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首页> 外文期刊>Current opinion in anaesthesiology >Maternal haemodynamic changes during spinal anaesthesia for caesarean section.
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Maternal haemodynamic changes during spinal anaesthesia for caesarean section.

机译：剖宫产术中脊髓麻醉期间孕妇的血流动力学变化。

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PURPOSE OF REVIEW: Maternal haemodynamic changes during spinal anaesthesia for caesarean section have traditionally been evaluated by noninvasive blood pressure and heart rate. Recent publications have addressed the importance of cardiac output measurement in the assessment of the maternal circulation. In this review, a physiological approach is suggested for the prevention and treatment of haemodynamic instability during caesarean section in healthy women and in those with preeclampsia or cardiac disease. RECENT FINDINGS: A better understanding of the maternal haemodynamic effects of spinal anaesthesia and the effects of vasopressors has emerged from the monitoring of cardiac output during caesarean section in healthy women and in those with severe preeclampsia or cardiac disease. Based on maternal physiological arguments, phenylephrine is the vasopressor of choice in healthy pregnant women. New work demonstrating cardiac dysfunction in some women with severe preeclampsia has implications for risk assessment and anaesthesia. Recent publications suggest that combined spinal-epidural and continuous spinal anaesthesia is well tolerated in pregnant women with cardiac disease. SUMMARY: The most frequent response to spinal anaesthesia for elective caesarean section is a marked decrease in systemic vascular resistance and partial compensation from increased stroke volume and heart rate. Early administration of phenylephrine by bolus or continuous infusion is indicated in most cases. Recent work has expanded our knowledge of the therapeutic range of phenylephrine and indicates that the heart rate response to vasopressors is a good surrogate marker for cardiac output. Further research should examine haemodynamic changes during spinal anaesthesia in high-risk pregnant women with early onset preeclampsia or cardiac disease.
机译：审查目的：剖宫产术在脊髓麻醉过程中的产妇血流动力学变化传统上是通过无创血压和心率评估的。最近的出版物已经讨论了心输出量测量在评估母体循环中的重要性。在这篇综述中，提出了一种生理学方法来预防和治疗健康妇女以及先兆子痫或心脏病患者的剖腹产过程中的血流动力学不稳定。最近的发现：通过监测健康妇女和严重先兆子痫或心脏病患者的剖腹产期间的心输出量，可以更好地了解脊麻的产妇血流动力学效应和升压药的作用。根据母亲的生理学观点，去氧肾上腺素是健康孕妇的首选升压药。在某些患有严重先兆子痫的妇女中表现出心脏功能障碍的新工作对风险评估和麻醉有影响。最近的出版物表明，患有心脏病的孕妇对脊柱硬膜外麻醉和连续性脊柱麻醉的联合耐受性良好。摘要：选择性剖宫产术对脊柱麻醉的最常见反应是全身血管阻力显着降低，中风量和心率增加导致部分补偿。在大多数情况下，建议通过推注或连续输注及早给予去氧肾上腺素。最近的工作扩大了我们对去氧肾上腺素的治疗范围的了解，并表明对升压药的心率反应是心输出量的良好替代指标。进一步的研究应检查早发型先兆子痫或心脏病的高危孕妇在脊髓麻醉期间的血流动力学变化。

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