• 四川大學(xué)華西醫(yī)院麻醉科（610041 成都）;

目的 　系統(tǒng)評價納洛酮在成人心肺腦復(fù)蘇中的作用。
方法 　計算機檢索MEDLINE（1966～2006.6）、EMbase（1984～2006.6）、Cochrane圖書館（2006年第2期）和中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫(1978～2006.6) 、中國期刊全文數(shù)據(jù)庫（1994～2006.6），納入納洛酮治療心肺腦復(fù)蘇的隨機對照試驗（RCT）。由兩名研究者獨立進行質(zhì)量評估和交叉核對，并采用RevMan4.2.7軟件進行統(tǒng)計分析。
結(jié)果 　共納入10個RCT，研究對象均為年齡在18～75歲的急診搶救﹑留觀和住院的心搏驟停，需要進行心肺復(fù)蘇的患者。納入研究的質(zhì)量均不高。結(jié)果表明納洛酮聯(lián)合常規(guī)心肺復(fù)蘇的療效優(yōu)于常規(guī)心肺復(fù)蘇。
結(jié)論 　納洛酮聯(lián)合常規(guī)心肺復(fù)蘇的成功率和神經(jīng)功能恢復(fù)優(yōu)于常規(guī)心肺復(fù)蘇。但由于納入研究的質(zhì)量較差，能夠合并的樣本例數(shù)較少，還需要進行高質(zhì)量、大樣本隨機對照試驗，才能為臨床工作提供充足的證據(jù)。

引用本文： 鄧 佳,李 茜,劉 斌. 納洛酮在成人心肺腦復(fù)蘇中的作用評價. 中國循證醫(yī)學(xué)雜志, 2006, 06(11): 820-825. doi: 復(fù)制

1. 莊心良, 曾因明, 陳伯鑾. 主編. 現(xiàn)代麻醉學(xué). 第3版. 北京: 人民衛(wèi)生出社; 2004. 2306~2311.
2. 陳克田, 李明亭. 內(nèi)啡肽與納洛酮. 見: 孟慶林. 主編. 納洛酮的基礎(chǔ)研究與臨床應(yīng)用. 北京: 經(jīng)濟日報出版社; 1996. 209.
3. 靳偉民, 韓樹堂. 鹽酸納洛酮治療顱腦損傷合并呼吸驟停 (附49例報告). 急診醫(yī)學(xué), 1997; 6(): 339.
4. 邵孝. 心肺腦復(fù)蘇. 見: 邵孝, 蔣朱明. 主編. 急診醫(yī)學(xué). 上海: 上海科學(xué)技術(shù)出版社; 1992. 55~69.
5. 孟慶林, 胡長欣, 候延奎. 鹽酸納洛酮拮抗乙醇中毒作用機理的探討. 中國急救醫(yī)學(xué), 1996; 16(): 2.
6. 楊天德, 劉橋義, 陳意生, 等. 納洛酮對缺血再灌注心肌超微結(jié)構(gòu)的影響. 見: 孟慶林. 主編. 納洛酮的基礎(chǔ)研究與臨床應(yīng)用. 北京: 經(jīng)濟日報出版社; 1996. 6~8.
7. 陳天鐸, 董晨明, 李培杰, 等. 納洛酮對心肺腦復(fù)蘇作用的評價. 急診醫(yī)學(xué), 2000; (1): 5~7.
8. 李婷, 吳巖. 納絡(luò)酮用于心肺腦復(fù)蘇24例療效觀察. 吉林大學(xué)學(xué)報?醫(yī)學(xué)版, 2004; 30(5): 768.
9. 姚品安, 宋秀琴. 納洛酮在心肺腦復(fù)蘇中的療效觀察. 中國實用醫(yī)學(xué)研究雜志, 2004; 3(6): 507~508.
10. 車海明. 納洛酮在急性中毒心肺復(fù)蘇中的應(yīng)用. 中華臨床醫(yī)藥雜志, 2004; 5(2): 94.
11. 羅寶權(quán), 黃崇軍, 吳宗波, 等．納洛酮聯(lián)合腎上腺素進行心肺復(fù)蘇. 臨床薈萃, 2003; 18(9): 523~524.
