA BE as the dependent factors. We found that the significant factors predicting UA pH were: use of ephedrine, uterine incision-to-delivery time, maximum decrease in systolic arterial pressure and the interaction between ephedrine use and duration of hypotension (adjusted R2 = 0.39, F15,321 = 15.4, p < 0.0001). The significant factors predicting UA BE were: use of ephedrine and the interaction between ephedrine use and duration of hypotension (adjusted R2 = 0.52, F15,321 = 25.0, p < 0.0001). We conclude that, in order to minimise the risk of fetal acidosis, ephedrine should not be used before delivery, uterine incision-to-delivery time should be as short as possible, and alpha-agonists such as metaraminol or phenylephrine should be used to minimise both the magnitude and duration of hypotension.
我们对在脊髓麻醉下进行的337例连续择期剖宫产术中预测脐动脉pH值（UA pH）和标准碱剩余（UA BE）的因素进行了研究。以UA pH和UA BE作为因变量进行多元线性回归分析。我们发现，预测UA pH的显著因素为：麻黄碱的使用、子宫切开至分娩时间、收缩压最大降幅以及麻黄碱使用与低血压持续时间之间的相互作用（调整后R2 = 0.39，F15,321 = 15.4，p < 0.0001）。预测UA BE的显著因素为：麻黄碱的使用以及麻黄碱使用与低血压持续时间之间的相互作用（调整后R2 = 0.52，F15,321 = 25.0，p < 0.0001）。我们得出结论，为了将胎儿酸中毒风险降至最低，不应在分娩前使用麻黄碱，子宫切开至分娩时间应尽可能短，并且应使用间羟胺或去氧肾上腺素等α受体激动剂以将低血压的程度和持续时间降至最低。
