在脊髓麻醉下剖腹产的血压管理:英国多中心审计 (2023)
J Blackburn1, E J Yates2, M S Jarvis3
1Worcestershire Hospitals Acute Trust, Worcestershire, UK.
International journal of obstetric anesthesia
|April 4, 2025
概括
在剖腹产期间,由于脊髓麻醉,产妇的低血压是常见的. 遵守血管压缩剂指南的程度较低,影响患者的安全,需要改进管理策略.
科学领域:
- 产科和妇科 产科和妇科
- 麻醉学 麻醉学
- 临床审计 临床审计
背景情况:
- 剖腹产时的脊髓麻醉可以导致严重的孕产妇低血压.
- 美国国家卫生和护理卓越研究所 (NICE) 的指导方针建议保持静缩血压 (SBP) ≥90%的基线.
- 未经治疗的低血压会对母亲的健康造成风险.
研究的目的:
- 审计遵守NICE关于在脊髓麻醉下剖腹产期间使用血管压缩剂的指南.
- 评估血管压缩剂的选择和施用方法.
- 为了评估手术内低血压的发生率.
主要方法:
- 在英国西米德兰斯地区进行了多中心前性审计.
- 收集了526名在脊髓麻醉下进行剖腹产的成年患者的数据.
- 测量的主要结果是维持手术期间SBP ≥90%的基线.
主要成果:
- 只有9.1%的病例实现了维持SBP在基线≥90%的主要结果.
- 烯是最常见的第一线血管压缩剂 (91%),通常通过速度控制装置 (73.8%) 管理.
- 遵守推的预防性费尼莱弗林给药率很低 (37.6%),低血压 (SBP <80%基线) 在25.9%的病例中发生.
结论:
- 在脊髓麻醉下的剖腹产中,手术内低血压很普遍.
- 人们严重缺乏遵守当前关于血管压缩剂选择和使用的指导方针.
- 将最佳的低血压管理整合到部门的协议中,对于改善恢复至关重要.
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