US Clinical registry databases were searched. Studies comparing phenylephrine boluses (both therapeutic and prophylactic) with infusion (both fixed- and variable-rate) assessing various feto-maternal outcomes were included. The primary outcome was the incidence of maternal hypotension. Secondary maternal outcomes included the incidence of reactive hypertension, bradycardia, nausea, or vomiting; secondary neonatal outcomes included umbilical arterial pH, partial pressure of oxygen (paO2), umbilical venous pH, fetal acidosis, Apgar Scores at 1 and 5 minutes. All outcomes were quantitatively analyzed using the random effects model. Risk of bias was assessed using the Cochrane Collaboration R0B 2.0 tool. RESULTS: We included 15 studies with 2153 parturients. The parturients receiving phenylephrine bolus during cesarean delivery under spinal or combined spinal-epidural anesthesia had a significant increase in the incidence of predelivery hypotension compared to phenylephrine infusion (risk ratio [RR], 2.34, 95% confidence interval [CI], 1.72–3.18). Reactive hypertension (RR, 0.48, 95% CI, 0.29–0.79) and bradycardia (RR, 0.57, 95% CI, 0.41–0.79) were less common in the parturients receiving phenylephrine bolus; whereas, vomiting (RR, 2.15, 95% CI, 1.53–3.03) was more common compared to the infusion group. No statistically significant difference was observed in the incidence of nausea or any fetal outcomes (umbilical artery pH, paO2, umbilical venous pH, fetal acidosis, and Apgar scores at 1 and 5 minutes) between either of the groups. Three studies had a high risk of bias. CONCLUSIONS: A prophylactic phenylephrine infusion significantly reduces the incidence of predelivery hypotension in parturients undergoing cesarean delivery under neuraxial anesthesia in comparison to the therapeutic or prophylactic phenylephrine bolus group. A prophylactic phenylephrine infusion may be considered in all parturients without preexisting hypertensive disorder or cardiovascular disorders to reduce the risk of predelivery hypotension. More evidence is needed to guide optimal hemodynamic management for patients with hypertensive or cardiovascular disorders....

中文翻译：

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去氧肾上腺素推注和输注方案对剖宫产期间母体和胎儿结局的比较：系统评价和荟萃分析


检索了美国临床登记数据库。纳入了比较去氧肾上腺素推注（治疗性和预防性）与输注（固定速率和可变速率）评估各种胎母结局的研究。主要结局是孕产妇低血压的发生率。次要孕产妇结局包括反应性高血压、心动过缓、恶心或呕吐的发生率;次要新生儿结局包括脐动脉 pH 值、氧分压 （paO2）、脐静脉 pH 值、胎儿酸中毒、1 分钟和 5 分钟 Apgar 评分。使用随机效应模型对所有结果进行定量分析。使用 Cochrane 协作 R0B 2.0 工具评估偏倚风险。结果： 我们纳入了 15 项研究，涉及 2153 例产妇。与去氧肾上腺素输注相比，在脊髓或脊髓硬膜外麻醉下剖宫产时接受去氧肾上腺素推注的产妇产前低血压发生率显著增加（风险比 [RR]，2.34,95% 置信区间 [CI]，1.72-3.18）。反应性高血压 （RR， 0.48， 95% CI， 0.29-0.79） 和心动过缓 （RR， 0.57， 95% CI， 0.41-0.79） 在接受去氧肾上腺素推注的产妇中较少见;而与输注组相比，呕吐 （RR， 2.15， 95% CI， 1.53–3.03） 更常见。两组之间在恶心发生率或任何胎儿结局 （脐动脉 pH 值、paO2、脐静脉 pH 值、胎儿酸中毒和 1 分钟和 5 分钟的 Apgar 评分） 方面均未观察到统计学意义差异。3项研究存在高偏倚风险。 结论： 与治疗性或预防性去氧肾上腺素推注组相比，预防性去氧肾上腺素输注可显著降低椎管内麻醉下剖宫产产妇产前低血压的发生率。对于所有既往没有高血压疾病或心血管疾病的产妇，可以考虑预防性输注去氧肾上腺素，以降低分娩前低血压的风险。需要更多的证据来指导高血压或心血管疾病患者的最佳血流动力学管理。