Allen T K, Muir H A, George R B, Habib A S
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Int J Obstet Anesth. 2009 Oct;18(4):356-61. doi: 10.1016/j.ijoa.2009.03.014. Epub 2009 Sep 5.
Intravenous fluids and vasopressors are used for managing spinal-induced hypotension during cesarean delivery, but the choice of vasopressor and the type and timing of fluid administration remain controversial.
We conducted an electronic survey of all members of the Society for Obstetric Anesthesia and Perinatology between February and March 2007 to determine their preferences for preventing and treating spinal-induced hypotension with respect to fluid and vasopressor administration.
The response rate was 292/746 (39%). Fifty percent worked in academic institutions and 56% had >50% of their clinical responsibility to obstetric anesthesia. For prophylaxis, 35% used fluid preloading, 30% fluid preloading with vasopressors, and 12% fluid co-loading with vasopressors. Of those using vasopressors for prophylaxis, 32% used ephedrine, 26% used phenylephrine, and 33% based their choice on heart rate. For treatment, 32% used ephedrine, 23% used phenylephrine, and 41% used either agent based on heart rate. Anesthesiologists in academic practice were less likely to use fluid preloading only (P=0.028) and more likely to use fluid co-loading and vasopressors (P=0.003). They were also more likely to administer phenylephrine for prophylaxis compared with those in private practice (P=0.042).
Significant variations in practice exist in the prevention and treatment of spinal-induced hypotension. Fluid preloading and the prophylaxis and treatment of hypotension with ephedrine continue to be common practices.
剖宫产期间静脉输液和血管升压药用于处理腰麻引起的低血压，但血管升压药的选择以及输液的类型和时机仍存在争议。
2007年2月至3月，我们对产科麻醉与围产医学协会的所有成员进行了电子调查，以确定他们在预防和治疗腰麻引起的低血压方面对输液和血管升压药使用的偏好。
回复率为292/746（39%）。50%的人在学术机构工作，56%的人承担超过50%的产科麻醉临床工作。对于预防，35%的人采用预充液，30%的人采用预充液加血管升压药，12%的人采用联合充液加血管升压药。在使用血管升压药进行预防的人中，32%使用麻黄碱，26%使用去氧肾上腺素，33%根据心率进行选择。对于治疗，32%的人使用麻黄碱，23%的人使用去氧肾上腺素，41%的人根据心率使用其中任何一种药物。学术机构的麻醉医生单独使用预充液的可能性较小（P = 0.028），而使用联合充液和血管升压药的可能性较大（P = 0.003）。与私人执业的麻醉医生相比，他们在预防时使用去氧肾上腺素的可能性也更大（P = 0.042）。
在预防和治疗腰麻引起的低血压方面存在显著的实践差异。预充液以及使用麻黄碱预防和治疗低血压仍然是常见的做法。