12. 郭美華, 任景艷, 趙莉. 納洛酮聯(lián)合腎上腺素進行心肺復(fù)蘇的療效觀察. 實用醫(yī)技雜志, 2005; 12(2B): 459.
13. 劉秀娟, 余勝利. 納洛酮對心肺腦復(fù)蘇的臨床療效觀察. 貴州醫(yī)藥, 2002; 26(1): 40~41.
14. 林翔, 鄭偉, 朱宏剛. 鹽酸納洛酮在心肺腦復(fù)蘇急診搶救中的應(yīng)用. 中國廠礦醫(yī)學(xué), 2006; 19(1): 18~19.
15. 趙林明, 張兆順, 劉玉橋. 納洛酮治療呼吸心搏驟?；颊吲R床觀察. 現(xiàn)代中西醫(yī)結(jié)合雜志, 2006; 15(5): 584~585.
16. 王云峰, 王瑞斌. 納絡(luò)酮在腦復(fù)蘇中的療效觀察. 基層醫(yī)學(xué)論壇, 2004; 8(1): 43.
17. 郭美華, 任景艷, 趙莉. 納洛酮聯(lián)合腎上腺素心肺復(fù)蘇33例療效觀察. 中華全科醫(yī)師雜志, 2005; 4(9): 553.
18. 憔天鐸, 董晨明, 李培杰, 等. 心肺腦復(fù)蘇期間應(yīng)用納洛酮臨床價值的探討. 甘肅科技, 1999; (4).
19. 董晨明, 陳天鐸, 李培杰. 納洛酮在呼吸復(fù)蘇中的臨床應(yīng)用. 中國醫(yī)刊, 2000; 35(11): 49.
20. 董晨明, 李俠, 張京梅. 在心肺腦復(fù)蘇中納洛酮的臨床應(yīng)用體會. 傷殘醫(yī)學(xué)雜志, 2000; 8(3): 38~40.
21. 陳天鐸, 董晨明, 李培杰. 納絡(luò)酮用于心肺腦復(fù)蘇21例療效觀察. 中國危重病急救醫(yī)學(xué), 2001; 13(3): 182.
22. 高超, 劉建中. 心肺復(fù)蘇中聯(lián)合應(yīng)用腎上腺素與納洛酮的研究. 寧夏醫(yī)學(xué)雜志, 2004; 26(11): 680~682.
23. 王偉強, 沈建妹, 陳淑葉. 大劑量納洛酮心肺復(fù)蘇療效分析. 中國綜合臨床, 2003; 19(11): 989~990.
24. 崔小鋒. 常規(guī)心肺復(fù)蘇加用納洛酮救治心臟驟停體會. 右江民族醫(yī)學(xué)院學(xué)報, 2000; (3): 403~404.
25. 馬玉英, 杜廣勝, 楊晚青, 等. 鹽酸納洛酮在腦復(fù)蘇中的療效觀察. 農(nóng)墾醫(yī)學(xué), 2000; 22(2): 91.
26. 曹秋菊, 孫瑞林. 納洛酮用于心腦肺復(fù)蘇術(shù)31例臨床分析. 鎮(zhèn)江醫(yī)學(xué)院學(xué)報, 1999; 9(2): 229.
27. Zhuang XL, Zeng YM, Chen BL. Editor-in-chief. Modern Anesthesiology. 3rd ed. Beijing: People’s Medical Publishing House; 2004. 2306–2311.
28. Chen KT, Li MT. Endogenous opioid and naloxone. In: Meng QL. Editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 209.
29. Le WM, Han ST. Effect of naloxone on craniocerebral injury and apnoea. Journal of Emergency Medicine, 1997; 6(): 339.
30. Shao X. Cardiopulmonary-cerebral Resuscitation. In: Shao X. Jiang ZM. editor-in-chief. Shanghai: Shanghai Science and Technique Press; 1992. 55–69.
31. Lou HC, Tweed WA, Davis JM. Preferential blood flow increase tothe brain stem in moderate neonatal hypoxia: reyersal by naloxone. EurJ Pediatr, 1985; 144(): 225.
32. Meng QL, Hu CX, Hou YK. Mechanism of antagonism of naloxone to ethanol. Chinese Journal of Critical Care Medicine, 1996; 16(): 2.
