Naloxone for Cardio - Pulmonary - Cerebral Resuscitation: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

DENG Jia , LI Qian ,  LIU Bin

Department of Anesthesiology, West China Hostital, Sichuan University, Chengdu 610041,China;

Corresponding?author：

LIU Bin, Email: dengjia2001519@163.com

Keywords：

Naloxone; CPCR; Randomized controlled trials; Systematic review; Meta-analysis

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Objective 　To assess the efficacy of naloxone for cardio-pulmonary-cerebral resuscitation (CPCR).
Methods 　Randomized controlled trials (RCTs) involving naloxone for CPCR were identified from MEDLINE (1966 – Jun.2006), EMbase (1974 - Jun.2006), PubMed, The Cochrane Library (Issue2,2006), CBM(1978 - Jun.2006) and CNKI (1994 - Jun.2006). The quality of the trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by the Cochrane Collaboration was used for statistical analysis.
Results 　Ten RCTs were included. The quality of included RCTs was low. All the patients were in-patients or out-patients receiving CPCR due to cardial arrest at the age of 18-75 years. Meta-analysis indicated that the resuscitation rate in naloxone group was significantly higher than the placebo group (P lt;0.00001). And the recovery of the brain function in naloxone group was better than in the placebo group(P lt;0.00001)
Conclusions 　Naloxone is effective for CPCR and it may ameliorate its prognosis. Because of the low quality of included trials and the small sample size, more RCTs are required to assess the efficacy of naloxone for CPCR.

Citation： DENG Jia,LI Qian,LIU Bin. Naloxone for Cardio - Pulmonary - Cerebral Resuscitation: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(11): 820-825. doi: Copy

