腰麻下行剖宫产期间低血压的预防：随机对照试验的系统回顾和网络荟萃分析
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Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials.
背景与目的
在腰麻下行剖宫产手术通常会使产妇发生低血压。本文通过系统回顾和网络荟萃分析，比较了各种在腰麻下行剖宫产术产妇发生低血压的预防方法。
方 法
本研究主要纳入2018年12月以前MEDLINE、Embase和Web of Science数据库中关于预防腰麻后低血压的干预措施与另一种干预措施或非活性控制措施进行比较随机对照试验。两位评审员提取了关于试验特征、方法和结果的数据。评估了个体试验(Cochrane工具)和证据质量(等级检查表)的偏倚风险。共包括109个试验（8561名妇女）和12种不同的方法，结果得到30个直接比较。
结 果
按OR（95%CI）根据有效率从高到低依次为：间羟胺0.11（0.04-0.26）；去甲肾上腺素0.13（0.06-0.28）；苯肾上腺素0.18（0.11-0.29）；腿部压迫0.25（0.14-0.43）；麻黄碱0.28（0.18-0.43）；麻醉诱导前给予胶体0.38（0.24-0.61）；血管紧张素2，0.12（0.02-0.75）；麻醉诱导后给予胶体0.52（0.30-0.90）；美芬丁胺0.09（0.01-1.30）；麻醉诱导后给予晶体0.78（0.46-1.31）；麻醉诱导前给予晶体1.16（0.76-1.79）。与对照组相比，苯肾上腺素易引起产妇发生心动过缓 (95%CI) 0.23 (0.07-0.79)。 麻黄碱对脐动脉pH的降低程度大于苯肾上腺素，标准差(95%CI)为0.78 (0.47~1.49)。
结 论
为预防低血压的发生，在腰麻下行剖宫产期间应该给健康的妇女使用升压药。
原始文献摘要
Fitzgerald JP, Fedoruk KA, Jadin SM, et al. Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials.[J] .Anaesthesia, 2019, undefined: undefined.
Spinal anaesthesia for caesarean section commonly causes maternal hypotension. This systematic review and network meta-analysis compared methods to prevent hypotension in women receiving spinal anaesthesia for caesarean section. We selected randomised controlled trials that compared an intervention to prevent hypotension with another intervention or inactive control by searching MEDLINE and Embase, Web of Science to December 2018. There was no language restriction. Two reviewers extracted data on trial characteristics, methods and outcomes. We assessed risk of bias for individual trials (Cochrane tool) and quality of evidence (GRADE checklist). We assessed 109 trials (8561 women) and 12 different methods that resulted in 30 direct comparisons. Methods ranked by OR (95%CI) from most effective to least effective were: metaraminol 0.11 (0.04-0.26); norepinephrine 0.13 (0.06-0.28); phenylephrine 0.18 (0.11-0.29); leg compression 0.25 (0.14-0.43); ephedrine 0.28 (0.18-0.43); colloid given before induction of anaesthesia 0.38 (0.24-0.61); angiotensin 2, 0.12 (0.02-0.75); colloid given after induction of anaesthesia 0.52 (0.30-0.90); mephentermine 0.09 (0.01-1.30); crystalloid given after induction of anaesthesia 0.78 (0.46-1.31); and crystalloid given before induction of anaesthesia 1.16 (0.76-1.79). Phenylephrine caused maternal bradycardia compared with control, OR (95%CI) 0.23 (0.07-0.79). Ephedrine lowered umbilical artery pH more than phenylephrine, standardised mean difference (95%CI) 0.78 (0.47-1.49). We conclude that vasopressors should be given to healthy women to prevent hypotension during caesarean section with spinal anaesthesia.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：何幼芹 审校：王贵龙