Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials

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.     

脐带间充质干细胞移植治疗子宫切口瘢痕缺陷大鼠的疗效观察

目的:将脐带华通胶间充质干细胞(WJMSCs)移植到子宫切口瘢痕缺陷(PCSD)模型大鼠体内,探讨其治疗效果。方法:取雌性SD大鼠50只、将其随机分为3组:正常手术组(N-O组)10只、模型对照组(M-C组)20只和模型治疗组(M-T组)20只。孕第19天N-O组剖宫取胎后连续缝合子宫切口;M-C组与M-T组剖宫产术后子宫肌壁注射脂多糖(LPS)联合电凝(功率为10 W)子宫切缘,间断缝合切口。M-T组分A、B亚组(各10只),A组静脉注射0.5 m L+阴道灌注0.5 m L(1×10~9/L)WJMSCs,B组阴道灌注1 m L同浓度WJMSCs,每周1次,共3次;M-C亦分A、B亚组(各10只),与M-T组同样方法处理,仅将生理盐水替代WJMSCs。各组治疗后第1和4周,分别处死6和4只,留双侧子宫进行HE染色、Masson染色、肌动蛋白(actin)和细胞角蛋白免疫组化染色,通过体视学分析,检测子宫肌层和内膜的修复情况。结果:WJMSCs治疗后第1和4周,M-C组子宫肌层厚度和actin体积密度(Vv)均显著低于N-O组,肌层胶原纤维Vv和内膜缺陷率高于N-O组(P0.05);WJMSCs治疗后第1和4周,M-T的A和B组的肌层厚度和actin Vv均显著高于M-C组,肌层胶原纤维Vv低于M-C组;M-C组内膜缺陷率高于其它组(P0.05)。结论:WJMSCs可促进PCSD大鼠子宫肌层结构和功能的修复。静脉+局部联合治疗和单纯阴道治疗效果无明显差别。