蛛网膜下腔-硬膜外联合麻醉剖宫产低血压的预防与处理

背景 低血压是剖宫产产妇蛛网膜下腔硬膜外联合麻醉(combined spinal and epidural anesthesia,CSEA)后的常见并发症,处理不当可对母体和胎儿造成不良影响. 目的 从低血压的发生机制入手,分析不同方法防治低血压,改善母婴循环及内环境的效果,为临床麻醉管理提供参考. 内容 麻醉前预扩容,改变孕妇体位,调整麻醉平面,换用局部麻醉药物,运用5-羟色胺3(5-hydroxytryptamine 3,5-HT3)受体拮抗药、抗胆碱能药物或缩血管药物等均可缓解低血压,但效果各异,联合运用效果更佳. 趋向 麻醉前根据患者不同情况预测其发生低血压的概率及严重程度,可针对性地选择不同防治方法,但仍需进一步研究.

Prevention and treatment of maternal hypotension under combined spinal and epidural anesthesia for caesarean section

Background Maternal hypotension is a common complication of combined spinal and epidural anesthesia (CSEA) during caesarean delivery,which is associated with adverse effects on both the mother and the fetus when appropriate treatments were not used.Objective To review the effects of different methods for preventing and treating maternal hypotension,improving the circulation and internal environment of maternal and fetus according to the mechanism of hypotension,and to provide a reference for clinical anesthesia.Content Hypotension could be relieved by the following treatments:fluid preloading,maternal position,anesthesia plane,local anesthetic,the 5-hydroxytryptamine 3 (5-HT3) receptor antagonist,anticholinergic drugs or vasopressors although their effects are different.Therefore,combination of these treatments can get better effects.Trend Predicting the incidence and severity of hypotension according to maternal different conditions may help choose the targeted strategies,while more relevant researches should be carried out.