Bishop David G, Cairns Carel, Grobbelaar Mariette, Rodseth Reitze N
From the *Perioperative Research Group, Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa; and †Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
Anesth Analg. 2017 Sep;125(3):904-906. doi: 10.1213/ANE.0000000000001905.
Phenylephrine infusions are considered as standard management for obstetric spinal hypotension, but there remains reluctance to implement them in resource-limited contexts. This prospective, alternating intervention study of patients undergoing elective or urgent cesarean delivery under spinal anesthesia compared a vasopressor bolus strategy to fixed-rate, low-dose prophylactic phenylephrine infusion with supplemental boluses. The primary outcome was the incidence of severe hypotension (mean arterial pressure <70% baseline or systolic blood pressure <80 mm Hg). Fewer patients receiving prophylactic phenylephrine infusions had severe hypotension (47.4% [n = 120/253] vs 62.1% [n = 157/253], P = .001, estimated relative risk 0.84, 95% confidence interval, 0.69-1.02), with no significant difference in the rate of hypertension (15% [n = 39/253] vs 11% [n = 27/253], P = .11, estimated relative risk 1.39, confidence interval 0.87-2.20). Guidelines for resource-constrained settings should consider a fixed, low-dose phenylephrine infusion in combination with rescue vasopressor bolus therapy.
去氧肾上腺素输注被视为产科脊髓性低血压的标准治疗方法，但在资源有限的情况下，人们仍然不愿采用这种方法。这项前瞻性、交替干预研究对在脊髓麻醉下接受择期或急诊剖宫产的患者进行了比较，将血管升压药推注策略与固定速率、低剂量预防性去氧肾上腺素输注加补充推注进行了对比。主要结局是严重低血压的发生率（平均动脉压<基线的70%或收缩压<80 mmHg）。接受预防性去氧肾上腺素输注的患者中发生严重低血压的较少（47.4% [n = 120/253] 对62.1% [n = 157/253]，P = .001，估计相对风险0.84，95%置信区间，0.69 - 1.02），高血压发生率无显著差异（15% [n = 39/253] 对11% [n = 27/253]，P = .11，估计相对风险1.39，置信区间0.87 - 2.20）。资源受限环境的指南应考虑采用固定的低剂量去氧肾上腺素输注联合抢救血管升压药推注治疗。
