Mitra J K, Roy J, Bhattacharyya P, Yunus M, Lyngdoh N M
Department of Anesthesiology, Critical Care and Pain Medicine, NEIGRIHMS, Shillong, Meghalaya, India.
J Postgrad Med. 2013 Apr-Jun;59(2):121-6. doi: 10.4103/0022-3859.113840.
Hypotension during cesarean section under spinal anesthesia remains a frequent scenario in obstetric practice. A number of factors play a role in altering the incidence and severity of hypotension. Counteracting aortocaval compression does not significantly prevent hypotension in most singleton pregnancies. Intravenous crystalloid pre-hydration is not very efficient. Thus, the focus has changed toward co-hydration and use of colloids. Among vasopressors, phenylephrine is now established as a first line drug, although there is limited data in high-risk patients. Though ephedrine crosses the placenta more than phenylephrine and can possibly cause alterations in the fetal physiology, it has not been shown to affect the fetal Apgar or neurobehavioral scores.
在产科实践中，脊髓麻醉下剖宫产术中低血压仍是常见情况。多种因素在改变低血压的发生率和严重程度方面发挥作用。在大多数单胎妊娠中，对抗主动脉腔静脉压迫并不能显著预防低血压。静脉输注晶体液进行预扩容效果不佳。因此，关注点已转向联合扩容和使用胶体液。在血管升压药中，去氧肾上腺素目前已被确立为一线药物，尽管高危患者的数据有限。虽然麻黄碱比去氧肾上腺素更易透过胎盘，可能会引起胎儿生理改变，但尚未显示其会影响胎儿阿氏评分或神经行为评分。
