去氧肾上腺素对蛛网膜下隙麻醉剖宫产产妇血流动力学和母婴预后的影响

去氧肾上腺素针对于剖宫产产妇因蛛网膜下隙麻醉引起的低血压具有良好效果。过去麻黄素被认为是产科患者首选的升压药，但现在去氧肾上腺素得到越来越广泛的应用，主要是因为研究表明注射去氧肾上腺素能改善胎儿的酸碱状态，预防性使用去氧肾上腺素能减少低血压的发生率及相关副作用。本篇综述针对麻黄素与去氧肾上腺素对产妇血流动力学（动脉血压、心率和心排血量）及术中恶心和呕吐的影响加以较，同时比较了去氧肾上腺素治疗性单剂给药与预防性输注对低血压的疗效，还评价了与麻黄素相比，去氧肾上腺素对子宫胎盘血流灌注以及胎儿预后（如新生儿酸碱状态和Apgar评分）的影响，还对去氧肾上腺素的最佳给药方案进行了讨论。

Phenylephrine is effective for the management of spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery under spinal anesthesia. While ephedrine was previously considered the vasopressor of choice in obstetric patients, phenylephrine is increasingly being used. This is largely due to studies suggesting improved fetal acid-base status with the use of phenylephrine as well as the low incidence of hypotension and its related side effects with prophylactic phenylephrine regimens. This review highlights the effects of phenylephrine compared with ephedrine on maternal hemodynamics （arterial blood pressure, heart rate, and cardiac output）, and occurrence of intraoperative nausea and vomiting. The impact of the administration of phenylephrine as a bolus for the treatment of established hypotension compared with its administration as a prophylactic infusion is discussed. This article also reviews the impact of phenylephrine compared with ephedrine on uteroplacental perfusion, and fetal outcomes such as neonatal acid-base status and Apgar scores. The optimum dosing regimen for phenylephrine administration is also discussed.