1.	莊心良, 曾因明, 陳伯鑾. 主編. 現代麻醉學. 第3版. 北京: 人民衛生出社; 2004. 2306~2311.
2.	陳克田, 李明亭. 內啡肽與納洛酮. 見: 孟慶林. 主編. 納洛酮的基礎研究與臨床應用. 北京: 經濟日報出版社; 1996. 209.
3.	靳偉民, 韓樹堂. 鹽酸納洛酮治療顱腦損傷合并呼吸驟停 (附49例報告). 急診醫學, 1997; 6(): 339.
4.	邵孝. 心肺腦復蘇. 見: 邵孝, 蔣朱明. 主編. 急診醫學. 上海: 上海科學技術出版社; 1992. 55~69.
5.	孟慶林, 胡長欣, 候延奎. 鹽酸納洛酮拮抗乙醇中毒作用機理的探討. 中國急救醫學, 1996; 16(): 2.
6.	楊天德, 劉橋義, 陳意生, 等. 納洛酮對缺血再灌注心肌超微結構的影響. 見: 孟慶林. 主編. 納洛酮的基礎研究與臨床應用. 北京: 經濟日報出版社; 1996. 6~8.
7.	陳天鐸, 董晨明, 李培杰, 等. 納洛酮對心肺腦復蘇作用的評價. 急診醫學, 2000; (1): 5~7.
8.	李婷, 吳巖. 納絡酮用于心肺腦復蘇24例療效觀察. 吉林大學學報?醫學版, 2004; 30(5): 768.
9.	姚品安, 宋秀琴. 納洛酮在心肺腦復蘇中的療效觀察. 中國實用醫學研究雜志, 2004; 3(6): 507~508.
10.	車海明. 納洛酮在急性中毒心肺復蘇中的應用. 中華臨床醫藥雜志, 2004; 5(2): 94.
11.	羅寶權, 黃崇軍, 吳宗波, 等．納洛酮聯合腎上腺素進行心肺復蘇. 臨床薈萃, 2003; 18(9): 523~524.
12.	郭美華, 任景艷, 趙莉. 納洛酮聯合腎上腺素進行心肺復蘇的療效觀察. 實用醫技雜志, 2005; 12(2B): 459.
13.	劉秀娟, 余勝利. 納洛酮對心肺腦復蘇的臨床療效觀察. 貴州醫藥, 2002; 26(1): 40~41.
14.	林翔, 鄭偉, 朱宏剛. 鹽酸納洛酮在心肺腦復蘇急診搶救中的應用. 中國廠礦醫學, 2006; 19(1): 18~19.
15.	趙林明, 張兆順, 劉玉橋. 納洛酮治療呼吸心搏驟停患者臨床觀察. 現代中西醫結合雜志, 2006; 15(5): 584~585.
16.	王云峰, 王瑞斌. 納絡酮在腦復蘇中的療效觀察. 基層醫學論壇, 2004; 8(1): 43.
17.	郭美華, 任景艷, 趙莉. 納洛酮聯合腎上腺素心肺復蘇33例療效觀察. 中華全科醫師雜志, 2005; 4(9): 553.
18.	憔天鐸, 董晨明, 李培杰, 等. 心肺腦復蘇期間應用納洛酮臨床價值的探討. 甘肅科技, 1999; (4).
19.	董晨明, 陳天鐸, 李培杰. 納洛酮在呼吸復蘇中的臨床應用. 中國醫刊, 2000; 35(11): 49.
20.	董晨明, 李俠, 張京梅. 在心肺腦復蘇中納洛酮的臨床應用體會. 傷殘醫學雜志, 2000; 8(3): 38~40.
21.	陳天鐸, 董晨明, 李培杰. 納絡酮用于心肺腦復蘇21例療效觀察. 中國危重病急救醫學, 2001; 13(3): 182.
22.	高超, 劉建中. 心肺復蘇中聯合應用腎上腺素與納洛酮的研究. 寧夏醫學雜志, 2004; 26(11): 680~682.
23.	王偉強, 沈建妹, 陳淑葉. 大劑量納洛酮心肺復蘇療效分析. 中國綜合臨床, 2003; 19(11): 989~990.
24.	崔小鋒. 常規心肺復蘇加用納洛酮救治心臟驟停體會. 右江民族醫學院學報, 2000; (3): 403~404.
25.	馬玉英, 杜廣勝, 楊晚青, 等. 鹽酸納洛酮在腦復蘇中的療效觀察. 農墾醫學, 2000; 22(2): 91.
26.	曹秋菊, 孫瑞林. 納洛酮用于心腦肺復蘇術31例臨床分析. 鎮江醫學院學報, 1999; 9(2): 229.
27.	Zhuang XL, Zeng YM, Chen BL. Editor-in-chief. Modern Anesthesiology. 3rd ed. Beijing: People’s Medical Publishing House; 2004. 2306–2311.
28.	Chen KT, Li MT. Endogenous opioid and naloxone. In: Meng QL. Editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 209.
29.	Le WM, Han ST. Effect of naloxone on craniocerebral injury and apnoea. Journal of Emergency Medicine, 1997; 6(): 339.
30.	Shao X. Cardiopulmonary-cerebral Resuscitation. In: Shao X. Jiang ZM. editor-in-chief. Shanghai: Shanghai Science and Technique Press; 1992. 55–69.
31.	Lou HC, Tweed WA, Davis JM. Preferential blood flow increase tothe brain stem in moderate neonatal hypoxia: reyersal by naloxone. EurJ Pediatr, 1985; 144(): 225.
32.	Meng QL, Hu CX, Hou YK. Mechanism of antagonism of naloxone to ethanol. Chinese Journal of Critical Care Medicine, 1996; 16(): 2.
33.	Yang TD, Liu QY, Cheng YS, et al. Effect of naloxone for ultrastructure of ischemia reperfusion cardiac muscle. In: Meng QL. editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 6–8.
34.	Hughes GS. Naloxone and methylprednisolone sodium succinate enhance sympathomedullary discharge in patients with septic shock. Life sci, 1984; 35(): 2319.
35.	Mcintosh TK. Effect of an opiate antagonist (naloxone) and agonist/ an2tagonist (nalbuphine) in primate hemorrhagic shock : relationship to cat2echolaminer elease. Cire shock, 1985; 17(): 313.
36.	McGuire W, Fowlie PW. Naloxone for narcotic exposed newborn infants: systematic review. Archives of Disease in Childhood Fetal & Neonatal Edition, 2003; 88(4): F308–F311.
