From the Department of Anaesthesia, Erasmus University Medical Centre, Rotterdam, The Netherlands (KR, MK), the Department of Anaesthesia, Hôpital Antoine Béclère, GHU AP-HP. Université Paris-Saclay, Clamart, France (FJM), the Department of Anaesthesia, Northwick Park Hospital, Harrow, UK (DNL), the Department of Anaesthesia, University Hospital RWTH Aachen, Aachen, Germany (RR), and the Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland (MH).
Eur J Anaesthesiol. 2020 Dec;37(12):1126-1142. doi: 10.1097/EJA.0000000000001371.
Fluid loading is one of the recognised measures to prevent hypotension due to spinal anaesthesia in women scheduled for a caesarean section.
We aimed to evaluate the current evidence on fluid loading in the prevention of spinal anaesthesia-induced hypotension.
Systematic review and network meta-analysis with trial sequential analysis and meta-regression.
Medline, Epub, Embase.com (Embase and Medline), Cochrane Central, Web of Science and Google Scholar were used.
Only randomised controlled trials were used. Patients included women undergoing elective caesarean section who received either crystalloid or colloid fluid therapy as a preload or coload. The comparator was a combination of either a different fluid or time of infusion.
A total of 49 studies (4317 patients) were included. Network meta-analysis concluded that colloid coload and preload offered the highest chance of success (97 and 67%, respectively). Conventional meta-analysis showed that crystalloid preload is associated with a significantly higher incidence of maternal hypotension than colloid preload: risk ratio 1.48 (95% CI 1.29 to 1.69, P < 0.0001, I = 60%). However, this result was not supported by Trial Sequential Analysis. There was a significant dose-response effect for crystalloid volume preload (regression coefficient = -0.073), which was not present in the analysis of only double-blind studies. There was no dose-response effect for the other fluid regimes.
Unlike previous meta-analysies, we found a lack of data obviating an evidence-based recommendation. In most studies, vasopressors were not given prophylactically as is recommended. Studies on the best fluid regimen in combination with prophylactic vasopressors are needed. Due to official european usage restrictions on the most studied colloid (HES), we recommend crystalloid coload as the most appropriate fluid regimen.
CRD42018099347.
液体负荷是预防剖宫产产妇椎管内麻醉引起低血压的公认措施之一。
我们旨在评估预防椎管内麻醉引起低血压的液体负荷的现有证据。
系统评价和网络荟萃分析，包括试验序贯分析和荟萃回归。
使用了 Medline、Epub、Embase.com（Embase 和 Medline）、Cochrane 中心、Web of Science 和 Google Scholar。
仅使用随机对照试验。纳入的患者包括接受择期剖宫产的女性，她们接受晶体液或胶体液作为预负荷或共负荷治疗。对照组为不同液体或输注时间的组合。
共有 49 项研究（4317 名患者）纳入。网络荟萃分析得出结论，胶体共负荷和预负荷的成功率最高（分别为 97%和 67%）。传统荟萃分析表明，与胶体预负荷相比，晶体液预负荷与产妇低血压的发生率显著增加相关：风险比 1.48（95%CI 1.29 至 1.69，P<0.0001，I=60%）。然而，试验序贯分析并不支持这一结果。晶体液预负荷量存在显著的剂量反应效应（回归系数=-0.073），而在仅分析双盲研究的分析中则不存在。其他液体方案则没有剂量反应效应。
与之前的荟萃分析不同，我们发现缺乏数据，无法提出循证建议。在大多数研究中，没有按照推荐预防性使用血管加压药。需要进行研究以确定最佳液体方案与预防性血管加压药的联合使用。由于最受研究的胶体（HES）的官方欧洲使用限制，我们建议晶体液共负荷是最合适的液体方案。
CRD42018099347。
