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| 间断推注与持续背景输注罗哌卡因和阿片类药物用于硬膜外分娩镇痛的Meta分析 |
| Intermittent bolus versus continuous infusion for epidural labor analgesia: a systematic review and Meta-analysis |
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| DOI：10.12089/jca.2018.11.014 |
| 中文关键词: 分娩镇痛 硬膜外镇痛 间断推注 持续输注 罗哌卡因 Meta分析 |
| 英文关键词: Obstetrical analgesia Epidural analgesia Intermittent bolus Continuous infusion Ropivacaine Meta-analysis |
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| 摘要点击次数: 2794 |
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| 中文摘要: |
目的 采用Meta分析评价间断硬膜外推注(intermittent epidural bolus, IEB)(IEB组)与持续硬膜外输注(continuous epidural infusion, CEI)(CEI组)罗哌卡因和阿片类药物用于维持分娩镇痛的有效性和安全性。
方法 检索CENTRAL、PubMed、EMBASE、WOS、CBM、CNKI、VIP和万方数据库, 时间从建库到2018年3月。纳入比较间断1 h推注与持续背景输注罗哌卡因和阿片类药物用于维持硬膜外分娩镇痛的随机对照试验(RCT)。采用RevMan 5.3软件进行分析。
结果 最终纳入文献12篇, 共1 383例产妇。与CEI组比较, IEB组明显降低器械助产率(OR=0.52, 95%CI 0.33～0.82, P<0.05)和运动阻滞发生率(OR=0.15, 95%CI 0.05～0.44, P<0.05), 明显降低麻醉药物额外需求率 (OR=0.13, 95%CI0.09～0.2, P<0.05)和罗哌卡因用量 (SMD=-1.04, 95%CI -1.18～-0.91, P<0.05), 明显减少第一产程时间 (MD=-11.22 min, 95%CI -16.51～-5.92, P<0.05)和第二产程时间 (MD=-3.25 min, 95%CI -5.14～-1.37, P<0.05)。两组剖宫产率、新生儿1 min Apgar评分及低血压、恶心呕吐、皮肤瘙痒发生率差异无统计学意义。
结论 与持续背景输注罗哌卡因和阿片类药物用于维持硬膜外分娩镇痛相比较, 间断1 h推注的
方法 可降低器械助产率及运动阻滞发生率, 降低麻醉药物的额外需求率同时减少罗哌卡因的用量。 |
| 英文摘要: |
Objective To assess the effectiveness and safety of intermittent epidural bolus (IEB) compared with continuous epidural infusion (CEI) for the maintenance of labor analgesia.
Methods We searched the CENTRAL, PubMed, EMBASE, WOS, CBM, CNKI, VIP and Wanfang Database from their establishment to March 2018. We included all randomized controlled trials (RCTs) involving women undergoing epidural labor analgesia, which compared intermittent 1 hour bolus with continuous infusion of ropivacaine and opioids. Meta-analyses were performed using RevMan 5.3 software.
Results We included twelve studies involving 1383 pregnant women. Compared with CEI, IEB resulted in a lower incidence of instrumental vaginal birth (OR = 0.52, 95%CI 0.33 to 0.82, P<0.05) and motor block (OR = 0.15, 95%CI 0.05 to 0.44, P<0.05). There were less supplemental bolus (OR = 0.13, 95%CI 0.09 to 0.2, P<0.05) and total dosage of ropivacaine (SMD = -1.04, 95%CI -1.18 to -0.91, P<0.05) in IEB group. Additionally, IEB resulted in a shorter duration of first the stage of labor (MD = -11.22 min, 95%CI -16.51 to -5.92, P<0.05) and second stage of labor (MD = -3.25 min, 95%CI -5.14 to -1.37, P<0.05). But there were no statistical differences between IEB and CEI in Apgar scores at one minute, the rate of caesarean section, hypotension, pruritus, nausea and vomiting.
Conclusion Current evidence suggests that intermittent 1 hour bolus of ropivacaine and opioids for the maintenance of epidural labor analgesia can reduce the rate of instrumental vaginal birth and motor block, the supplemental bolus and the total dosage of ropivacaine. |
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