International consensus statement on the use of uterotonic agents during caesarean section
International consensus statement on the use of uterotonic agents during caesarean section
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DOI：
10.1111/anae.14757
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发表时间：
2019-07-25
期刊：
影响因子：
10.7
通讯作者：
Kinsella, S. M.
中科院分区：
文献类型：
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作者：
Heesen, M.;Carvalho, B.;Kinsella, S. M.
在剖腹产手术中，新生儿分娩后常规给予子宫收缩药。然而，相关研究存在很大的异质性，主要是在低风险的择期病例或分娩不复杂的妇女中进行的。这反映在临床实践中的相当大的变化。择期剖腹产和产时剖腹产的剂量需求之间存在显著差异。标准推荐剂量高于所需剂量，有可能造成急性心血管不良反应。我们建议一个小的初始剂量的催产素，然后滴定输注。对于有子宫收缩乏力危险因素的妇女，催产素的推荐剂量可能需要增加。与催产素等效剂量的卡贝缩宫素具有类似的作用，同时避免了在初始剂量后连续输注的要求，并减少了对额外子宫收缩剂的需要。与催产素一样，卡贝缩宫素的剂量要求在产时剖腹产时更高。如果缩宫素/卡贝缩宫素不能产生良好的子宫张力，应尽早考虑使用二线药物。患有心脏病的女性可能对催产素和其他子宫收缩剂的不良反应非常敏感，需要个性化管理。
It is routine to give a uterotonic drug following delivery of the neonate during caesarean section. However, there is much heterogeneity in the relevant research, which has largely been performed in low-risk elective cases or women with uncomplicated labour. This is reflected in considerable variation in clinical practice. There are significant differences between dose requirements during elective and intrapartum caesarean section. Standard recommended doses are higher than required, with the potential for acute cardiovascular adverse effects. We recommend a small initial bolus dose of oxytocin, followed by a titrated infusion. The recommended doses of oxytocin may have to be increased in women with risk factors for uterine atony. Carbetocin at equipotent doses to oxytocin has similar actions, while avoiding the requirement for a continuous infusion after the initial dose and reducing the need for additional uterotonics. As with oxytocin, carbetocin dose requirements are higher for intrapartum caesarean sections. A second-line agent should be considered early if oxytocin/carbetocin fails to produce good uterine tone. Women with cardiac disease may be very sensitive to the adverse effects of oxytocin and other uterotonics, and their management needs to be individualised.