Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
Anesth Analg. 2012 Feb;114(2):377-90. doi: 10.1213/ANE.0b013e3182373a3e. Epub 2011 Nov 21.
Phenylephrine is effective for the management of spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery under spinal anesthesia. While ephedrine was previously considered the vasopressor of choice in obstetric patients, phenylephrine is increasingly being used. This is largely due to studies suggesting improved fetal acid-base status with the use of phenylephrine as well as the low incidence of hypotension and its related side effects with prophylactic phenylephrine regimens. This review highlights the effects of phenylephrine compared with ephedrine on maternal hemodynamics (arterial blood pressure, heart rate, and cardiac output), and occurrence of intraoperative nausea and vomiting. The impact of the administration of phenylephrine as a bolus for the treatment of established hypotension compared with its administration as a prophylactic infusion is discussed. This article also reviews the impact of phenylephrine compared with ephedrine on uteroplacental perfusion, and fetal outcomes such as neonatal acid-base status and Apgar scores. The optimum dosing regimen for phenylephrine administration is also discussed.
去氧肾上腺素可有效治疗椎管内麻醉下剖宫产产妇的低血压。虽然去氧肾上腺素过去被认为是产科患者的首选升压药，但去氧肾上腺素的使用越来越多。这主要是由于研究表明去氧肾上腺素的使用可改善胎儿酸碱状态，且预防性使用去氧肾上腺素方案低血压及其相关副作用的发生率低。本文重点介绍了去氧肾上腺素与麻黄碱对产妇血流动力学（动脉血压、心率和心输出量）的影响，以及术中恶心和呕吐的发生情况。讨论了去氧肾上腺素作为治疗低血压的推注药物与作为预防性输注药物的应用效果。本文还回顾了去氧肾上腺素与麻黄碱对胎盘灌注和新生儿酸碱状态和 Apgar 评分等胎儿结局的影响。还讨论了去氧肾上腺素的最佳给药方案。
