Zhao Shiyue, Chen Qi, Qin Peipei, Liu Ling, Wei Ke
Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
BMC Anesthesiol. 2024 Dec 4;24(1):447. doi: 10.1186/s12871-024-02819-9.
Vasopressors are effective in managing perioperative hypotension in high-risk parturients undergoing Caesarean section (CS). Nevertheless, the optimal vasopressor for addressing hypotension induced by neuraxial anesthesia remains a subject of investigation.
We compared hypotension episodes among high-risk parturients who received ephedrine, noradrenaline, or phenylephrine by searching four electronic databases and reviewing the relevant references. Inclusion criteria encompassed randomized controlled trials directly comparing two or more vasopressors in the context of managing hypotension in high-risk parturients undergoing neuraxial anesthesia for CS. A network meta-analysis was performed using fixed-effects and Bayesian random-effects models.
We analyzed 13 trials involving 1,262 patients. While our direct and indirect comparisons revealed no reveal statistically significant differences in the number of hypotensive episodes among patients treated with different vasopressors, vasopressors were hierarchically ranked. Phenylephrine (Rank of the best choice = 0.81) exhibited the highest effectiveness in preventing hypotension, followed by ephedrine (Rank of the best choice = 0.10) and noradrenaline (Rank of the best choice = 0.09). Bradycardia occurrence was higher in patients administered phenylephrine compared to those given noradrenaline (risk ratio [RR]: 0.23; 95% confidence interval [CI]: 0.03 to 0.85) or ephedrine (RR: 0.01; 95% CI: 0.00 to 0.12). Notably, patients treated with phenylephrine or noradrenaline experienced reduced occurrences of nausea or vomiting compared to those who received ephedrine (RR: 0.37; 95% CI: 0.19 to 0.59 for phenylephrine and RR: 0.28; 95% CI: 0.10 to 0.75 for noradrenaline). Regarding fetal outcomes, no significant differences were noted between noradrenaline and phenylephrine. Overall norepinephrine in maternal outcomes may be more favorable.
Our findings suggest the potential advantages of phenylephrine for reducing hypotensive episodes in high-risk parturients undergoing CS. Noradrenalin may emerge as an alternative, particularly for women at high risk of caesarean delivery.
This systematic review was registered at PROSPERO (CRD42023397259).
血管升压药在处理接受剖宫产（CS）的高危产妇围手术期低血压方面有效。然而，用于治疗腰麻引起的低血压的最佳血管升压药仍是一个研究课题。
我们通过检索四个电子数据库并查阅相关参考文献，比较了接受麻黄碱、去甲肾上腺素或去氧肾上腺素的高危产妇的低血压发作情况。纳入标准包括直接比较两种或更多血管升压药在处理接受腰麻的CS高危产妇低血压方面的随机对照试验。使用固定效应和贝叶斯随机效应模型进行网络荟萃分析。
我们分析了13项涉及1262例患者的试验。虽然我们的直接和间接比较显示，不同血管升压药治疗的患者低血压发作次数没有统计学上的显著差异，但血管升压药有分层排名。去氧肾上腺素（最佳选择排名=0.81）在预防低血压方面表现出最高的有效性，其次是麻黄碱（最佳选择排名=0.10）和去甲肾上腺素（最佳选择排名=0.09）。与给予去甲肾上腺素（风险比[RR]：0.23；95%置信区间[CI]：0.03至0.85）或麻黄碱（RR：0.01；95%CI：0.00至0.12）的患者相比，接受去氧肾上腺素治疗的患者心动过缓发生率更高。值得注意的是，与接受麻黄碱治疗的患者相比，接受去氧肾上腺素或去甲肾上腺素治疗的患者恶心或呕吐发生率降低（去氧肾上腺素的RR：0.37；95%CI：0.19至0.59，去甲肾上腺素的RR：0.28；95%CI：0.10至0.75）。关于胎儿结局，去甲肾上腺素和去氧肾上腺素之间没有显著差异。总体而言，去甲肾上腺素在产妇结局方面可能更有利。
我们的研究结果表明，去氧肾上腺素在减少接受CS的高危产妇低血压发作方面具有潜在优势。去甲肾上腺素可能成为一种替代药物，特别是对于剖宫产高危女性。
本系统评价在PROSPERO（CRD42023397259）注册。