33. Yang TD, Liu QY, Cheng YS, et al. Effect of naloxone for ultrastructure of ischemia reperfusion cardiac muscle. In: Meng QL. editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 6–8.
34. Hughes GS. Naloxone and methylprednisolone sodium succinate enhance sympathomedullary discharge in patients with septic shock. Life sci, 1984; 35(): 2319.
35. Mcintosh TK. Effect of an opiate antagonist (naloxone) and agonist/ an2tagonist (nalbuphine) in primate hemorrhagic shock : relationship to cat2echolaminer elease. Cire shock, 1985; 17(): 313.
36. McGuire W, Fowlie PW. Naloxone for narcotic exposed newborn infants: systematic review. Archives of Disease in Childhood Fetal & Neonatal Edition, 2003; 88(4): F308–F311.
37. Cheng TD, Dong CM, Li PJ, et al. Clinical study on the administration of naloxone during closed-chest cardiopulmonary-cerebral resuscitation. Journal of Emergency Medicine, 2000; (1): 5–7.
38. Li T, Wu Y. Efficacy evaluation of naloxone in 24 cases of cardiopulmonary-cerebral resuscitation. Journal of Jilin University (Medicine Edition), 2004; 30(5): 768.
39. Yao PA, Song XQ. Clinical efficacy on the administration of naloxone during cardiopulmonary-cerebral resuscitation. Chinese Research Journal of Practical Medicine, 2004; 3(6): 507–508.
40. Che HM. Application of naloxone during cardiopulmonary resuscitation after acute toxicosis. Chinese Clinical Medicine, 2004; 5(2): 94.
41. Luo BQ, Huang CJ, Wu ZB, et al. Naloxone combined with adrenaline for cardiopulmonary resuscitation. Clinical Focus, 2003; 18(9): 523–524.
42. Guo MH, Ren JY, Zhao L. Effect of Naloxone combined with adrenaline for cardiopulmonary resuscitation. Journal of Practical Medical Techniques, 2005; 12(2B): 459.
43. Liu XJ, Yu SL. Efficacy evaluation of naloxone for cardiopulmonary-cerebral resuscitation. Guizhou Medical Journal, 2002; 26(1): 40–41.
44. Lin X, Zheng W, Zhu HG. Application of naloxone in cardiopulmonary-cerebral resuscitation. Chinese Medicine of Factory and Mine, 2006; 19(1): 18–19.
45. Zhao LM, Zhang ZS, Liu YQ. Clinical observation of naloxone for cardiac arrest. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2006; 15(5): 584–585.
46. Wang XF, Wang RB. Clinical efficacy of naloxone for cerebral resuscitation. Medical Forums in Basic, 2004; 8(1): 43.
47. Guo MH, Ren JY, Zhao L. Clinical efficacy of naloxone combined with adrenaline for 33 cardiopulmonary-cerebral resuscitation cases. Chinese Journal of General Practitioners, 2005; 4(9): 553.
48. Chen TZ, Dong CM, Li PJ, et al. Clinical efficacy of the administration of naloxone during cardiopulmonary-cerebral resuscitation. Gansu Science and Technology, 1999; (4).
49. Dong CM, Chen TZ, Li PJ. Clinical application of naloxone in cardiopulmonary resuscitation. Chinese Journal of Medicine, 2000; 35(11): 49.
50. Dong CM, Li X, Zhang JM. Clinical study on administration of naloxone during closed-chest cardiopulmonary-cerebral resuscitation. Medical Journal of Trauma and Disability, 2000; 8(3): 38–40.
51. Chen TZ, Dong CM, Li PJ. Efficacy evaluation of naloxone in 21 cases of cardiopulmonary-cerebral resuscitation. Chinese Critical Care Medicine, 2001; 13(3): 182.
52. Gao C, Liu JZ. Study of applying of epinephrine with naloxone hydrochloride to patients during cardiopulmonary resuscitation. Ningxia Medical Journal, 2004; 26(11): 680–682.
53. Wang WQ, Shen JM, Chen SY. Efficacy evaluation of large dose naloxone for cardiopulmonary-cerebral resuscitation. Clinical Medicine of China, 2003; 19(11): 989–990.
