瑞芬太尼用于全身麻醉剖宫产对新生儿影响的Meta分析

目的系统评价瑞芬太尼用于全身麻醉下剖宫产时对新生儿的影响。方法检索Cochrane Library、PubMed、OVID、EMbase、CNKI、万方等中外数据库,收集1990年-2012年关于瑞芬太尼用于全身麻醉下剖宫产的临床随机对照研究。按Cochrane系统评价方法评估文献质量,用Revman 5.1软件对提取的数据进行Meta分析。结果共纳入10项研究,包括342例产妇。与空白对照组相比,瑞芬太尼降低新生儿1 min Apgar评分[WMD=0.46,95%CI(0.65,0.27),P<0.000 01],提高出生时脐动脉pH值[WMD=0.01,95%CI(0.00,0.02),P=0.004],增加出生时窒息发生率[RR=1.76,95%CI(1.06,2.95),P=0.03];当诱导剂量为1.0～1.5μg/kg时,对5 min Apgar评分无影响[WMD=0.14,95%CI(0.32,0.04),P=0.13]。结论瑞芬太尼用于全身麻醉剖宫产可减轻新生儿酸中毒,但是会对新生儿产生一过性的呼吸抑制。

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

Objective To assess the influence of remifentanil on newborns during cesarean section under general anesthesia.Methods Databases including Cochrane Library,PubMed,OVID,EMbase,and CNKI were searched for randomized controlled trails associating with remifentanil used for general anesthesia induction in cesarean section between 1990 and 2012.Study selection and meta-analysis were conducted according to Cochrane Handbook Systematic Reviews.Data in these trials were extracted by three reviewers independently and were analyzed by ReMan 5.1 software.Results Ten trials were identified including altogether 342 pregnant women.Compared with placebo,remifentanil could reduce the 1 min Apgar score [WMD=-0.46,95% CI(-0.65,-0.27),P<0.000 01],increase umbilical arterial pH value [WMD=0.01,95%CI(0.00,0.02),P=0.004],and increase the incidence of respiratory depression [RR=1.76,95% CI(1.06,2.95),P=0.03].However,it had no impact on 5 min Apgar score when the induction dose was between 1.0 to 1.5 μg/kg [WMD=-0.14,95% CI(-0.32,0.04),P=0.13].Conclusion Remifentanil used for general anesthesia induction in cesarean section can reduce acidosis of the newborns,but may also induce transient respiratory depression.