37.	Cheng TD, Dong CM, Li PJ, et al. Clinical study on the administration of naloxone during closed-chest cardiopulmonary-cerebral resuscitation. Journal of Emergency Medicine, 2000; (1): 5–7.
38.	Li T, Wu Y. Efficacy evaluation of naloxone in 24 cases of cardiopulmonary-cerebral resuscitation. Journal of Jilin University (Medicine Edition), 2004; 30(5): 768.
39.	Yao PA, Song XQ. Clinical efficacy on the administration of naloxone during cardiopulmonary-cerebral resuscitation. Chinese Research Journal of Practical Medicine, 2004; 3(6): 507–508.
40.	Che HM. Application of naloxone during cardiopulmonary resuscitation after acute toxicosis. Chinese Clinical Medicine, 2004; 5(2): 94.
41.	Luo BQ, Huang CJ, Wu ZB, et al. Naloxone combined with adrenaline for cardiopulmonary resuscitation. Clinical Focus, 2003; 18(9): 523–524.
42.	Guo MH, Ren JY, Zhao L. Effect of Naloxone combined with adrenaline for cardiopulmonary resuscitation. Journal of Practical Medical Techniques, 2005; 12(2B): 459.
43.	Liu XJ, Yu SL. Efficacy evaluation of naloxone for cardiopulmonary-cerebral resuscitation. Guizhou Medical Journal, 2002; 26(1): 40–41.
44.	Lin X, Zheng W, Zhu HG. Application of naloxone in cardiopulmonary-cerebral resuscitation. Chinese Medicine of Factory and Mine, 2006; 19(1): 18–19.
45.	Zhao LM, Zhang ZS, Liu YQ. Clinical observation of naloxone for cardiac arrest. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2006; 15(5): 584–585.
46.	Wang XF, Wang RB. Clinical efficacy of naloxone for cerebral resuscitation. Medical Forums in Basic, 2004; 8(1): 43.
47.	Guo MH, Ren JY, Zhao L. Clinical efficacy of naloxone combined with adrenaline for 33 cardiopulmonary-cerebral resuscitation cases. Chinese Journal of General Practitioners, 2005; 4(9): 553.
48.	Chen TZ, Dong CM, Li PJ, et al. Clinical efficacy of the administration of naloxone during cardiopulmonary-cerebral resuscitation. Gansu Science and Technology, 1999; (4).
49.	Dong CM, Chen TZ, Li PJ. Clinical application of naloxone in cardiopulmonary resuscitation. Chinese Journal of Medicine, 2000; 35(11): 49.
50.	Dong CM, Li X, Zhang JM. Clinical study on administration of naloxone during closed-chest cardiopulmonary-cerebral resuscitation. Medical Journal of Trauma and Disability, 2000; 8(3): 38–40.
51.	Chen TZ, Dong CM, Li PJ. Efficacy evaluation of naloxone in 21 cases of cardiopulmonary-cerebral resuscitation. Chinese Critical Care Medicine, 2001; 13(3): 182.
52.	Gao C, Liu JZ. Study of applying of epinephrine with naloxone hydrochloride to patients during cardiopulmonary resuscitation. Ningxia Medical Journal, 2004; 26(11): 680–682.
53.	Wang WQ, Shen JM, Chen SY. Efficacy evaluation of large dose naloxone for cardiopulmonary-cerebral resuscitation. Clinical Medicine of China, 2003; 19(11): 989–990.
54.	Cui XF. Naloxone combined with routine cardiopulmonary resuscitation for cardiac arrest. Journal of Youjiang Medical College For Nationalities, 2000; (3): 403–404.
55.	Ma YY, Du GS, Yang WQ, et al. Efficacy evaluation of naloxone for cerebral resuscitation. Agricultural Reclamation Medicine, 2000; 22(2): 91.
56.	Cao QJ, Sun RL. Clinical analysis of naloxone in 31 cases of cardiopulmonary-cerebral resuscitation. Journal of Zhenjiang Medical College, 1999; 9(2): 229.

