Fantin R, Ortner C M, Klein K U, Putz G, Marhofer D, Jochberger S
Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, 94305, Stanford, CA, USA.
Anaesthesist. 2020 Apr;69(4):254-261. doi: 10.1007/s00101-020-00755-0.
Arterial hypotension during cesarean delivery under spinal anesthesia can cause maternal and fetal adverse effects. Therefore, current guidelines recommend the continuous and preferably prophylactic use of vasopressors, emphasizing the use of alpha-agonists, such as phenylephrine. Besides a left lateral uterine displacement either an intravenous colloid preloading or a crystalloid co-loading is recommended. The blood pressure goal is to maintain a systolic arterial blood pressure of at least 90% of the initial baseline value and to avoid a drop to less than 80% of this baseline. To achieve this goal a prophylactic continuous phenylephrine infusion with an adjustable flow rate is recommended. It is advised to start with an initial dose of 25-50 µg/min, initiated immediately following the intrathecal injection of the local anesthetic and titrated according to the vital parameters. Parturients with cardiac diseases should be preoperatively evaluated following individual hemodynamic goals.
脊髓麻醉下剖宫产术中的动脉低血压可导致母婴不良影响。因此，当前指南推荐持续且最好预防性使用血管升压药，强调使用α-激动剂，如去氧肾上腺素。除了采取左侧子宫移位外，还建议静脉输注胶体液进行预负荷或输注晶体液进行联合负荷。血压目标是维持动脉收缩压至少为初始基线值的90%，并避免降至该基线值的80%以下。为实现这一目标，建议预防性持续输注去氧肾上腺素，流速可调节。建议初始剂量为25-50μg/min，在鞘内注射局部麻醉药后立即开始，并根据生命体征参数进行滴定。患有心脏病的产妇应根据个体血流动力学目标在术前进行评估。
