Influence of Remifentanil on Newborns During Cesarean Section under General Anesthesia: A Meta Analysis_West China Medical Journal

Authors：

GU Juan ¹ , CHEN Jie ² , CHEN Yuanjing ¹ ,  LIU Bin ¹

1. Department of Anesthesiology; 2. Center of Evidence-based Medicine; West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIU Bin, Email: gujuangujuan@163.com

Keywords：

瑞芬太尼; 新生兒; 剖宮產; Meta分析

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目的　系統評價瑞芬太尼用于全身麻醉下剖宮產時對新生兒的影響。方法　檢索Cochrane Library、PubMed、OVID、EMbase、CNKI、萬方等中外數據庫，收集1990年－2012年關于瑞芬太尼用于全身麻醉下剖宮產的臨床隨機對照研究。按Cochrane系統評價方法評估文獻質量，用Revman 5.1軟件對提取的數據進行Meta分析。結果　共納入10項研究，包括342例產婦。與空白對照組相比，瑞芬太尼降低新生兒1 min Apgar評分[WMD=?0.46，95%CI（?0.65，?0.27），P＜0.000 01]，提高出生時臍動脈pH值[WMD=0.01，95%CI（0.00，0.02），P=0.004]，增加出生時窒息發生率[RR=1.76，95%CI（1.06，2.95），P=0.03]；當誘導劑量為1.0～1.5 μg/kg時，對5 min Apgar評分無影響[WMD=?0.14，95%CI（?0.32，0.04），P=0.13]。結論　瑞芬太尼用于全身麻醉剖宮產可減輕新生兒酸中毒，但是會對新生兒產生一過性的呼吸抑制。

Citation： GU Juan,CHEN Jie,CHEN Yuanjing,LIU Bin. Influence of Remifentanil on Newborns During Cesarean Section under General Anesthesia: A Meta Analysis. West China Medical Journal, 2012, 27(9): 1361-1365. doi: Copy

1.	Rittmaster RS, Cutler Jr GB, Sobel DO, et al. Morphine inhibits the pituitary-adrenal response to ovine corticotropinreleasing hormone in normal subjects[J]. J Clin Endocrinol Metab, 1985, 60(5): 891-895.
2.	Kan RE, Hughes SC, Rosen MA, et al. Intravenous remifentanil: placental transfer, maternal and neonatal effects[J]. Anesthesiology, 1998, 88(6): 1467-1474.
3.	Draisci G, Valente A, Suppa E, et al. Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial[J]. Int J Obstet Anesth, 2008, 17(2): 130-136.
4.	Ngan Kee WD, Khaw KS, Ma KC, et al. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial[J]. Anesthesiology, 2006, 104(1): 14-20.
5.	Yoo KY, Jeong CW, Park BY, et al. Effects of remifentanil on cardiovascular and bispectral index responses to endotracheal intubation in severe pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia[J]. Br J Anaesth, 2009, 102(6): 812-819.
6.	趙娜, 李有長. 瑞芬太尼在剖宮產麻醉中應用的研究[J]. 重慶醫學, 2006, 35(21): 1976-1977.
7.	陳皆鋒, 張新民, 丁潔嵐, 等. 瑞芬太尼復合異丙酚用于剖宮產術產婦全麻的臨床效果觀察[J]. 安徽醫藥, 2006, 10(2): 102-103.
8.	劉琳, 嚴海雅. 瑞芬太尼用于剖宮產術全身麻醉對母嬰的影響[J]. 現代實用醫學, 2010, 22(6): 668-669.
9.	Park BY, Yoo KY, Lee MK, et al. Maternal and neonatal effects of remifentanil used during induction of general anesthesia in preeclamptic patients undergoing cesarean delivery[J]. Korean J Anesthesiol, 2009, 57(1): 62-68.
10.	曾葵, 楊瑩瑩, 黃瀚, 等. 剖宮產全麻誘導使用瑞芬太尼對新生兒的影響[J]. 四川大學學報(醫學版), 2009, 40(4): 755-757.
11.	Bouattour L, Ben Amar H, Bouali Y, et al. Maternal and neonatal effects of remifentanil for general anaesthesia for Caesarean delivery[J]. Ann Fr Anesth Reanim, 2007, 26(4): 299-304.

1. 　Rittmaster RS, Cutler Jr GB, Sobel DO, et al. Morphine inhibits the pituitary-adrenal response to ovine corticotropinreleasing hormone in normal subjects[J]. J Clin Endocrinol Metab, 1985, 60(5): 891-895.
2. 　Kan RE, Hughes SC, Rosen MA, et al. Intravenous remifentanil: placental transfer, maternal and neonatal effects[J]. Anesthesiology, 1998, 88(6): 1467-1474.
3. 　Draisci G, Valente A, Suppa E, et al. Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial[J]. Int J Obstet Anesth, 2008, 17(2): 130-136.
4. 　Ngan Kee WD, Khaw KS, Ma KC, et al. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial[J]. Anesthesiology, 2006, 104(1): 14-20.
5. 　Yoo KY, Jeong CW, Park BY, et al. Effects of remifentanil on cardiovascular and bispectral index responses to endotracheal intubation in severe pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia[J]. Br J Anaesth, 2009, 102(6): 812-819.
6. 　趙娜, 李有長. 瑞芬太尼在剖宮產麻醉中應用的研究[J]. 重慶醫學, 2006, 35(21): 1976-1977.
7. 　陳皆鋒, 張新民, 丁潔嵐, 等. 瑞芬太尼復合異丙酚用于剖宮產術產婦全麻的臨床效果觀察[J]. 安徽醫藥, 2006, 10(2): 102-103.
8. 　劉琳, 嚴海雅. 瑞芬太尼用于剖宮產術全身麻醉對母嬰的影響[J]. 現代實用醫學, 2010, 22(6): 668-669.
9. 　Park BY, Yoo KY, Lee MK, et al. Maternal and neonatal effects of remifentanil used during induction of general anesthesia in preeclamptic patients undergoing cesarean delivery[J]. Korean J Anesthesiol, 2009, 57(1): 62-68.
10. 　曾葵, 楊瑩瑩, 黃瀚, 等. 剖宮產全麻誘導使用瑞芬太尼對新生兒的影響[J]. 四川大學學報(醫學版), 2009, 40(4): 755-757.
11. 　Bouattour L, Ben Amar H, Bouali Y, et al. Maternal and neonatal effects of remifentanil for general anaesthesia for Caesarean delivery[J]. Ann Fr Anesth Reanim, 2007, 26(4): 299-304.

West China Medical Journal

Influence of Remifentanil on Newborns During Cesarean Section under General Anesthesia: A Meta Analysis

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