摘要
目的应用Meta分析方法评价不同浓度布比卡因复合舒芬太尼或芬太尼用于硬膜外分娩镇痛时对产妇和新生儿的影响。方法检索PubMed、Embase、WOK、CNKI、CBM和万方数据库,时间从1970年至2015年5月,所有关于不同浓度布比卡因用于分娩镇痛的随机对照试验。按照Cochrane协作网偏倚风险评估标准对纳入研究的方法学质量进行评价,并采用RevMan 5.0软件进行Meta分析。将布比卡因浓度≤0.1%定义为低浓度组,>0.1%为高浓度组。结果共纳入13篇文献,共1 593例患者。低浓度组的器械助产率明显低于高浓度组(OR=0.62,95%CI 0.49~0.79,P<0.001)。低浓度组自然分娩率明显高于高浓度组(OR=1.47,95%CI 1.17~1.84,P<0.001)。低浓度组第一产程时间明显缩短(SMD=-21.66,95%CI-34.75^-8.57,P=0.001)。低浓度组局麻药总量明显减少(SMD=-29.14,95%CI-38.42^-19.86,P<0.001)。低浓度组皮肤瘙痒发生率明显增加(OR=21.15,95%CI 2.75~162.51,P=0.003)。结论低浓度布比卡因复合舒芬太尼或芬太尼用于硬膜外分娩镇痛可降低器械助产率,提高自然分娩率,但皮肤瘙痒发生率增加。
Objective To systematically assess the effect of low concentration versus high concentration of bupivacaine for labour analgesia on obstetric and anesthetic outcomes. Methods We searched PubMed, Embase, Web of Knowledge, CNKI, CBM, and Wanfang Database for randomized controlled trials of laboring patients that compared low concentrations （defined as ≤0.1 % epidural bupivacaine） of epidural local anesthetic with high concentrations for maintenance of analgesia. Two reviewers independently screened the trials according to inclusion and exclusion criteria, extracted the data, and assessed the quality of methodology. Meta-analyses were performed using RevMan 5.0 software. Results Thirteen randomized controlled trials （RCTs） involving 1593 patients were included. Low concentrations were associated with a reduction in the incidence of assisted vaginal delivery （OR=0.62, 95%CI 0. 49-0. 79,P〈0. 001）. Low concentrations were associated with an increment in the incidence of spontaneous vaginal delivery （OR= 1.47,95 GCI 1.17-1.84,P〈0. 001）. The low concentrations group had a shorter first stage of labour （SMD ：- 21.66, 95G CI -34.75- -8.57, P=0. 001）, less total dose of local anesthetic （SMD=-29.14, 95 %CI -38.42-19.86, P〈0. 001）, more pruritus （OR= 21.15, 95%CI 2.75-162.51, P：0. 003）. There were no differ- ences between groups in motor block and second stage of labour. Conclusion The use of low concentration bupivacaine for labour epidural analgesia reduces the incidence of assisted vaginal delivery and increases the incidence of spontaneous vaginal delivery and pruritus. But larger sample sizes, double- blind RCTs are needed to verify this conclusion.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2015年第8期737-742,共6页
Journal of Clinical Anesthesiology