54. Cui XF. Naloxone combined with routine cardiopulmonary resuscitation for cardiac arrest. Journal of Youjiang Medical College For Nationalities, 2000; (3): 403–404.
55. Ma YY, Du GS, Yang WQ, et al. Efficacy evaluation of naloxone for cerebral resuscitation. Agricultural Reclamation Medicine, 2000; 22(2): 91.
56. Cao QJ, Sun RL. Clinical analysis of naloxone in 31 cases of cardiopulmonary-cerebral resuscitation. Journal of Zhenjiang Medical College, 1999; 9(2): 229.
  1. 1. 莊心良, 曾因明, 陳伯鑾. 主編. 現(xiàn)代麻醉學(xué). 第3版. 北京: 人民衛(wèi)生出社; 2004. 2306~2311.
  2. 2. 陳克田, 李明亭. 內(nèi)啡肽與納洛酮. 見: 孟慶林. 主編. 納洛酮的基礎(chǔ)研究與臨床應(yīng)用. 北京: 經(jīng)濟日報出版社; 1996. 209.
  3. 3. 靳偉民, 韓樹堂. 鹽酸納洛酮治療顱腦損傷合并呼吸驟停 (附49例報告). 急診醫(yī)學(xué), 1997; 6(): 339.
  4. 4. 邵孝. 心肺腦復(fù)蘇. 見: 邵孝, 蔣朱明. 主編. 急診醫(yī)學(xué). 上海: 上?？茖W(xué)技術(shù)出版社; 1992. 55~69.
  5. 5. 孟慶林, 胡長欣, 候延奎. 鹽酸納洛酮拮抗乙醇中毒作用機理的探討. 中國急救醫(yī)學(xué), 1996; 16(): 2.
  6. 6. 楊天德, 劉橋義, 陳意生, 等. 納洛酮對缺血再灌注心肌超微結(jié)構(gòu)的影響. 見: 孟慶林. 主編. 納洛酮的基礎(chǔ)研究與臨床應(yīng)用. 北京: 經(jīng)濟日報出版社; 1996. 6~8.
  7. 7. 陳天鐸, 董晨明, 李培杰, 等. 納洛酮對心肺腦復(fù)蘇作用的評價. 急診醫(yī)學(xué), 2000; (1): 5~7.
  8. 8. 李婷, 吳巖. 納絡(luò)酮用于心肺腦復(fù)蘇24例療效觀察. 吉林大學(xué)學(xué)報?醫(yī)學(xué)版, 2004; 30(5): 768.
  9. 9. 姚品安, 宋秀琴. 納洛酮在心肺腦復(fù)蘇中的療效觀察. 中國實用醫(yī)學(xué)研究雜志, 2004; 3(6): 507~508.
  10. 10. 車海明. 納洛酮在急性中毒心肺復(fù)蘇中的應(yīng)用. 中華臨床醫(yī)藥雜志, 2004; 5(2): 94.
  11. 11. 羅寶權(quán), 黃崇軍, 吳宗波, 等．納洛酮聯(lián)合腎上腺素進行心肺復(fù)蘇. 臨床薈萃, 2003; 18(9): 523~524.
  12. 12. 郭美華, 任景艷, 趙莉. 納洛酮聯(lián)合腎上腺素進行心肺復(fù)蘇的療效觀察. 實用醫(yī)技雜志, 2005; 12(2B): 459.
  13. 13. 劉秀娟, 余勝利. 納洛酮對心肺腦復(fù)蘇的臨床療效觀察. 貴州醫(yī)藥, 2002; 26(1): 40~41.
  14. 14. 林翔, 鄭偉, 朱宏剛. 鹽酸納洛酮在心肺腦復(fù)蘇急診搶救中的應(yīng)用. 中國廠礦醫(yī)學(xué), 2006; 19(1): 18~19.
  15. 15. 趙林明, 張兆順, 劉玉橋. 納洛酮治療呼吸心搏驟?；颊吲R床觀察. 現(xiàn)代中西醫(yī)結(jié)合雜志, 2006; 15(5): 584~585.
  16. 16. 王云峰, 王瑞斌. 納絡(luò)酮在腦復(fù)蘇中的療效觀察. 基層醫(yī)學(xué)論壇, 2004; 8(1): 43.
