Cheng Chu, Liao Alan Hsi-Wen, Chen Chien-Yu, Lin Yu-Cih, Kang Yi-No
School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Anesthesiology, Taipei Medical University Hospital, No. 252, Wuxing Street, Taipei, 11031, Taiwan.
Sci Rep. 2021 Mar 11;11(1):5630. doi: 10.1038/s41598-021-85179-5.
The aim of this study was to reveal the effects of anaesthesia strategies on maternal mean arterial pressure (MAP), heart rate, vasopressor consumption, adverse events, and neonatal resuscitation when women with preeclampsia (PE) undergo caesarean section (CS). Three major databases were searched for randomized controlled trials (RCTs) and prospective controlled studies (PCSs). Two authors independently screened, extracted, and checked eligibility and outcome data. Outcomes involved MAP, vasopressor use, maternal adverse events, APGAR scores, and neonatal resuscitation. Pooled estimates were carried out by contrast-based network meta-analysis, and pooled effect sizes were presented with 95% confidence interval (CI). Eleven RCTs and one PCS (n = 782) formed three-node network meta-analysis, and non-significant differences were observed in MAP, 5-min APGAR score, and neonatal intubation rate among the three anaesthesia strategies. General anaesthesia had significantly lower vasopressor consumption than spinal anaesthesia did (standardised mean difference = - 1.19, 95% confidence interval [CI]: - 1.76 to - 0.63), but it had higher maternal adverse event rate (risk ratio = 2.00, 95% CI 1.16-3.47). Because no optimal anaesthesia strategy has been shown to achieve a balanced maternal and neonatal outcome, therefore a shared decision-making process may be required regarding the most suitable choice of anaesthetic strategy for individual preeclamptic mother undergoing CS. Future larger studies may need to focus on evaluating the role of vasopressors on maternal hemodynamic as well as factors affecting maternal outcomes for different anaesthetic techniques in preeclamptic women undergoing CS.
本研究的目的是揭示子痫前期（PE）妇女剖宫产（CS）时麻醉策略对产妇平均动脉压（MAP）、心率、血管升压药用量、不良事件及新生儿复苏的影响。检索了三个主要数据库以查找随机对照试验（RCT）和前瞻性对照研究（PCS）。两位作者独立筛选、提取并核对纳入标准和结局数据。结局包括MAP、血管升压药使用情况、产妇不良事件、阿氏评分及新生儿复苏。采用基于对比的网状Meta分析进行合并估计，并给出合并效应量及95%置信区间（CI）。11项RCT和1项PCS（n = 782）构成三节点网状Meta分析，三种麻醉策略在MAP、5分钟阿氏评分及新生儿插管率方面未观察到显著差异。全身麻醉的血管升压药用量显著低于脊髓麻醉（标准化均数差 = -1.19，95%置信区间[CI]：-1.76至-0.63），但产妇不良事件发生率更高（风险比 = 2.00，95% CI 1.16 - 3.47）。由于尚未证明有最佳麻醉策略能实现母婴结局的平衡，因此对于接受CS的子痫前期个体母亲选择最合适的麻醉策略可能需要共同决策过程。未来更大规模的研究可能需要着重评估血管升压药对产妇血流动力学的作用以及不同麻醉技术对接受CS的子痫前期妇女产妇结局的影响因素。
