分娩时局部和全身应用阿片类药物镇痛的系统评价

目的运用Cochrane系统评价的方法，评价分娩时局部和全身应用阿片类药物镇痛的有效性与安全性。方法计算机检索PubMed（1966-2008．1）、EMbase（1980-2008．1）、Cochrane图书馆（2008年第1期）、CBM（1978-2008．1）、CNKI（1979-2008．1），同时筛选纳入研究的参考文献，收集有关比较局部和全身应用阿片类药物镇痛的随机对照试验，由两名评价员独立评价文献质量，并采用RevMan4．2．10软件对纳入研究结果进行Meta分析：结果共纳入12个研究，5909例产妇。Meta分析结果显示，局部和全身应用阿片类药比较进行分晚镇痛．母亲对局部应用阿片类药分娩镇痛疼痛缓解更满意[RR=I．63，95％CI（1．27，2．09）]，两组5min新生儿Apgar评分〈7，差异无统计学意义：RR=0．63，95％CI（0.40，1．01）]：结论现有证据显示，与局部用药比较，全身心用阿片类药物镇痛的母亲对分娩疼痛缓解更满意。但两组均存在对母亲和新生儿的不良影响。因此，要证明哪种途径应用阿片类药进行分娩镇痛更加有效和安全，尚需开展更多高质量的随机对照研究。

Local versus Systemic Application of Opioids for Labor Analgesia:A Systematic Review

Objective To assess the effectiveness and safety of local versus systemic application of opioids for labor analgesia.Methods We searched PubMed(1966 to January 2008),EMBASE(1980 to January 2008),The Cochrane Library(Issue 1,2008),CBM(1978 to January 2008),CNKI(1979 to January 2008)for randomized controlled trials(RCTs) involving local versus systemic application of opioids for labor analgesia.Quality assessment and data extraction were conducted by two reviewers independently.Meta-analyses were conducted with The Cochrane Collaboration's RevMan 4.2.10 software.Results A total of 12 trials involving 5 909 participants met the inclusion criteria.Meta-analyses showed that local application of opioids was superior to systemic application in terms of maternal satisfaction with pain relief during labor(RR 1.63,95%CI 1.27 to 2.09).No significant difference was found between the two groups in the incidence of low neonatal Apgar score at 5 minutes(RR 0.63,95%CI 0.40 to 1.01).Conclusion Local application of opioids for labor analgesia appears to be more effective than systematic use in reducing pain during labor.But as for safety concerns,maternal and neonatal adverse effects are observed in both groups.Thus,more high-quality and large-scale RCTs are needed.