  17. 17. 郭美華, 任景艷, 趙莉. 納洛酮聯(lián)合腎上腺素心肺復(fù)蘇33例療效觀察. 中華全科醫(yī)師雜志, 2005; 4(9): 553.
  18. 18. 憔天鐸, 董晨明, 李培杰, 等. 心肺腦復(fù)蘇期間應(yīng)用納洛酮臨床價值的探討. 甘肅科技, 1999; (4).
  19. 19. 董晨明, 陳天鐸, 李培杰. 納洛酮在呼吸復(fù)蘇中的臨床應(yīng)用. 中國醫(yī)刊, 2000; 35(11): 49.
  20. 20. 董晨明, 李俠, 張京梅. 在心肺腦復(fù)蘇中納洛酮的臨床應(yīng)用體會. 傷殘醫(yī)學(xué)雜志, 2000; 8(3): 38~40.
  21. 21. 陳天鐸, 董晨明, 李培杰. 納絡(luò)酮用于心肺腦復(fù)蘇21例療效觀察. 中國危重病急救醫(yī)學(xué), 2001; 13(3): 182.
  22. 22. 高超, 劉建中. 心肺復(fù)蘇中聯(lián)合應(yīng)用腎上腺素與納洛酮的研究. 寧夏醫(yī)學(xué)雜志, 2004; 26(11): 680~682.
  23. 23. 王偉強, 沈建妹, 陳淑葉. 大劑量納洛酮心肺復(fù)蘇療效分析. 中國綜合臨床, 2003; 19(11): 989~990.
  24. 24. 崔小鋒. 常規(guī)心肺復(fù)蘇加用納洛酮救治心臟驟停體會. 右江民族醫(yī)學(xué)院學(xué)報, 2000; (3): 403~404.
  25. 25. 馬玉英, 杜廣勝, 楊晚青, 等. 鹽酸納洛酮在腦復(fù)蘇中的療效觀察. 農(nóng)墾醫(yī)學(xué), 2000; 22(2): 91.
  26. 26. 曹秋菊, 孫瑞林. 納洛酮用于心腦肺復(fù)蘇術(shù)31例臨床分析. 鎮(zhèn)江醫(yī)學(xué)院學(xué)報, 1999; 9(2): 229.
  27. 27. Zhuang XL, Zeng YM, Chen BL. Editor-in-chief. Modern Anesthesiology. 3rd ed. Beijing: People’s Medical Publishing House; 2004. 2306–2311.
  28. 28. Chen KT, Li MT. Endogenous opioid and naloxone. In: Meng QL. Editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 209.
  29. 29. Le WM, Han ST. Effect of naloxone on craniocerebral injury and apnoea. Journal of Emergency Medicine, 1997; 6(): 339.
  30. 30. Shao X. Cardiopulmonary-cerebral Resuscitation. In: Shao X. Jiang ZM. editor-in-chief. Shanghai: Shanghai Science and Technique Press; 1992. 55–69.
  31. 31. Lou HC, Tweed WA, Davis JM. Preferential blood flow increase tothe brain stem in moderate neonatal hypoxia: reyersal by naloxone. EurJ Pediatr, 1985; 144(): 225.
  32. 32. Meng QL, Hu CX, Hou YK. Mechanism of antagonism of naloxone to ethanol. Chinese Journal of Critical Care Medicine, 1996; 16(): 2.
  33. 33. Yang TD, Liu QY, Cheng YS, et al. Effect of naloxone for ultrastructure of ischemia reperfusion cardiac muscle. In: Meng QL. editor-in-chief. Basic Research and Clinical Application of Naloxone. Beijing: Economic Daily Press; 1996. 6–8.
  34. 34. Hughes GS. Naloxone and methylprednisolone sodium succinate enhance sympathomedullary discharge in patients with septic shock. Life sci, 1984; 35(): 2319.
  35. 35. Mcintosh TK. Effect of an opiate antagonist (naloxone) and agonist/ an2tagonist (nalbuphine) in primate hemorrhagic shock : relationship to cat2echolaminer elease. Cire shock, 1985; 17(): 313.
  36. 36. McGuire W, Fowlie PW. Naloxone for narcotic exposed newborn infants: systematic review. Archives of Disease in Childhood Fetal & Neonatal Edition, 2003; 88(4): F308–F311.
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