低浓度局部麻醉药无痛分娩镇痛对产科结局的影响：随机对照试验的系统评价和Meta分析
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
Effects of Epidural Labor Analgesia With Low Concentrations of Local Anesthetics on ObstetricOutcomes:A Systematic Review and Meta-analysis of Randomized Controlled Trials
背景与目的
低浓度局部麻醉药（LCLAs）越来越受到产科硬膜外镇痛的青睐。 然而，持续低浓度局麻药的硬膜外镇痛对第二产程的时间和胎儿出生率的影响仍然存在争议。 本文对低浓度局麻药硬膜外镇痛与非硬膜外止痛对产科结果的影响进行系统评估和Meta分析。
方 法
检索了PubMed，Embase和Cochrane对照试验登记册的数据库，由2名研究人员进行了独立检索，随机对照试验比较了使用LCLAs和非硬膜外止痛的硬膜外分娩镇痛。主要指标是第二产程的时间和胎儿的出生率;次要指标包括剖宫产率，顺产分娩率和第一产程的持续时间。
结 果
十项研究（包括1809名妇女）。在第二产程时间组之间无显著性差异（平均差为5.71分钟，95%可信区间[CI]，-6.14 17.83；P = 36）或出生率（风险比[RR] = 1.52，95% CI，0.97-2.4；P = 07）。在剖宫产分娩率组间无显著性差异（RR = 0.8，95% CI，0.6-1.05；P = 11），顺产分娩率（RR = 0.98，95% CI，0.91-1.06；P = 62），或第一产程的持续时间（平均差= 17.34分钟，95% CI，-5.89 40.56；P = 14）。
结 论
与非硬膜外镇痛相比，低浓度局麻药的硬膜外镇痛不伴随第二产程的延长或出生率增加。荟萃分析的结果是基于低质量的小型试验。这些结论需要通过大样本和高质量的试验来确认。
原始文献摘要
Wang TT1, Sun S, Huang SQ. Effects of Epidural Labor Analgesia With Low Concentrations of Local Anesthetics on ObstetricOutcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Anesth Analg. 2017 May;124(5):1571-1580
BACKGROUND: Low concentrations of local anesthetics (LCLAs) are increasingly popular for epidural labor analgesia. The effects ofepidural analgesia with low concentrations of anesthetics on the duration of the second stage of labor and the instrumental birth rate, however, remain controversial. A systematic review was conducted to compare the effects of epidural analgesia with LCLAs with those of nonepidural analgesia on obstetric outcomes.
METHODS:The databases of PubMed, Embase, and the Cochrane controlled trials register were independently searched by 2 researchers, and randomized controlled trials that compared epidural labor analgesia utilizing LCLAs with nonepidural analgesia were retrieved. The primary outcomes were the duration of the second stage of labor and the instrumental birth rate; secondary outcomesincluded the cesarean delivery rate, the spontaneous vaginal delivery rate, and the duration of the first stage of labor.
RESULTS:Ten studies (1809 women) were included. There was no significant difference between groups in the duration of the second stage of labor (mean difference = 5.71 minutes, 95% confidence interval [CI], -6.14 to 17.83; P = .36) or the instrumental birth rate (risk ratio [RR] = 1.52, 95% CI, 0.97-2.4; P = .07). There was no significant difference between groups in the cesarean delivery rate (RR = 0.8, 95% CI, 0.6-1.05; P = .11), the spontaneous vaginal delivery rate (RR = 0.98, 95% CI, 0.91-1.06; P = .62), or the duration of the first stage of labor (mean difference = 17.34 minutes, 95% CI, -5.89 to 40.56; P = .14).
CONCLUSIONSCompared with nonepidural analgesia, epidural analgesia with LCLAs is not associated with a prolonged duration of the second stage of labor or an increased instrumental birth rate. The results of this meta-analysis are based on small trials of lowquality. These conclusions require confirmation by large-sample and high-quality trials in the future.
麻醉学文献进展分享
联系我们