Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster.
Department of Anesthesiology, Intensive Care and Pain Medicine, Florence - Nightingale - Hospital Düsseldorf, Düsseldorf, Germany.
Curr Opin Anaesthesiol. 2020 Jun;33(3):291-298. doi: 10.1097/ACO.0000000000000848.
Hypotension during cesarean section remains a frequent complication of spinal anesthesia and is associated with adverse maternal and fetal events.
Despite ongoing research, no single measure for sufficient treatment of spinal-induced hypotension was identified so far. Current literature discusses the efficacy of low-dose spinal anesthesia, timing and solutions for adequate fluid therapy and various vasopressor regimens. Present guidelines favor the use of phenylephrine over ephedrine because of decreased umbilical cord pH values, while norepinephrine is discussed as a probable superior alternative with regard to maternal bradycardia, although supporting data is limited. Alternative pharmacological approaches, such as 5HT3-receptor antagonists and physical methods may be taken into consideration to further improve hemodynamic stability.
Current evidence favors a combined approach of low-dose spinal anesthesia, adequate fluid therapy and vasopressor support to address maternal spinal-induced hypotension. As none of the available vasopressors is associated with relevantly impaired maternal and fetal outcomes, none of them should be abandoned from obstetric practice. Rapid crystalloid co-loading is of equivalent efficacy as compared with colloids and should be preferred because of a more favorable risk profile.
剖宫产术中低血压仍然是脊髓麻醉常见的并发症，与产妇和胎儿不良事件相关。
尽管目前仍在研究，但迄今为止尚未确定治疗脊髓诱导性低血压的单一措施。目前的文献讨论了低剂量脊髓麻醉、适当液体治疗的时机和溶液以及各种血管加压剂方案的疗效。目前的指南倾向于使用去氧肾上腺素而不是麻黄碱，因为去氧肾上腺素可降低脐动脉 pH 值，而去甲肾上腺素被认为是一种可能更好的替代药物，因为它可减少产妇心动过缓，但支持数据有限。替代的药物治疗方法，如 5HT3 受体拮抗剂和物理方法，可以考虑进一步改善血液动力学稳定性。
目前的证据支持采用低剂量脊髓麻醉、适当液体治疗和血管加压剂支持的综合方法来处理产妇脊髓诱导性低血压。由于目前尚无任何一种血管加压剂与明显的产妇和胎儿结局受损相关，因此不应从产科实践中放弃使用。与胶体相比，快速晶体液共同加载具有同等的疗效，并且由于风险状况更好，因此应优先选择。
