晶、胶体容量预负荷降低蛛网膜下隙阻滞剖宫产术中低血压发生率的Meta分析

Crystalloid versus colloid preload for reducing the incidence of hypotension in cesarean section under subarachnoid block: a meta-analysis

摘要:

目的 蛛网膜下隙阻滞下行剖宫产术，麻醉前10～30 min或麻醉同时预先输注一定容量的晶、胶体溶液可有效减少术中低血压及恶心、呕吐的发生率，但对补充晶体液或胶体液、补液量以及补液时机的选择目前仍存争议。该文采用Meta分析的方法进行系统评价，为临床补液策略提供参考。方法 选择PubMed、EMBASE、Cochrane Library及Research Gate数据库，检索所有相关随机对照试验。主要指标为术中出现低血压患者的数量；次要指标为术中出现恶心、呕吐症状患者的数量。结局各指标均采用随机效应模型，用比值比（O^R）及95%可信区间（95% CI）进行表示。结果 蛛网膜下隙阻滞下行剖宫产术，与晶体液相比，同等量胶体预负荷可使术中低血压发生率降低［O^R=0.40（95% CI：0.27，0.59）］；麻醉前10～30 min或麻醉同时快速输注500 ml胶体液可使术中低血压发生率降低［O^R=0.45（95% CI：0.31，0.66）］，同等量晶、胶体容量预负荷在降低术中恶心、呕吐方面则无明显差异，均可使术中恶心、呕吐几率降低［O^R=0.72（95% CI：0.43，1.19）］。结论 蛛网膜下隙阻滞下行剖宫产术，麻醉前10～30 min或麻醉同时预先快速输注500 ml胶体溶液可显著降低产妇术中低血压的发生率。

Abstract:

Objective In cesarean section under subarachnoid block, infusion of crystalloids or colloids 10 to 30 minutes prior to the anesthesia or at the same time of anesthesia is effective for reducing the incidence of hypotension, nausea and vomiting during the surgery. However, whether crystalloids or colloids are better, the amount of the fluid administration, and the timing of infusion still remain controversial. Thus, we addressed these issues via systemic evaluation and meta-analysis, aiming to provide evidence for fluid infusion in these conditions.Methods The PubMed, EMBASE, Cochrane Library and Research Gate databases were searched against for relevant randomized controlled trials. The primary outcome was the number of patients developing hypotension during the surgery, while the incidence of nausea and vomiting was set as the secondary outcome. We applied the random effects model to analyze the data, and the results were presented as odds ratio (O^R) and 95% confidence interval (CI).Results Compared with the crystalloids, preload of the same amount of colloids could lower the incidence of intraoperative hypotension in pregnant women undergoing cesarean section under subarachnoid block [O^R = 0.40, (95% CI: 0.27, 0.59)]. Specifically, infusion of 500 ml colloids 10 to 30 minutes prior to the anesthesia or at the same time of anesthesia could reduce the incidence of hypotension during the surgery [O^R = 0.45, (95% CI: 0.31, 0.66)]. However, there was no significant difference in lowering the incidence of nausea and vomiting during the surgery [O^R = 0.72, (95% CI: 0.43, 1.19)], and both crystalloids and colloids could reduce the incidence of intraoperative nausea and vomiting.Conclusions The use of 500 ml colloids rather than crystalloids 10 to 30 minutes prior to the anesthesia or at the same time of anesthesia can lower the incidence of hypotension in pregnant women undergoing cesarean section under subarachnoid block.