Department of Anaesthesia, Kantonsspital Baden, Switzerland.
Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA.
Anaesthesia. 2019 Oct;74(10):1305-1319. doi: 10.1111/anae.14757. Epub 2019 Jul 25.
It is routine to give a uterotonic drug following delivery of the neonate during caesarean section. However, there is much heterogeneity in the relevant research, which has largely been performed in low-risk elective cases or women with uncomplicated labour. This is reflected in considerable variation in clinical practice. There are significant differences between dose requirements during elective and intrapartum caesarean section. Standard recommended doses are higher than required, with the potential for acute cardiovascular adverse effects. We recommend a small initial bolus dose of oxytocin, followed by a titrated infusion. The recommended doses of oxytocin may have to be increased in women with risk factors for uterine atony. Carbetocin at equipotent doses to oxytocin has similar actions, while avoiding the requirement for a continuous infusion after the initial dose and reducing the need for additional uterotonics. As with oxytocin, carbetocin dose requirements are higher for intrapartum caesarean sections. A second-line agent should be considered early if oxytocin/carbetocin fails to produce good uterine tone. Women with cardiac disease may be very sensitive to the adverse effects of oxytocin and other uterotonics, and their management needs to be individualised.
在剖宫产分娩新生儿后，常规给予子宫收缩药物。然而，相关研究存在很大的异质性，这些研究主要在低风险选择性病例或产程无并发症的女性中进行。这反映在临床实践中有很大的差异。选择性剖宫产和产时剖宫产的剂量需求有显著差异。标准推荐剂量高于所需剂量，可能会产生急性心血管不良作用。我们建议给予小剂量的催产素初始推注，然后进行滴定输注。对于有子宫收缩乏力危险因素的女性，可能需要增加催产素的推荐剂量。卡贝缩宫素与催产素等效剂量具有相似作用，同时避免了初始剂量后持续输注的需要，并减少了对其他子宫收缩药物的需求。与催产素一样，卡贝缩宫素在产时剖宫产中剂量需求更高。如果催产素/卡贝缩宫素不能产生良好的子宫收缩，应尽早考虑二线药物。患有心脏病的女性可能对催产素和其他子宫收缩药物的不良反应非常敏感，需要个体化管理。