1. 莊心良, 曾因明, 陳伯鑾. 主編. 現代麻醉學. 第3版. 北京: 人民衛生出社; 2004. 2306~2311.
2. 陳克田, 李明亭. 內啡肽與納洛酮. 見: 孟慶林. 主編. 納洛酮的基礎研究與臨床應用. 北京: 經濟日報出版社; 1996. 209.
3. 靳偉民, 韓樹堂. 鹽酸納洛酮治療顱腦損傷合并呼吸驟停 (附49例報告). 急診醫學, 1997; 6(): 339.
4. 邵孝. 心肺腦復蘇. 見: 邵孝, 蔣朱明. 主編. 急診醫學. 上海: 上海科學技術出版社; 1992. 55~69.
5. 孟慶林, 胡長欣, 候延奎. 鹽酸納洛酮拮抗乙醇中毒作用機理的探討. 中國急救醫學, 1996; 16(): 2.
6. 楊天德, 劉橋義, 陳意生, 等. 納洛酮對缺血再灌注心肌超微結構的影響. 見: 孟慶林. 主編. 納洛酮的基礎研究與臨床應用. 北京: 經濟日報出版社; 1996. 6~8.
7. 陳天鐸, 董晨明, 李培杰, 等. 納洛酮對心肺腦復蘇作用的評價. 急診醫學, 2000; (1): 5~7.
8. 李婷, 吳巖. 納絡酮用于心肺腦復蘇24例療效觀察. 吉林大學學報?醫學版, 2004; 30(5): 768.
9. 姚品安, 宋秀琴. 納洛酮在心肺腦復蘇中的療效觀察. 中國實用醫學研究雜志, 2004; 3(6): 507~508.
10. 車海明. 納洛酮在急性中毒心肺復蘇中的應用. 中華臨床醫藥雜志, 2004; 5(2): 94.
11. 羅寶權, 黃崇軍, 吳宗波, 等．納洛酮聯合腎上腺素進行心肺復蘇. 臨床薈萃, 2003; 18(9): 523~524.
12. 郭美華, 任景艷, 趙莉. 納洛酮聯合腎上腺素進行心肺復蘇的療效觀察. 實用醫技雜志, 2005; 12(2B): 459.
13. 劉秀娟, 余勝利. 納洛酮對心肺腦復蘇的臨床療效觀察. 貴州醫藥, 2002; 26(1): 40~41.
14. 林翔, 鄭偉, 朱宏剛. 鹽酸納洛酮在心肺腦復蘇急診搶救中的應用. 中國廠礦醫學, 2006; 19(1): 18~19.
15. 趙林明, 張兆順, 劉玉橋. 納洛酮治療呼吸心搏驟停患者臨床觀察. 現代中西醫結合雜志, 2006; 15(5): 584~585.
16. 王云峰, 王瑞斌. 納絡酮在腦復蘇中的療效觀察. 基層醫學論壇, 2004; 8(1): 43.
17. 郭美華, 任景艷, 趙莉. 納洛酮聯合腎上腺素心肺復蘇33例療效觀察. 中華全科醫師雜志, 2005; 4(9): 553.
18. 憔天鐸, 董晨明, 李培杰, 等. 心肺腦復蘇期間應用納洛酮臨床價值的探討. 甘肅科技, 1999; (4).
19. 董晨明, 陳天鐸, 李培杰. 納洛酮在呼吸復蘇中的臨床應用. 中國醫刊, 2000; 35(11): 49.
20. 董晨明, 李俠, 張京梅. 在心肺腦復蘇中納洛酮的臨床應用體會. 傷殘醫學雜志, 2000; 8(3): 38~40.
21. 陳天鐸, 董晨明, 李培杰. 納絡酮用于心肺腦復蘇21例療效觀察. 中國危重病急救醫學, 2001; 13(3): 182.
22. 高超, 劉建中. 心肺復蘇中聯合應用腎上腺素與納洛酮的研究. 寧夏醫學雜志, 2004; 26(11): 680~682.
23. 王偉強, 沈建妹, 陳淑葉. 大劑量納洛酮心肺復蘇療效分析. 中國綜合臨床, 2003; 19(11): 989~990.
24. 崔小鋒. 常規心肺復蘇加用納洛酮救治心臟驟停體會. 右江民族醫學院學報, 2000; (3): 403~404.
25. 馬玉英, 杜廣勝, 楊晚青, 等. 鹽酸納洛酮在腦復蘇中的療效觀察. 農墾醫學, 2000; 22(2): 91.
26. 曹秋菊, 孫瑞林. 納洛酮用于心腦肺復蘇術31例臨床分析. 鎮江醫學院學報, 1999; 9(2): 229.
27. Zhuang XL, Zeng YM, Chen BL. Editor-in-chief. Modern Anesthesiology. 3rd ed. Beijing: People’s Medical Publishing House; 2004. 2306–2311.
28. Chen KT, Li MT. Endogenous opioid and naloxone. In: Meng QL. Editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 209.
29. Le WM, Han ST. Effect of naloxone on craniocerebral injury and apnoea. Journal of Emergency Medicine, 1997; 6(): 339.
30. Shao X. Cardiopulmonary-cerebral Resuscitation. In: Shao X. Jiang ZM. editor-in-chief. Shanghai: Shanghai Science and Technique Press; 1992. 55–69.
31. Lou HC, Tweed WA, Davis JM. Preferential blood flow increase tothe brain stem in moderate neonatal hypoxia: reyersal by naloxone. EurJ Pediatr, 1985; 144(): 225.
32. Meng QL, Hu CX, Hou YK. Mechanism of antagonism of naloxone to ethanol. Chinese Journal of Critical Care Medicine, 1996; 16(): 2.
33. Yang TD, Liu QY, Cheng YS, et al. Effect of naloxone for ultrastructure of ischemia reperfusion cardiac muscle. In: Meng QL. editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 6–8.
34. Hughes GS. Naloxone and methylprednisolone sodium succinate enhance sympathomedullary discharge in patients with septic shock. Life sci, 1984; 35(): 2319.
35. Mcintosh TK. Effect of an opiate antagonist (naloxone) and agonist/ an2tagonist (nalbuphine) in primate hemorrhagic shock : relationship to cat2echolaminer elease. Cire shock, 1985; 17(): 313.
36. McGuire W, Fowlie PW. Naloxone for narcotic exposed newborn infants: systematic review. Archives of Disease in Childhood Fetal & Neonatal Edition, 2003; 88(4): F308–F311.
37. Cheng TD, Dong CM, Li PJ, et al. Clinical study on the administration of naloxone during closed-chest cardiopulmonary-cerebral resuscitation. Journal of Emergency Medicine, 2000; (1): 5–7.
