去氧肾上腺素与去甲肾上腺素在剖宫产术中预防和治疗脊髓麻醉所致低血压的比较：文献综述
Phenylephrine Versus Noradrenaline for the Prevention and Treatment of Spinal-Induced Hypotension During Caesarean Section: A Literature Review.
摘要(中文译文)
脊髓麻醉因其起效迅速、可靠性高和良好的安全性，是剖宫产最常用的麻醉技术。尽管具有这些优势，脊髓麻醉诱导的低血压仍是常见并发症，可能对母婴健康产生不良影响，包括恶心、呕吐、头晕、心输出量降低及子宫胎盘灌注受损。去氧肾上腺素仍是指南支持的治疗剖宫产期间脊髓诱导低血压的一线血管升压药，因其在维持母体血压方面有效，且对胎儿酸碱状态有利，与麻黄碱相比胎儿酸中毒风险更低。然而，它可能引起反射性心动过缓并降低母体心输出量。去甲肾上腺素已成为一种有前景的替代选择，因其α-肾上腺素能效应结合适度的β1活性，可能更好地维持母体心率和心输出量。通过PubMed/MEDLINE、Scopus和Google Scholar进行了叙述性文献综述。纳入评估脊髓麻醉下剖宫产期间母体血流动力学结局、母体不良反应、新生儿结局或血管升压药疗效的研究。近期试验和荟萃分析表明，去甲肾上腺素的疗效与去氧肾上腺素相当，新生儿结局相似，并可能具有母体血流动力学优势。然而，去氧肾上腺素仍是当前指南支持的一线药物，而去甲肾上腺素在最佳剂量、安全性及常规一线使用方面仍需进一步明确。本综述评估去氧肾上腺素和去甲肾上腺素在剖宫产期间脊髓诱导低血压预防和治疗中的应用。
Abstract
Spinal anaesthesia is the most commonly used anaesthetic technique for caesarean section due to its rapid onset, reliability, and favourable safety profile. Despite these advantages, spinal-induced hypotension remains a common complication with potential adverse effects on maternal and fetal well-being, including nausea, vomiting, dizziness, reduced cardiac output, and impaired uteroplacental perfusion. Phenylephrine remains the guideline-supported first-line vasopressor for spinal-induced hypotension during caesarean delivery because of its effectiveness in maintaining maternal blood pressure and its favourable fetal acid-base profile, including a lower risk of fetal acidosis compared with ephedrine. However, it may cause reflex bradycardia and reduced maternal cardiac output. Norepinephrine (noradrenaline) has emerged as a promising alternative because its α-adrenergic effects, combined with modest β1 activity, may better preserve maternal heart rate and cardiac output. A narrative literature review was conducted using PubMed/MEDLINE, Scopus, and Google Scholar. Studies were included if they evaluated maternal haemodynamic outcomes, adverse maternal effects, neonatal outcomes, or vasopressor efficacy during caesarean delivery under spinal anaesthesia. Recent trials and meta-analyses suggest that noradrenaline provides comparable efficacy to phenylephrine, with similar neonatal outcomes and potential maternal haemodynamic advantages. However, phenylephrine remains the current guideline-supported first-line agent, while noradrenaline requires further clarification regarding optimal dosing, safety, and routine first-line use. This review evaluates phenylephrine and noradrenaline for both prophylaxis and rescue treatment of spinal-induced hypotension during caesarean section.
如何引用
AMA
Manar A Alrashid, Jood H Hamdan, Soroush Ansari Lari. Phenylephrine Versus Noradrenaline for the Prevention and Treatment of Spinal-Induced Hypotension During Caesarean Section: A Literature Review.. Cureus. 2026; doi:10.7759/cureus.111632.
APA
Manar A Alrashid, Jood H Hamdan, Soroush Ansari Lari (2026). Phenylephrine Versus Noradrenaline for the Prevention and Treatment of Spinal-Induced Hypotension During Caesarean Section: A Literature Review.. Cureus. https://doi.org/10.7759/cureus.111632
GB/T 7714
Manar A Alrashid, Jood H Hamdan, Soroush Ansari Lari. Phenylephrine Versus Noradrenaline for the Prevention and Treatment of Spinal-Induced Hypotension During Caesarean Section: A Literature Review.[J]. Cureus, 2026 doi:10.7759/cureus.111632.
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