分娩時局部和全身應用阿片類藥物鎮痛的系統評價_《中國循證醫學雜志》

作者：

周俊 ,  林雪梅 , 羅林麗 , 馬玉姍

四川大學華西第二醫院麻醉科 (成都610041);

關鍵詞：

阿片類藥物分娩鎮痛系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20080148

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目的　運用Cochrane系統評價的方法，評價分娩時局部和全身應用阿片類藥物鎮痛的有效性與安全性。
方法　計算機檢索PubMed（1966～2008. 1）、EMbase（1980～2008.1）、Cochrane 圖書館（2008年第1期）、CBM（1978～2008.1）、CNKI（1979～2008.1），同時篩選納入研究的參考文獻，收集有關比較局部和全身應用阿片類藥物鎮痛的隨機對照試驗，由兩名評價員獨立評價文獻質量，并采用RevMan4.2.10 軟件對納入研究結果進行Meta 分析。
結果　共納入12個研究，5909例產婦。Meta分析結果顯示，局部和全身應用阿片類藥比較進行分娩鎮痛，母親對局部應用阿片類藥分娩鎮痛疼痛緩解更滿意［RR=1.63，95%CI（1.27，2.09）］，兩組5min新生兒Apgar評分 lt;7，差異無統計學意義［RR=0.63，95%CI（0.40，1.01）］。
結論　現有證據顯示，與局部用藥比較，全身應用阿片類藥物鎮痛的母親對分娩疼痛緩解更滿意。但兩組均存在對母親和新生兒的不良影響。因此，要證明哪種途徑應用阿片類藥進行分娩鎮痛更加有效和安全，尚需開展更多高質量的隨機對照研究。

引用本文： 周俊,林雪梅,羅林麗,馬玉姍. 分娩時局部和全身應用阿片類藥物鎮痛的系統評價. 中國循證醫學雜志, 2008, 08(8): 652-661. doi: 10.7507/1672-2531.20080148 復制

1.	徐惠芳. 分娩鎮痛及其研究進展. 中華麻醉學雜志, 2001, 21(5): 319-320.
2.	Tan TK. Epidural analgesia in obstetrics. Ann Acad Med Singapore, 1998, 27(2): 235-242.
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4.	Clark A, Carr D, Loyd G, et al. The influence of epidural analgesia on cesarean delivery rates: a randomised, prospective clinical trial. Am J Obstet Gynecol, 1998, 179: 1527-1533.
5.	Gambling DR, Sharma SK, Ramin SM, et al. A randomized study of combined spinal-epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate. Anesthesiology, 1998, 89: 1336-1344.
6.	Halpern SH, Muir H, Breen TW, et al. A multicentre randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labour. Anaesth Analg, 2004, 99: 1532-1538.
7.	Head B, Owen J, Vincent R, et al. A randomized trial of intrapartum analgesia in women with severe preeclampsia. Obstet Gynecol, 2002, 99: 452-457.
8.	Hill JB, Alexander JM, Sharma SK, et al. A comparison of the effects of epidural and meperidine analgesia during labor on fetal heart rate. Obstet Gynecol, 2003, 102(2): 333-337.
9.	Jain S, Arya S, Gopalan S, et al. Analgesic efficacy of intramuscular opioids versus epidural analgesia in labor. Int J Gynecol Obstet, 2003, 83:19-27.
10.	Lucas M, Sharma S, Leveno K, et al. A randomized trial of labor epidural analgesia in women with preeclampsia. Anesthesiology, 1998, 88(4 Suppl): A25.
11.	Ramin S, Gambling DR, Lucas MJ, et al. Randomised trial of epidural versus intravenous analgesia during labour. Obstet Gynecol, 1995, 86(5): 783-789.
12.	Sharma SK, Sidawi JE, Raminas SM, et al. Cesarean delivery: a randomized trial of epidural versus patient-controlled meperidine analgesia during labor. Anesthesiology, 1997, 87(3): 487-494.
13.	Sharma SK, Alexander JM, Messick G, et al. Cesarean delivery: a randomized trial of epidural analgesia versus intravenous meperidine analgesia during labor in nulliparous women. Anesthesiology, 2002, 96(3): 546-551.
14.	Vella LM, Willatts DG, Knott C, et al. Epidural fentanyl in labour. An evaluation of the systemic contribution to analgesia. Anaesthesia, 1985, 40(8): 741-747.
15.	Wong CA, Scavone BM, Peaceman AM, et al. The risk of caesarean delivery with neuroaxial analgesia given early versus late in labour. N Engl J Med, 2005, 352: 655-665.

1. 徐惠芳. 分娩鎮痛及其研究進展. 中華麻醉學雜志, 2001, 21(5): 319-320.
2. Tan TK. Epidural analgesia in obstetrics. Ann Acad Med Singapore, 1998, 27(2): 235-242.
3. 劉關鍵. 統計方法在循證醫學中的應用. 見: 李幼平, 主編. 循證醫學. 北京: 高等教育出版社, 2003. 50-66.
4. Clark A, Carr D, Loyd G, et al. The influence of epidural analgesia on cesarean delivery rates: a randomised, prospective clinical trial. Am J Obstet Gynecol, 1998, 179: 1527-1533.
5. Gambling DR, Sharma SK, Ramin SM, et al. A randomized study of combined spinal-epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate. Anesthesiology, 1998, 89: 1336-1344.
6. Halpern SH, Muir H, Breen TW, et al. A multicentre randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labour. Anaesth Analg, 2004, 99: 1532-1538.
7. Head B, Owen J, Vincent R, et al. A randomized trial of intrapartum analgesia in women with severe preeclampsia. Obstet Gynecol, 2002, 99: 452-457.
8. Hill JB, Alexander JM, Sharma SK, et al. A comparison of the effects of epidural and meperidine analgesia during labor on fetal heart rate. Obstet Gynecol, 2003, 102(2): 333-337.
9. Jain S, Arya S, Gopalan S, et al. Analgesic efficacy of intramuscular opioids versus epidural analgesia in labor. Int J Gynecol Obstet, 2003, 83:19-27.
10. Lucas M, Sharma S, Leveno K, et al. A randomized trial of labor epidural analgesia in women with preeclampsia. Anesthesiology, 1998, 88(4 Suppl): A25.
11. Ramin S, Gambling DR, Lucas MJ, et al. Randomised trial of epidural versus intravenous analgesia during labour. Obstet Gynecol, 1995, 86(5): 783-789.
12. Sharma SK, Sidawi JE, Raminas SM, et al. Cesarean delivery: a randomized trial of epidural versus patient-controlled meperidine analgesia during labor. Anesthesiology, 1997, 87(3): 487-494.
13. Sharma SK, Alexander JM, Messick G, et al. Cesarean delivery: a randomized trial of epidural analgesia versus intravenous meperidine analgesia during labor in nulliparous women. Anesthesiology, 2002, 96(3): 546-551.
14. Vella LM, Willatts DG, Knott C, et al. Epidural fentanyl in labour. An evaluation of the systemic contribution to analgesia. Anaesthesia, 1985, 40(8): 741-747.
15. Wong CA, Scavone BM, Peaceman AM, et al. The risk of caesarean delivery with neuroaxial analgesia given early versus late in labour. N Engl J Med, 2005, 352: 655-665.

《中國循證醫學雜志》

分娩時局部和全身應用阿片類藥物鎮痛的系統評價

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《中國循證醫學雜志》

分娩時局部和全身應用阿片類藥物鎮痛的系統評價

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