Effect of combined colloid preloading and crystalloid coloading versus combined colloid and crystalloid coloading on maternal cardiac output during spinal anesthesia for cesarean section under combined prophylactic noradrenaline infusion

作者：Xiangyu Gao, Yu Huang, Sumei Hu, Chuantao Lin, Yi You, Shihong Huang, Ming Liu, Jian­ying Yan · 发表于：Frontiers in Medicine · 年份：2025 · DOI：10.3389/fmed.2025.1421947 · 被引用次数：2 · 研究领域：Hemodynamic Monitoring and Therapy、Trauma, Hemostasis, Coagulopathy, Resuscitation、Enhanced Recovery After Surgery

Objective Hypotension is a common complication of spinal anesthesia during cesarean section, and no single intervention has been shown to eliminate maternal hypotension. Fluid loading strategies combined with vasopressor drug regimens can achieve this goal by maximizing cardiac output (CO) and minimizing the fall in systemic vascular resistance (SVR). However, the optimal fluid volume, type, and timing of administration have not been fully elucidated. Therefore, this study aimed to use Vigileo techniques in order to compare the effects of different fluid loading strategies on CO fluctuation under a norepinephrine infusion. Methods We recruited 102 healthy term parturients scheduled for elective cesarean section under spinal anesthesia for this randomized double-blind study and divided them into two groups: the colloid preload followed by crystalloid coload group (500 ml each; Group 1, n = 51), and the colloid and crystalloid coload group (500 ml each; Group 2, n = 51). The infusion of norepinephrine was started after intrathecal injection. Vigileo was used to monitor invasive hemodynamic indices. Our primary outcome was standardized maternal cardiac output (CO) readings taken from spinal anesthesia until delivery. The secondary outcome measures were stroke volume (SV), systolic blood pressure (SBP), heart rate (HR), number of episodes of hypotension, hypertension, bradycardia, nausea/vomiting and total norepinephrine dose. Neonatal outcome was assessed by recording Apgar scor...