38. Li T, Wu Y. Efficacy evaluation of naloxone in 24 cases of cardiopulmonary-cerebral resuscitation. Journal of Jilin University (Medicine Edition), 2004; 30(5): 768.
39. Yao PA, Song XQ. Clinical efficacy on the administration of naloxone during cardiopulmonary-cerebral resuscitation. Chinese Research Journal of Practical Medicine, 2004; 3(6): 507–508.
40. Che HM. Application of naloxone during cardiopulmonary resuscitation after acute toxicosis. Chinese Clinical Medicine, 2004; 5(2): 94.
41. Luo BQ, Huang CJ, Wu ZB, et al. Naloxone combined with adrenaline for cardiopulmonary resuscitation. Clinical Focus, 2003; 18(9): 523–524.
42. Guo MH, Ren JY, Zhao L. Effect of Naloxone combined with adrenaline for cardiopulmonary resuscitation. Journal of Practical Medical Techniques, 2005; 12(2B): 459.
43. Liu XJ, Yu SL. Efficacy evaluation of naloxone for cardiopulmonary-cerebral resuscitation. Guizhou Medical Journal, 2002; 26(1): 40–41.
44. Lin X, Zheng W, Zhu HG. Application of naloxone in cardiopulmonary-cerebral resuscitation. Chinese Medicine of Factory and Mine, 2006; 19(1): 18–19.
45. Zhao LM, Zhang ZS, Liu YQ. Clinical observation of naloxone for cardiac arrest. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2006; 15(5): 584–585.
46. Wang XF, Wang RB. Clinical efficacy of naloxone for cerebral resuscitation. Medical Forums in Basic, 2004; 8(1): 43.
47. Guo MH, Ren JY, Zhao L. Clinical efficacy of naloxone combined with adrenaline for 33 cardiopulmonary-cerebral resuscitation cases. Chinese Journal of General Practitioners, 2005; 4(9): 553.
48. Chen TZ, Dong CM, Li PJ, et al. Clinical efficacy of the administration of naloxone during cardiopulmonary-cerebral resuscitation. Gansu Science and Technology, 1999; (4).
49. Dong CM, Chen TZ, Li PJ. Clinical application of naloxone in cardiopulmonary resuscitation. Chinese Journal of Medicine, 2000; 35(11): 49.
50. Dong CM, Li X, Zhang JM. Clinical study on administration of naloxone during closed-chest cardiopulmonary-cerebral resuscitation. Medical Journal of Trauma and Disability, 2000; 8(3): 38–40.
51. Chen TZ, Dong CM, Li PJ. Efficacy evaluation of naloxone in 21 cases of cardiopulmonary-cerebral resuscitation. Chinese Critical Care Medicine, 2001; 13(3): 182.
52. Gao C, Liu JZ. Study of applying of epinephrine with naloxone hydrochloride to patients during cardiopulmonary resuscitation. Ningxia Medical Journal, 2004; 26(11): 680–682.
53. Wang WQ, Shen JM, Chen SY. Efficacy evaluation of large dose naloxone for cardiopulmonary-cerebral resuscitation. Clinical Medicine of China, 2003; 19(11): 989–990.
54. Cui XF. Naloxone combined with routine cardiopulmonary resuscitation for cardiac arrest. Journal of Youjiang Medical College For Nationalities, 2000; (3): 403–404.
55. Ma YY, Du GS, Yang WQ, et al. Efficacy evaluation of naloxone for cerebral resuscitation. Agricultural Reclamation Medicine, 2000; 22(2): 91.
56. Cao QJ, Sun RL. Clinical analysis of naloxone in 31 cases of cardiopulmonary-cerebral resuscitation. Journal of Zhenjiang Medical College, 1999; 9(2): 229.

Chinese Journal of Evidence-Based Medicine

Naloxone for Cardio - Pulmonary - Cerebral Resuscitation: A Systematic Review

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